Bladder catheterization. The algorithm performance in men, women, children, the technique, complications

The algorithm for catheterization of the bladder provides a preliminary survey patient, specimen collection, elimination of possible contraindications to the procedure with the further introduction catheter. This is a medical procedure that is performed for the treatment of men and women. It is used as an emergency method for diseases of the genitourinary system.

The essence of the procedure,

Bladder catheterization - a therapeutic effect, the algorithm implementation which comprises administering to a rubber, metal or plastic tube into the cavity of the body excretion.

Manipulation can be carried out with the aim of a comprehensive diagnosis of the urogenital sphere, or is used to treat the patient. Installing a catheter with a plastic or rubber tube runs nurses, nurses who provide care for patients who require assistance.

Bladder catheterization using metal-based pipes is exceptionally medical procedure that is performed by a urologist or a surgeon, and the patient is under anesthesia.

Installation catheter is considered urine drainage radical method, as this method of diagnosis and treatment carries a risk of injury to the mucous membrane of the urethra and bladder bubble. In addition, it is quite painful, and severe pain in the area of ​​the passage of the catheter tube, for a long time felt after the termination of the anesthetic.

Advantages and disadvantages

Bladder catheterization, the algorithm implementation which provides a preliminary examination of the patient, has its advantages and disadvantages pronounced. The table below merits medical procedures are described in detail and potential risks.

Advantages of the procedure	disadvantages catheterization
It allows you to collect urine in patients who are unconscious and can not independently carry out the act of urination.	During insertion of the catheter hose occurs trauma urethral mucosa, formed microscopic scratches and damage of large dimensions.
It is an important element of the comprehensive diagnosis of the urogenital sphere. According to the established catheter into the cavity of the bladder and urethra are special contrast solutions that enable timely identify neoplastic processes, set the size of the studied authorities.	There is always a risk of perforation of the bladder wall, which entails carrying out emergency surgery and can lead to disability of the patient. Body with broken integrity is no longer performing its functions, the collection and accumulation of urine, lose their elasticity, and the person becomes dependent on the life of the catheter.
It serves as the emergency and urgent way to diversion of urine, which is especially important for patients who, due to the development of chronic disease suffer from acute retention of urine outflow.	Damage to the urethral mucosa causes urogenital system infections by pathogenic microorganisms. Developing comorbidities as cystitis, urethritis. Not excluded ingress of pathogenic microflora in the renal tissue, which will cause an acute or chronic pyelonephritis.
Clock takes away the accumulated urine in the bladder, if their own urine channel sick person no longer fulfills its functions.	Hose indwelling catheter requires periodic flushing with antiseptic solutions, which hit the inside of the bladder causes a burning sensation and discomfort. Common cases of catheter clogging and blocking the outflow of stagnant urine process. In patients developing bladder inflammation, impaired kidney filtration function and may cause symptoms of intoxication.
It gives the opportunity to organize stable urine excretion in patients who have undergone a surgical operation, may independently exercise urination, but is temporarily not able to get out of bed, or else are unconscious condition.	For prolonged catheterization occurs atrophy of the muscle fibers in the pelvic region, responsible for the contraction of the sphincter. This element of the urinary system is responsible for the retention of accumulated urine and opens at the moment the act of urination. Atrophy of his muscles leads to incontinence, involuntary urine dripping when lifting, coughing, squats, psycho-emotional strain.

Bladder catheterization, the algorithm implementation which comprises administering a local anesthetic, appointed doctor urologist, a surgeon or a nephrologist. This manipulation is shown only in extreme cases where the potential harm from the catheter insertion procedure is less than the complications that can arise without catheterization.

testimony

There are clinical cases when bladder catheterization is a mandatory part of the overall combination of diagnostic or therapeutic action.

Catheter insertion into the lumen of the urethra and the bladder is shown in the presence of a person following diseases and pathological states of the organism:

• hematuria, accompanied by the formation of thrombi, some of which are found in the urinary cavity bubble (there is a risk of blockage of the urethra, damage to the mucous membrane and its beginning necrotic process);
• urinary incontinence, it causes unconsciousness elderly patients or dysfunction of the muscles responsible for the natural outflow of urine;
• postoperative period, when the patient is contraindicated voltage lower abdomen, as well as smoking rise from the bed;
• chronic prostate hyperplasia, overgrown tissue which blocked the urethral channel;
• acute pain of unknown etiology that occurs in humans at the moment the act urination, and the results of diagnostic testing show no contraindications to the installation catheter;
• paraplegic with full or partial loss of sensitivity genital and urinary urgency or outflow of urine;
• intoxication caused by stagnation of urine, blood saturation with nitrogen-containing substances and dysfunction of the muscles of the bladder;
• presence of benign or malignant tumors in the bladder lumen, which disrupt the natural process of collection and outflow of urine outside the body.

