Catheterization in women: the need for the procedure and the technique for its implementation Bladder catheterization technique

Quite often, with pathological processes in the human body, more often of a urological nature, it becomes necessary to drain the MP, that is, to create an artificial outflow of urine from the urinary-vesical reservoir cavity. In modern medical practice, this process is carried out using a whole set of modified devices (catheters) made of various materials. Bladder catheterization is used for both diagnostic and therapeutic purposes.

The indications for the drainage procedure are individual and depend on many reasons. Usually, these are patients with urological problems. A drainage system is required:

• When examining the urethral tract for the presence of obstruction in patients who have lost the ability to independently miction, which led to their long delay (more than 12 hours) and the development of acute pain syndrome, which may be a consequence of dysfunction of the MP innervation, a strong inflammatory process in the urethra, the presence of calculi, or tumor formations in the organs of the urinary system themselves and in the tissues adjacent to it.

• For laboratory monitoring of urine for microflora - for greater reliability of the results, sterile urine is taken directly from the reservoir urine-bladder cavity.
• If necessary, diagnostics with a contrast agent.
• For washing the urinary bladder cavity from stagnant urine, pus, or bloody clots formed as a result of infectious and inflammatory processes, or surgical interventions.
• Indications for catheterization are patients who have undergone surgical interventions on the organs of the urinary system, which contributes to the processes of complete regeneration and recovery.
• And finally, patients who are in a state of coma, who have lost the ability to independently miction.

Absolute contraindications for catheterization are due to:

• the patient has infectious urethritis;
• pathological disorders that prevent the flow of urine into the urinary bladder cavity;
• trauma to the urinary tract and urethral tract;
• the presence of blood in the urethra and scrotum;
• signs of urinary reflux;
• potential complications in the form of acute prostatitis or penile fracture;
• the real risk of infection of the MP from the outside.

Bladder drainage techniques

Depending on the condition of the patients and the purpose of drainage, urinary bladder catheterization in women and other patients of various ages can be one-time, carried out periodically (intermittent catheterization) or be installed for a permanent period. For each specific case, its own drainage system is selected.

A single catheterization procedure is used:

• if necessary, the withdrawal of urine from the reservoir vesical cavity for diagnostic assessment of the state of the MP and collection of urine for laboratory monitoring;
• y, to stabilize the condition just before childbirth;
• if necessary, medicinal irrigation of the reservoir tissues of the MP.

For such purposes, disposable catheters are used. The duration of the procedure does not exceed 2 minutes, and the minimal presence of a drainage tube in the body minimizes the risks of additional infection and the development of other complications.

Permanent catheterization has been used since the middle of the last century for chronic urinary problems. The drain is left in the urinary tract for an extended period. It is installed by the urethral route, or through a cystostomy (an incision in the pubic abdomen). However, studies show that prolonged drainage promotes the formation of calculi (stones) in the urinary system and increases the risk of malignant tumors in the MP.

According to the indications of international studies and the recommendations of the Association of Urologists - permanent catheters should not be installed for a period of more than 2 weeks.

Since the end of the 20th century, the intermittent drainage method has been widely used to replace permanent drainage. The method is based on 4, 6 single catheterization during the day, which simulates the normal processes of urine excretion with a single drainage. This technique presents the lowest risk of developing functional disorders in the kidneys, infectious and other disorders. It can be used for many months and years without causing any harm to health.

Types of drainage urinary systems

There are various types of bladder catheters, differing in material of manufacture, size and modification, for women, men and children, soft (rubber), hard or rigid (metal) and semi-soft (synthetic), equipped with additional internal channels (from 1 to 3) , for permanent and temporary drainage. Let's consider some of them used in medical practice:

• The Nelaton (Robinson) drainage system is the simplest version of a rubber or polymer catheter. Designed for intermittent drainage in uncomplicated cases. Made from polyvinyl. It becomes soft under the influence of body temperature. Equipped with two side holes and a closed, rounded end. They are used for both men and women, differ only in length - women from 12 cm to 15, men, up to 40 cm. Sizes are marked with different color coding. A special hydrophilic coating, when exposed to moisture, makes it slippery, which does not require additional lubrication, and minimizes the risk of additional infection.

