Catheterization is the procedure for introducing a catheter (for men and women) into the bladder through the urethral canal. Catheterization is used quite often and is used for the purpose of diagnosis and therapy.
Catheter placement guidelines
The catheter can be installed for a short period of time, for example, short-term installation of the catheter is necessary for surgical intervention, and for a long time, if the patient has difficulty with the act of urination. The latter can be caused by some diseases.
The male urethra can be affected by various pathological processes resulting from infection, trauma, and neoplastic syndrome. Violation of urination can provoke the development of such unpleasant consequences as renal failure and infertility. In this article, we will consider in detail the bladder catheterization algorithm in men.
Indications for the procedure
A catheter can be inserted for diagnostic purposes:
- To obtain samples of urine located in the cavity of the bladder. Samples are further used in laboratory studies, for example, to determine the microflora of the bladder.
- In order to determine the volume of urine that is excreted, observation of its organoleptic characteristics.
- To determine the level of patency of the urinary tract.
During treatment
In addition, catheterization can be performed in the treatment of:
- When restoring the urethra after the operation.
- In the presence of decompression of the bladder.
- In the presence of an acute delay in the excretion of urine, which can occur against a background of urethritis, a pathological change that affects the prostate gland.
- In order to treat the walls of the bladder with medicinal solutions.
- In chronic obstruction, which can be caused by hydronephrosis.
- In order to excrete urine, if the patient is not able to commit an act of urination. For example, if the patient is in a coma.
The algorithm for catheterization of the bladder in men is quite complicated, but patients should not cause fears for their health, since experienced specialists trust this procedure.
Contraindications for catheterization
Although there are many indications, catheterization may not always be possible. There are some contraindications:
- The presence of blood in the scrotum.
- The presence of bruising in the perineum.
- The presence of blood in the urethra .
- Injured bladder condition.
- Injured urethra.
- Prostatitis in acute form.
- Anuria
- Some diseases of the genitourinary system, for example, gonorrhea.
- Spasm of the urethral sphincter.
- Acute inflammatory processes occurring in the bladder or in the urethra.
- Penile fracture.
Features of catheterization in men
Due to the anatomical features of the urethra in men, only experienced professionals should perform the catheterization procedure. Difficulties in catheterization arise due to the fact that the male urethra has a relatively large length, about 25 centimeters. In addition, there are two physiological constrictions in the urethra that impede the free insertion of a catheter. And also it is very narrow.
The greatest caution must be observed if the procedure is performed using a metal catheter. If excessive force is used during the manipulation, then the walls of the urinary system can be damaged, resulting in the occurrence of false moves.
The bladder catheterization algorithm in men should be strictly adhered to.
Catheterization Instruments
For the catheterization procedure, you will need the following tools:
- Reservoir for urine. If a sterility test is intended, then the reservoir will need to be sterile.
- Syringe Janet.
- Furacilin solution.
- Tray.
- Rubber gloves.
- Diaper.
- Sterile tweezers.
- Vaseline oil (or glycerin).
- Sterile gauze napkins, two pieces.
- Sterile cotton balls, two pieces.
- Catheters of different sizes, sterile, two pieces. The introduction of a urinary catheter is a simple process, but requires caution.
Bladder Catheterization Algorithm for Men
If the procedure is performed using a soft catheter, then the specialist must perform the following steps:
- The medical worker must first prepare the hands, wash them thoroughly, and treat them with a disinfectant solution.
- The patient is laid on his back, his legs are slightly apart, while the knees should be bent. Between the legs you need to install a tray, and put a diaper under the pelvic area.
- The healthcare provider should wear sterile gloves, and grip the penis below the head with a sterile napkin. This will open the external opening of the urethra.
- Next, you need to treat the head with a cotton swab previously moistened in furatsilin. Processing should be carried out in the direction from the urethra to the edge of the head.
- By squeezing the glans penis, it is necessary to open the external urethral opening. After the hole has opened, several drops of sterile glycerin are poured into it.
With the help of tweezers, a catheter is captured, and its rounded hole is moistened with liquid paraffin or glycerin. After this, the catheter is inserted into the open opening of the urethra. Using sterile tweezers, the first five centimeters of the catheter are inserted, while holding the head.
Catheter immersion
Immerse the catheter into the urethra slowly, intercepting it with tweezers. In this case, the penis must be pulled onto the catheter with his free hand. A similar technique will allow the catheter to be advanced through the urethra with greater ease. In the area at the junction of the membranous part and the spongy, slight resistance may occur. If it occurs, it is necessary to pause for two to three minutes to wait for the disappearance of muscle spasm, and then continue the introduction of the catheter.
Physiological narrowing is also present at the entrance of the urethra to the bladder. In this area, re-insertion of a catheter is not excluded.
After the first portion of urine appears, the opposite tip of the catheter must be lowered into the urinal.
Before the end of urination, the bladder must be flushed. After that, observing safety measures, the catheter is carefully removed.
After the discharge of urine, a Janet syringe is filled into the catheter, filled with furatsilinovym solution, which is poured into the cavity of the bladder very slowly. The volume of the injected solution should be about 150 milliliters. After that, the catheter is sent to the tray to remove fluid. The flushing procedure should be carried out until the contents of the bladder become transparent.
After the flushing is completed, the catheter is removed from the urethra by performing gentle rotational movements. Then re-treat the external opening of the urethra with a cotton ball, previously moistened in a solution of furatsilina. At the end of the catheterization procedure, all instruments should be placed in a disinfectant solution.
If the use of a soft catheter does not allow you to perform the procedure, then you will need to use a metal one. Such a procedure for the introduction of a urinary catheter should be carried out exclusively by a qualified doctor, because the technique is very complicated, requiring special care and attention.
The patient is laid on his back, the urethral opening is treated. I turn the catheter down with its “beak” and push it along the urethra until it reaches the bladder. To overcome the area of the sphincter, the penis should be directed along the midline. The catheter is introduced further by slowly moving the urethra in the direction of the instrument.
If the procedure is performed correctly, then discharge in the urine container is observed, while the patient does not experience pain. Due to the fact that catheterization with a metal catheter is rather painful and traumatic, it is rarely performed.
Catheterization Complications
In some cases, the appearance of some complications is possible, for example:
- Urinary tract infection. As a result, pyelonephritis, cystitis, urethritis can develop.
- Damage to the urethra, sometimes significant, up to perforation.
Complications may arise due to errors made during the insertion of a catheter, especially a metal one, or due to insufficient preliminary examination of the patient. Most often, complications result from a violation of asepticity.