Except that bladder catheterization is used as part of the overall treatment, installation of the catheter is required for diagnosis of urinary organs.

The appointment procedure is determined by the attending physician and performed with his direct participation. If necessary, the catheter can be applied in other cases, if there are no medical contraindications, and its use is necessary to preserve the health of the patient.

Contraindications

Bladder catheterization, the algorithm includes a preliminary examination of the patient, has a number of contraindications.

These manipulations are not performed on patients who have found the following diseases or recurrent disease:

• abnormal narrowing of the urethral canalArising as a complication of acute inflammations of bacterial etiology, or having the same innate nature of origin;
• previously postponed surgery on the walls of the urethra or bladder, which violated the anatomical location of the urogenital system, or else led to their partial reconstruction (Indications or restrictions on the use of catheterization procedures may be determined individually by the physician urologist based on clinical features case may be);
• mechanical urethral injury or genitals, the consequences of which make it impossible to secure the introduction of a catheter into the urethra the tube system of the patient;
• all kinds of infections of the genitourinary system, Including those transmitted by unprotected sexual contact (set during the preliminary diagnostic study);
• ulcer formation on the mucosa of the urinary canalAccompanied sukrovichnymi or purulent secretions;
• Oncology Bladder with tumor location in the immediate vicinity of the urethral canal, which could lead to her injury and accelerate the cancer process;
• acute prostatitis (Before installing the catheter requires removal of acute inflammation, in part to reduce tissue swelling prostate, relieve compression pressure on the urethra and to facilitate the passage of the tube inside the urethra);
• lower pelvis injury with signs of fractures, soft tissue expansion in a bladder arrangement region (before catheterization is necessary to make sure that there are no breaks of the urethra, the bladder walls and fabrics kidney).

Based on the preliminary survey urologist or surgeon may take measures to prohibit the carrying out of catheterization due to the presence in the patient of other diseases of the genitourinary system, or as a greater risk of complications.

Furthermore, contraindicated introduce the catheter into the empty bladder. Ignoring this limitation entails walls organ damage and increases the risk of perforation.

What examinations necessary to pass

Bladder catheterization, a flowchart of which includes a comprehensive diagnosis of the genitourinary system, requires from the patient following delivery analysis and transmission of instrumental examination:

• Deposit of capillary blood for clinical analysis;
• urine collection for her general studies;
• venous blood sampling for biochemical analysis as well as detection of infectious microorganisms;
• swab urethral mucosa to exclude the possible presence of pathogenic organisms, as well as the inflammatory process;
• men are examined by a urologist for prostate pathologies and women examine gynecologist, determining the possible presence of inflammatory processes in internal genital organs;
• US bladder and kidney (used to determine the health status of the excretory organs of the system, the possible presence of tumor tissue structure changes, as well as other pathologies precluding secure patient catheterization).

If necessary, the method of MRI diagnosis of pelvic organs can be used. It is used in clinical situations in which the above analysis is not enough to obtain comprehensive information on the state of the genitourinary system of the patient.

In emergency situations where immediate installation of a catheter of the analyzes can carry out later, but their implementation is mandatory.

Training

Preparing the patient for catheter insertion into the cavity of the bladder, it includes completing a minimum number of steps. When the planned catheterization patient set the date and time of installation of the system. From the patient's consent is required to perform actions of the doctor and the medical staff.

Preparation for the procedure involves the following manipulations:

• man laid in a horizontal position, the legs lie straight without bending the knees (under the head can put a towel or pillow low);
• woman holds a similar horizontal position on a couch or bed, and her legs bent at the knees and divorced in hand;

  

• doctor performs sanitization of labia of women, foreskin and glans men (antiseptic solutions are used), as well as tissues located in the input circle into a urethra;
• the patient receives a local anesthetic is injected into the epithelial tissue suprapubic region;

After the above is considered ill prepared for catheterization procedure bladder. At the discretion of the attending physician may decide on full or partial removal of pubic hair. It is mandatory to be in the presence of a set of consumables.

This gel tube containing lidocaine, couple medical gloves, a disposable syringe of 10 ml capacity, the capacity for accumulating derived urine, sterile tampons, antiseptic solution for disinfecting water for intramuscular injection, sterile napkins.