• Mercier (Timman) system - equipped with an elastic curved tip, two holes and one outlet channel. It is used for complex infectious and inflammatory processes against the background of adenomatous growths in the prostate, or stenosis of the urethral tract.
• Nelaton Timman Tip System - has the characteristics of a foundational system, but the curved tip of the above device helps drain patients with prostate presence.
• Long-term catheter of the Pezzer system. It looks like an ordinary rubber tube equipped with two outlet channels and a clamp in the form of a tube thickening.
• The Foley drainage catheter is the most demanded type of drainage in urology. It is an excellent option for long-term use. Equipped with a special balloon (filled with sterile fluid) holding the device inside the MP. This catheter is used to flush the bladder, inject drugs, or drain urine into a urine collection bag attached to the end of the tube.

The drainage modification of this system (Foley catheter) can be different:

• two-channel with a common path for the outflow of urine and rinsing the MP and the channel through which the balloon fluid is introduced;
• three-channel with an additional channel for the administration of drugs, made of latex with a silicone coating (cheap option), which eliminates the deposition of salts inside the catheter, or made of silicone coated with silver (expensive option), which inhibits bacterial replication and reduces the risk of infection;
• two-channel with a beak-shaped curved Timman tip, which is the most convenient option for catheterization against the background of the prostate and its hyperplasia;
• with options for women's and children's modification (shorter in length and with a smaller diameter).

Drainage with rigid (metal) systems is rarely carried out today. In normal practice, catheterization with a soft catheter is used, which minimizes the risk of injury to the urethra.

In each case, the drainage system is selected by a doctor and installed by medical personnel. Self-draining is fraught with serious consequences, additional infection and the development of dangerous complications, since the procedure requires special preparation and knowledge of certain rules of the installation algorithm.

Self-catheterization is carried out only in emergency cases, when it is not possible to call a doctor, or medical assistance is too late.

Preparation for drainage manipulation

The preparatory period for patient catheterization consists of several stages, including:

• preliminary examination by a doctor to clarify the absence of contraindications;
• adherence to a certain nutritious diet (excluding fried and spicy foods, alcohol and sugary drinks with gas) a couple of days before the procedure;
• careful preparation of the patient by a specialist (treatment of the genitals with an antiseptic, familiarization with the technique of catheterization).

At the next stage, a special kit for catheterization is selected, including:

• A set of sterile materials at hand for the procedure - gauze, cotton swabs and napkins.
• Disposable medical gloves.
• Pain relievers and sterile solutions to facilitate placement of the catheter drainage tube.
• Sterile plastic tweezers and Janet cone-shaped syringe.
• Antiseptic solution and means for treating the genitals.
• Urine collection tray.

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Features of MP drainage in adults

Drainage of the urinary tract in men is associated with the peculiarities of the anatomical configuration of the urethra (long and curved) and the different structure of its sections - prostatic, membranous and cavernous, which makes it rather vulnerable and sensitive to various kinds of damage.

The algorithm for performing bladder catheterization in men is due to a specific, sequential technique of introducing a drainage device.

• The introduction of drainage to men can be in a standing or lying position. The classic method is lying on a couch with legs bent at the knees.
• The procedure begins with treating the head of the penis with an antiseptic, instilling sterile glycerin into the urethral slit and treating the end of the catheter tube with it.
• The urine collection vessel is placed between the patient's legs. If a permanent system is being installed, the patient is advised in parallel on its care. Sometimes a patient who has undergone surgery is offered an operation to remove the stoma.
• The next stage is the introduction of the system. Using tweezers treated with an antiseptic, the doctor, at a distance of 6 centimeters from the edge, grabs the catheter tube and gradually plunges it into the urethra. To prevent uncontrolled micrations, the head of the penis is squeezed slightly.

• Reaching the cavity of the urinary reservoir with the catheter is marked by the release of urine.
• After the urine comes out, the tube of the system is attached to a syringe with sterile furacilin, for subsequent washing of the urinary reservoir. If necessary, intravesical drug therapy is carried out in parallel.
• After intravesical lavage, the system is removed from the urethral cavity and disinfected. To avoid complications, the system is withdrawn from the bladder after the liquid or air has completely escaped from the balloon retainer.
• Remains of drops, solution or urine are removed from the penis with a sterile napkin, and the patient is advised to lie down after the procedure for an hour.

The peculiarities of the catheterization algorithm in women differ little from the technical features of the installation of the drainage system in men.

• The procedure for draining the MP in women is carried out lying on a couch with bent knees, legs apart. The woman is washed away, after which the ship is removed.
• A urine collection tray is placed at the base of the legs.
• The folds of the labia are processed in turn. Then they are moved apart by the doctor's fingers and the urethral passage is treated with an antiseptic.
• The base of the catheter is gently, by means of circular movements, immersed to a depth of 5 cm into the urethral cavity, the other end is placed in the urine collection tray. Urine output indicates the presence of a tube in the bladder reservoir.
• Upon completion of urination, an intravesical lavage procedure is performed with a sterile solution using a Janet syringe until the vesical cavity is completely cleared.
• The wash solution is discharged into the tray, the system is carefully removed, and the urethra is treated with a uroseptic.

