Cystostomy refers to catheterization of the bladder, characterized by the introduction of a drainage tube passing through the abdominal wall. In this case, the affected area must be constantly treated with antiseptic agents, and therefore the care of the cystostomy is of great importance.
Installation of this drainage tube can be performed both for a short period of time and for a long period. Therefore, patients are taught how to care for cystostomy at home.
The purpose of this catheter is to normalize the outflow of fluid from the bladder. This measure is applicable to patients with pathologies of the urethra, who, due to the disease, are unable to urinate on their own. If proper care for the cystostomy is not carried out, then this is fraught with complications that can pose a threat to the life of such a patient.
Key indications for installing drainage
As indications for installing drainage to the patient, experts call:
- Acute urine retention, in which the placement of the urethral catheter is not possible.
- The patient was prescribed massive and prolonged surgical intervention due to the inability to install a catheter through the urethra.
- Received urethral injury due to mechanical damage to the pelvic area and procedures performed on the urethra. In some cases, trauma to the urethra can be obtained during sex, as well as in the case of gross manipulations on the penis.
- Bladder injury.
- Therapy of complicated infectious inflammatory processes in the urinary system.
- If there is a need for prolonged urine diversion.
- To monitor diuresis in case of impossibility of catheter placement through the urethra.
Types of urinals
If you take into account the volume of the urinal, then emit bags that have a large capacity, up to 1.5-2 liters, and a small capacity, up to 500 ml.
Bags with low capacity can be endowed with a special device that allows you to fix the urinal by the leg. This makes it possible to increase the mobility and social adaptation of such patients.
Absolute contraindications
There are absolute and relative contraindications against the installation of a Foley catheter. In the first case, there are:
- The situation when the patient’s bladder is not full, is poorly palpated or poorly visualized during ultrasound.
- The patient is diagnosed with a malignant tumor of the bladder.
Relative contraindications
If we talk about relative contraindications, then there are:
- coagulopathy;
- the patient underwent surgery on the lower abdomen or pelvic cavity;
- the patient develops an oncological process in the pelvic area or the patient undergoes radiation therapy.
Preoperative procedures
Before surgery, the patient is informed of the possible consequences and consent is taken for surgery. However, before surgery, types of anesthesia are selected for a particular patient, including local anesthesia, as well as spinal or epidural anesthesia.
Basic care rules
To begin with, it should be noted that care for a tracheostomy, gastrostomy, colostomy and cystostomy is essentially the same. All manipulations are similar.
As for the cystostomy, both home and nursing care for the cystostomy should be provided taking into account the following rules:
- Care should be taken to ensure that both the catheter and the urinal tube are not twisted or kinked. Otherwise, the process of outflow of urine will be disrupted.
- Caring for a cystostomy requires that a catheter be clamped for several hours during the day, due to the need to simulate a urethra and exercise of the muscles of the bladder. This must be done exclusively in the daytime.
- Caring for a patient with a cystostomy also involves ensuring the cleanliness of the skin around the drainage, for which a baby or household soap is ideal. In some cases, the attending physician may recommend the use of antiseptics or ointments.
- The rules for caring for a cystostomy prohibit visits to the baths and saunas, as well as bathing or swimming. The most suitable option in this case is a shower, during which you should temporarily squeeze the catheter. In this case, skin care around the cystostomy can be carried out with running water using soap.
- Provided that the skin around the drainage is clean and there are no signs of an inflammatory process or infection, then you can abandon the use of plasters and dressings.
- You should constantly monitor that the urinal is located below the bladder both during the daytime and at night.
- When applying such a measure as a bladder cystostomy, care also includes the exclusion of flushing the catheter with the use of any solutions. Otherwise, there is a chance that microbes will penetrate into the lumen of the bladder, as a result of which the likelihood of developing infectious and inflammatory processes in the urinary system of the patient increases.
- In a situation where the drainage has become impassable or has begun to function poorly, it should be replaced with a new one.
- You should constantly ensure that the urinal is not filled to the maximum value. If the package is large, then it must be replaced every 8 hours, with a small volume it should be done every 3-4 hours.
- Experts recommend changing the drainage every week.
- And finally, changing the urinal is also necessary at least 1 time during the week.
Nursing
After the operation is completed, the patient is transferred to the ward, where nursing care for the cystotomy is provided. Remembering the key rules for caring for such patients, the first thing a nurse should pay attention to is fixing the urinal at a level below the waist. This will make it possible to prevent the reverse outflow of urine and the development of the ascending infection process.
