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(Passing
Foley's Catheter into the Urinary Bladder)
Urethral
catheterization is a frequently performed
bed side procedure; if done haphazardly it
may lead to infection, particularly if the
catheter is left for long periods.
Urethral
catheterization is done usually with a
balloon tip Foley Catheter of varying sizes
(8 Fr* to 26 Fr). The balloon size for most
of the applications is designed to hold
little over 5 ccs of fluid. Larger Foley
catheters with balloon capacity in excess of
30 ccs are available for specific urology
purposes. For an average adult sizes 14 to
18 Fr catheters are usually utilized.
Indications
for urethral catheterization:
1.
Urinary retention (palpable, prominent
urinary bladder)
2.
To keep the patient dry and manageable when
he is obtended or comatose
3.
Management of incontinence of urine
4.
To watch hourly urine output in intensive
care situation.
5.
As a part of urologic studies and also
managing post operative status.
6.
To obtain a catheterized specimen of urine
for culture and sensitivity when specially
required.
(Spontaneously
voided midstream specimen is good enough
under majority of circumstances and it is
rarely necessary to catheterize for
diagnosis of UTI).
Where
there is obvious injury to urethra following
trauma Foley catheterization should not be
attempted before cystourethrogram is
performed.
Requirements:
a.Water,
sterile Foley catheter bag with or without
hourly monitoring facility as the case may be.
b.
Betadine solution (povidone Iodine) _ paint.
c.
Where an assistant is not available, it is
better to have a table set up with a catheter
ready for use. Otherwise, a trained assistant
to hand over sterile catheter is desirable.
Procedure:
Although
the procedure may vary minimally between male
and female patients, the basic principles of
aseptic precautions and positioning are
essentially the same.
Preliminary hand wash and wearing of cap and
mask recommended.
Patient should be in the supine position with
legs slightly apart for the male and with legs
apart and knees flexed for the female patient.
A preliminary soap and water wash to the
external genitalia is desirable.
From
this point all procedures are done with
sterile gloves.
External preparation of genitalia is performed
using betadine pain and sterile drapes are
laid to provide adequate exposure to the
external genitalia.
Appropriate catheter is picked up and the
integrity of the balloon is checked by
introducing 5 cc of water into the balloon and
deflated.
The sterile catheter is lubricated adequately
with sterile jelly lubricant.
Catheterization
of the male patient
The
penis is held with the left hand away from the
scrotum and holding the catheter firmly with
the right hand the well lubricated catheter is
gently passed through the external urethral
meatus. This is gently and gradually advanced
and under most circumstances it is passed
through the urinary sphincter without any
problem. Occasionally some resistance may be
encountered at the level of the sphincter due
to prostatic hypertrophy. By gently advancing
further through the sphincter this can be
overcome to some extent and catheter can be
passed into the bladder.
Occasionally
a larger catheter or a "coude"
type of catheter may be required to overcome
this obstruction. When the catheter
*Fr-French |