Drainage of MP in children

The algorithm of MP catheterization in children, in contrast to adults, requires special care of the doctor or his assistant during the procedure, taking into account all the age characteristics of the child. The technique of catheterization of the bladder in children is carried out in compliance with strict antiseptic rules, on which, in the literal sense of the word, the life of a child can depend.

• Careful selection of drainage device to avoid injury - age appropriate size.
• Strict adherence to all antiseptic standards that help prevent infection.
• Carrying out manipulations on the filled MP (determined by the results of ultrasound).
• Providing good lighting of the workplace to avoid mistakes.

MP catheterization in girls

When draining the urinary tract in girls, a minimum amount of antiseptic agents are used to treat the perineum to reduce the risk of bacterial infection from the outside.

• The doctor gently spreads the small labia of the child a short distance to minimize the possibility of violating the integrity of the frenum.
• The system tube should be inserted without effort. If free introduction is impossible, the manipulation is stopped until the presence of obstacles to the outflow of urine is determined.
• To avoid twisting the tube into a spiral, its introduction is stopped with the first appearance of urine outflow.

• After emptying the bladder, the system is quickly but carefully removed to prevent the infection from entering from the outside.
• It is unacceptable to remove the system with the application of force, since the tube can be twisted into a knot. In this case, the presence of a urologist is required.

As you can see, this manipulation requires certain skills and knowledge, therefore, a qualified specialist should carry it out so that everything goes painlessly and without complications, and the results help in prescribing an effective course of therapy.

MP catheterization in boys

Drainage of the MP in boys involves the introduction of the system in different positions - lying or standing.

• The head of the penis is wiped with an antiseptic, the catheter is treated with purified liquid petroleum jelly.
• The foreskin of the penis, if not circumcised, is gently pushed back to expose the urethral opening. It should be borne in mind that newborn babies may have signs of physiological phimosis.
• To avoid reflex vocalizations, the base of the penis is slightly squeezed.
• To prevent kinking of the urethral canal, the penis is pulled upward, as if squeezing onto the drainage tube.
• In case of poor visibility of the urethral entrance, a drainage tube is inserted through the enlarged preputial space of the penis.

In the presence of resistance in the external sphincter of the urethra, the use of light pressure is acceptable. The manipulation continues after the intra-urethral spasm has passed. If the procedure is not possible due to the presence of an obstacle, it is postponed until the causal factor is clarified.

Possible complications

The specificity of the catheterization procedure itself, even with all the observance of the prescribed rules, does not guarantee the absence of the development of possible complications. They are able to manifest themselves:

• additional infection of urinary-vesical and urethral tissues;
• damage to the mucous membrane of organs;
• the development of pyelonephritis and catheterization fever;
• rupture of the urethral canal.

How to recover from catheterization

Depending on the diagnosis and general health of the patient, the drainage system of the urinary bladder can be installed for a long time, after which it is very difficult for the patient to restore the process of independent miction. For this, there is a special program that, through training sessions, helps to quickly cope with the problem. An indispensable condition - classes must be systematic. Classes consist of not many and not at all difficult exercises:

• Lie on your back and for 2, 3 minutes, alternately together and separately raise your legs up.
• Set your fists in the area of \u200b\u200bthe urinary bladder organ, sit down, focusing on your heels, inhale deeply, and as you exhale, lean forward as low as possible. Do inclinations up to 8 times.
• Kneel down and clasp your hands behind your back. Take a deep breath. As you exhale, slowly bend forward, as low as possible. We carry out up to 6 times.
• Lying on our back, we place our arms along the body, legs are straightened. We begin to gradually relax from the toes.

When starting your recovery, do not forget to coordinate the exercises with your doctor, maybe, what exactly is for you, they will be contraindicated. Do not self-medicate, trust a specialist. Because, each such patient must be under constant medical supervision.

INDICATIONS

Removal of urine for therapeutic and diagnostic purposes, control of urine output, rinsing of the bladder, administration of drugs.

CONTRAINDICATIONS

Lack of readings.

LOCATION

Neonatal pathology departments, neonatal intensive care unit (NICU) of maternity hospitals, intensive care unit and intensive care unit (ICU).