Hospital medical staff should ensure that the skin around the catheter is cleaned daily. Before the procedure, the nurse should thoroughly wash her hands with soap and put on sterile gloves.
During the first 7-10 days, the patient's skin around the drainage is treated with antiseptic agents. After this period, a soap solution is used to treat the skin, which is washed off with water after the procedure.
After cleansing the skin around the drain, the specialist fixes a sterile cloth. Equally important in caring for such patients is timely emptying and changing the urinal.
As for the change of catheter, for the first time this must be done after 4-6 weeks after surgery. Then the drainage will be replaced monthly.
As noted above, it is necessary to empty the urinal every 8 hours if the bag is large, and every 3-4 hours when it comes to a small bag.
To empty, place the urinal over the toilet and open the valve at the bottom of the bag. In this case, the accumulated urine is poured into the toilet. After emptying the package, the neck of the catheter should be treated with 40% alcohol solution. Then the valve of the neck of the catheter is closed.
Home care
In accordance with the memo, cystostomy care at home requires the following materials:
- dressings and sterile gloves;
- a container of water;
- toppers
- syringe;
- disinfectant solution and urine collection tank;
- sterile drainage.
First of all, under the buttocks of the patient, it is necessary to lay an oilcloth on which the underboard vessel will be located. Wearing sterile gloves, hygiene of the abdominal cavity and urogenital system should be carried out, after which gloves must be changed. Then, with a special syringe, 50 ml of an antiseptic solution is collected, which should slowly be introduced into the patient's bladder. This kind of procedure is carried out until the liquid acquires transparency.
During the procedure, you should make sure that the catheter does not bend, and the solution does not appear in the tray.
The urinal must be emptied and handled with disinfectants. As part of home care, washing the patient's bladder should be done twice a week. Equally important is the regular flushing and replacement of the catheter.
Catheter Replacement Procedure
In order to replace the cystostomy, it is necessary:
- a new catheter, similar in size to the previous one;
- new urinal;
- antiseptic solution;
- sterile gauze wipes, bandage and alcohol wipes;
- a pair of sterile gloves;
- new syringe;
- sterile fluid in order to inflate the catheter balloon.
The catheter replacement procedure consists of the following steps:
- Through a special valve, drain the fluid from the urinal.
- Rinse hands thoroughly and wear gloves before the procedure.
- After that, take a syringe without a needle and connect it to the port in order to inflate the spray can.
- Pull on the syringe until it is full of fluid from the urinal. After that, the syringe is disconnected from the catheter and the liquid contained in it is drained. A syringe must be filled with saline.
- The old catheter must be carefully pulled out of the hole and put into a plastic bag.
- The skin around the hole must be washed with an antiseptic, and then dried with a gauze.
- After this stage, gloves are recommended to be replaced with new ones.
- After replacing the gloves, a new catheter is carefully inserted into the lumen of the bladder, gradually removing the cover from it.
- After the appearance of urine in the catheter lumen, it should be injected even a few centimeters deeper and a syringe should be connected to the catheter port in order to inflate the balloon. To do this, you need to enter 6-8 ml of sterile liquid, after which the syringe must be disconnected.
- After the balloon is inflated, carefully pull the drain to make sure that the catheter is locked securely.
- Then, the skin around the catheter is treated with an antiseptic and dried with sterile wipes.
- A new patch must be attached to the skin around the catheter.
Possible consequences of cystostomy
In case of improper care of the cystostomy, some complications requiring medical intervention are possible:
- Catheter prolapse and the inability to independently replace the catheter, as well as leakage of urine past the drainage.
- The appearance in the urine of a significant amount of spotting.
- Fever.
- The appearance of redness, irritation and other signs of an infectious process around the drainage.
- The appearance of pain in the lateral region and in the lumbar region.
- Decreased volume or complete absence of excreted urine through a catheter.
Preventive measures
In order to avoid damage to the intestines, accurate visualization of the filled bladder, the identification of its contours and the determination of the site of surgery is necessary. In this case, the bladder is specially filled with saline.
Prior to surgery, the patient is prescribed antibiotic therapy in order to prevent gram-negative bacteremia. Thus, cystostomy care requires some skills and knowledge. In this case, the patient should carefully monitor their own condition and consult a doctor in case of manifestation of alarming symptoms, which were discussed above.