The procedure step by step

Bladder catheterization requires a doctor informed and professional activities. The installation procedure is catheter male and female patients is a bit different, due to the physiological characteristics of the structure of the urogenital system.

catheterization technique in men is as follows:

1. The penis is taken in hand, completely laid bare head and pulls back the foreskin epithelium, so it does not interfere with the current procedures.
2. At the base of the entrance to the urethra is set special nozzle conical shape that comes in Included with the catheter and then it is inserted through the urethra into the cavity based gel lidocaine.
3. Apply a small amount of gel on top of said catheter tube.
4. Checks the integrity of the balloon catheter, since it is a prerequisite for leaks. For this purpose, the balloon is filled with water for intramuscular injection. If there are no signs of impaired integrity of the system, the sterile fluid immediately discarded.
5. The male sexual organ is placed perpendicular to the position of the body and pulled up a bit.
6. A catheter is inserted into the urethra cavity unhurried and smooth movements up until the tube urine appears.
7. Hollow catheter balloon is completely filled with urine, and then advancing to the penis head foreskin.
8. The main part of the catheter is connected to a bag for collecting urine. The doctor is convinced that after a full urine outflow system installation has not stopped and it continues to flow into the bag.

catheterization procedure of the bladder in women takes place in compliance with the following medical protocol:

1. Labia parted fingers so easily visible entrance to the urethra.
2. The external urethra shed wiped using antiseptic wipes which are part of the consumable package.
3. With conical nozzle into the cavity of the urethra injected with lidocaine gel and a small amount of drug applied to the catheter tip.
4. In a similar manner verified integrity balloon catheter (filled with water for intramuscular injection, and then descends);
5. The catheter is introduced into the cavity of the urethra to the depth of 10 to 12 cm, or else until the first signs of urinary Incoming.
6. The main part of the system is connected to the bag for urine proceeds.

The final stage of bladder catheterization in women is to control the further inflow urine when all elements of the system are mounted and the plastic tube is inside the body excretory system

. In medical practice, there are clinical cases when catheterization male patients complicated too long urethral canal and the mucous membrane resistance. To resolve these difficulties, it is recommended to use a catheter with a diameter of 20F or Tiemann tip.

Recovering from

After final removal of the catheter formed of a cavity of the bladder, the patient must take care not to inflammation developed urethral canal. It is recommended to use the following recovery methods.

Baths of potassium permanganate solution

2-3 is necessary to take a crystal of potassium permanganate (manganese). Dissolve in 1 liter of warm boiled water. Make sure that the small particles of the chemical did not stay at the bottom of the jar.

Domestic antiseptic solution to add in a basin with warm water in compliance with the ratio of 1 liter of potassium permanganate in 4 l of normal fluid. Perform antiseptic baths by immersing the prepared genitals water. Duration reconstructive procedure 10-15 minutes. Frequency of use of the drug - 1-2 times a day.

Decoction of chamomile, sage and St. John's wort

For the preparation of an anti-inflammatory, antiseptic and anti-swelling broth need to take 1 tsp. l. sage, chamomile and St. John's wort. Add herbs in 500 ml of tap water and boil for a further 15 min.

After preparation, wait until the broth is cooled, and then taking it 250 ml in the morning and evening for 20 minutes. before meals. Recommended term rehabilitation treatment - 7 days.

Over the next 10 days after removal of the urinary catheter should refrain from intimacy. We can not allow hypothermia. This is especially true of the lower body. Women and men should take a daily shower and change underwear. It is important to monitor the hygiene of the intimate area.

How long will the result

Bladder catheterization - a diagnostic or therapeutic effect, which is performed to eliminate the symptoms of this disease and the organization of a stable flow of urine.

After placement of the catheter in the urinary system organs preserved stable positive effect, provided regular removal of waste products, eliminates the possibility of stagnation of urine in the cavity of the bladder, ureters and kidneys.

If you do not address the underlying disease that caused the violation of the outflow of urine, it is not excluded that after the removal of the catheter, the patient may need to reinstall.

possible complications

Professionally executed bladder catheterization eliminates and minimizes the risk of developing serious complications. In the case of finding a long catheter in the allocation system organs, improper care urine drainage system, or else incorrectly performed administration may occur the following problems with the patient's health:

• mucosal damage the urethral wall further from the appearance of wounds, ulcerative formations;
• infections of the genitourinary system bacterial pathogens with the development of acute and chronic inflammation;
• trauma to the tissues of the prostate gland in men;
• bladder rupture, the need for emergency surgery and further dependence on the catheter;
• damage to muscle fibers bladder sphincter;
• full or partial atrophy of the muscles responsible for the withholding and withdrawal reflex of urine, which is fraught with incontinence and involuntary urine outflow.

During catheterization it is very important to carry out the whole sequence of actions for the introduction of the catheter tube without make any sudden movements, carefully lubricate the tip of the lidocaine gel system, to anesthetize the area of ​​manipulation of the local anesthesia.

In such a case, the procedure will be successful, will allow to organize a rapid outflow of accumulated urine and exclude intoxication. Catheterization remains an effective method of evacuating urine during most urogenital diseases.

Registration of the article: Mila Friedan

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