COMPOSITION OF THE BRIGADE

Nurse.

EQUIPMENT

Hat, glasses, sterile masks and gloves, sterile napkins or diapers, mask, sterile urinary catheters (for premature babies - 5 Fr, for full-term babies - 8 Fr), vaseline oil, antiseptic solution, disinfectant solution (furacilin solution), urine bag, sterile oil ...

TRAINING

Treat your hands with a disinfectant solution. The position of the patient on his back with slightly bent knees and legs apart.

PERFORMANCE TECHNIQUE

Catheterization in girls .

● With one hand, part the labia, with the other hand from top to bottom (towards the anus), carefully wipe the genitals and the opening of the urethra with a disinfectant solution.

● Put on sterile gloves, cover the labia with sterile wipes.

● Dip the catheter in sterile vaseline oil and carefully insert the catheter into the urethra opening. The appearance of urine from the external opening of the catheter indicates that it is in the bladder.

● If necessary, secure the catheter.

Catheterization in boys.

● Place the baby on its back.

● Treat the penis (glans, foreskin and urethral opening) with a disinfectant solution.

● Put on gloves, cover the penis with sterile napkins, diapers.

● With one hand, spread the jaws of the external urethral opening, and with the other hand, with slight force, insert the catheter (Fig. 2).

● If the catheter must be left in the bladder, secure it. The catheter should be changed every 48 to 72 hours.

Figure: 2. Introduction of the catheter.

COMPLICATIONS

Infection of the bladder and urinary tract, trauma, hematuria, urethral stricture.

3. Setting enemas

Enemas are cleansing, siphon, hypertonic and nutritious. The most common are cleansing enemas. A common point for all types of enemas is the technique of inserting the tip into the rectum. It is believed that it is better to introduce the tip of the enema in a lateral position with the legs bent at the hip joints. However, it is possible to insert the tip in a supine position, with the legs leading to the stomach. The tip is inserted carefully, without violence, after having abundantly lubricated it with vaseline oil. The tip is inserted into the rectum in newborns by 3 cm, in a one-year-old child - by 4 cm, in older children - by 5 cm. The tip of the tip should be directed towards the sacrum after it has passed the sphincter of the anus.

Cleansing enemas

Cleansing enemas for children under 5 years old can be done with pear-shaped balloons. In older children, an Esmarch mug or special rubber tanks are used, usually an enema is given from boiled water with a temperature of 28-30 ° C. Depending on the age of the child, use once volume of fluid: in newborns - 30 ml, in 6 months - 90-100 ml, at 1 year - 200 ml, at 5 years - 300 ml, at 10 years old -400 ml, at 14 years old -500 ml. Decrease in water temperature to 22-24 ° С enhances the laxative effect of the enema. In the presence of steep and dense feces, it is useful after the first cleansing enema to put an enema of vaseline oil (about 30-50 ml) and then the second cleansing enema. In addition to vaseline oil, you can use sunflower, linseed, hemp, corn, etc. Enema from vaseline oil is used, as a rule, for very steep feces. The amount of oil solution, if a pure oil enema is given, is approximately 2 times less than with a cleansing enema with water.

The enema is administered by a nurse at the direction of a doctor.

EQUIPMENT

Pear-shaped rubber balloon or Esmarch mug. Vaseline oil. Boiled water at room temperature. Diaper. Pot. Latex gloves.

And gynecologists very often send their patients to undergo a procedure such as catheterization.

During this manipulation, a catheter is inserted into the woman's urethra, through which urine flows out or special medications are injected.

Bladder catheterization in women is prescribed for a variety of indications. At the same time, only an experienced specialist should always carry out such a procedure, because If the catheter is not inserted correctly, the urethra and urinary tract can be easily injured.

Most often, women are referred for catheterization in the following cases:

• for collecting urine for analysis (in contrast to the usual collection of morning urine in a container, this method of collecting urine makes it possible to obtain for research a more "pure" biological material without impurities);
• to fill the bladder with medicinal drugs in the treatment of various diseases;
• for washing and disinfecting the urinary tract (catheterization will help to remove pus from the organ, crushed small ones, etc.);
• to study the volume of residual urine filling the urinary bladder;
• to empty or fill the pelvic organ before performing an x-ray examination (during diagnostics, the urine bladder must be empty or filled with a special contrast agent, which, when x-rayed, will stain internal organs and tissues, so that the doctor can get a more accurate picture of the state of the urinary tract);
• to remove urine if it is impossible to empty yourself (urine retention, acute or chronic disturbance of normal urination, etc.)