Urinary catheterisation

Drainage of urine

Indication

Acute retention of urine

Urgent procedure is necessary for:

· Narrowing of the urethra
· Adenoma or cancer of the prostate
· Pelvic tumor
· Pelvis trauma
· Paraplegia

Urethral catheterisation

(for men)

Material

· Sterilised gloves and drapes

· Sterile catheters, generally Foleys n° 12,14,18 for example

· Lubrification with chlorhexidine (+ cetrimide) (see table page 7)

· Sterile compresses

· 10 ml syringe

Technique
(Figures 88, 89)

· Careful disinfection of the meatus, the glan and the prepuce, through the hole in the drapes.

· Coat the catheter with chlorhexidine (+ cetrimide) (see table page 7)

· The left hand holds the penis vertically

· The right hand carefully introduces the catheter through the meatus.

· Change the size of the catheter if introduction is difficult.

· When the catheter reaches the bulbar angle (13 to 15 cm), direct it towards the base.

· NEVER FORCE THE CATHETER, it is better to use a suprapubic catheter than to traumatise the urethra.

· Advance the catheter to the hilt before inflating the balloon (5 to 10 ml of liquid).

· Next, gently pull the catheter until the balloon abuts on the bladder neck.

· Always replace the prepuce around the glans, to prevent a paraphymosis.

· If the catheter is to remain in place, connect it to a sterile urine container, otherwise to a perfusion tube attached to a short necked bottle.

· Clean the meatus each day, and eventually, depending on the clinical context, institute antibiotic treatment (cotrimoxazole: 1,600 mg de SMX/day in 2 divided doses x 5 days for an adult.

FIGURE

FIGURE

FIGURE

Suprapubic catheterisation

Indications

When urethral catheterisation presents difficulties, and when there is a risk of damage to the urethra with the catheter (trauma to the bladder, trauma to the urethra, and urethral stenosis, etc.).

The bladder must be dilated: A DISTENDED BLADER IS OBLIGATORY.

Material

· A prepared pack exists with a unique "cystocath". If not available, a large trochar and long catheter perforated at one end (at least 14G), can be used.

· Drapes with a hole, and sterile gloves

· Suture material

· Local anesthetic

Technique

· Shave and then disinfect the suprapubic region with polyvidone iodine (see table page 7).

· Make a bubble in the skin with lidocaine a finger breadth above the symphysis pubis in the median line. Anesthetise the deep tissue planes (Figure 91).

· With the same syringe ensure that aspiration produces urine.

· Puncture through the anesthetised bubble, asking the patient to cough.

· Introduce the perforated drain: advance 10 to 15 cm of the catheter, remove the trocar and attach the catheter to a sterile urine container.

· Fix the drain to the skin with a non resorbable suture and a dressing.

· Clean the drain at least once a day and institute urinary antibiotic treatment (cotrimoxazo/e: 1,600 mg of SMX/day in 2 doses for adults x 5 days) (Figures 92, 93, 94).

FIGURE

FIGURE

FIGURE

FIGURE