Notes on catheterization

The article was professionally consulted by Specialist Doctor I Nguyen Hung - Endocrinologist - Department of Medical Examination & Internal Medicine - Vinmec Danang International Hospital

Catheterization is the procedure of inserting a tube through the patient's urethra to drain urine. This method is performed for the purpose of diagnosing and treating diseases of the bladder and urinary system.

Urinary catheterization, urinary drainage, bladder lavage is a procedure that drains urine out through the insertion of a tube from the opening of the urethra into the bladder. This procedure is used to diagnose and treat certain urological conditions.
1.1 Indications Urethral catheterization - bladder retention: The length of time the tube is kept depends on the doctor's prescription: 24 hours - up to 2 weeks. Indications for the following cases: urinary retention due to: Lower urinary tract obstruction due to benign prostatic tumor (benign prostatic hypertrophy), postpartum urinary retention, urinary retention in the emergency period of traumatic brain injury, spinal cord or due to cerebrovascular accident,...; Rest the bladder, do not stretch urine during and after surgery for bladder, urethral, ​​prostate surgery,...; Monitor urine continuously (every hour, continuously 24h) in cases of shock, acute renal failure, coma, surgery with anesthesia, postoperative resuscitation,...;

One-time urethral-bladder catheterization: After removing all the urine from the body, the catheter is removed. This method is currently rarely used because of the risk of causing urinary tract infection. Usually the doctor appoints this method when: Collecting urine for microbiological testing; Take cystogram or do urodynamic tests; Contrast injection for retrograde bladder X-ray; Empty bladder during labor when pregnant woman is unable to urinate on her own. Do not perform a one-time urethro- bladder catheterization in acute or chronic urinary retention because urinary retention will recur after several hours, increasing the risk of UTI; Intermittent urethral-bladder catheterization: Insertion time is 4-5 times a day, without leaving the catheter. After all urine has been removed from the body, the catheter is removed and can be reused according to the procedure specific to this procedure.

1.2 Contraindications Puncture, tear of urethra due to trauma; Urinary tract infections; Urethral stricture ; Prostate injury; Do not use metal rigid catheters for pregnant women.

2.1 Preparation of Implementation Personnel: Medical staff; Patients: Be consulted about the purpose, implementation process, sign the commitment to perform the procedure, prepare the standard posture; Equipment: Includes clean tools (medical tray, clamp bottle, bottle of antiseptic solution, jar of paraffin oil that has been steamed, solution of potassium permanganate, red medicine, cup of cotton and washing liquid, adhesive tape, rack, etc. test tubes, urinals, ...) and sterile equipment (tray, catheter depending on age and disease, chancre with holes, gauze, cotton, gloves, syringe,...).

2.2 Procedure for performing a male catheterization Getting ready: Patient position: Lie on back, legs bent, feet on bed, thighs slightly apart and pants below the knees; Under the patient's buttock, put a plastic sheet and put a urinal; Wash the genitals with an antiseptic solution, potassium permanganate or red medicine; Spread over the thighs and genitals to expose the urethral opening; Nelaton catheterization: One hand holds the penis, the other hand holds the lubricated catheter, slowly inserted into the urethra, pushing the catheter until urine flows out; When inserting the catheter into the urethra, the patient needs to open his mouth to breathe evenly; When the catheter passes through the movable urethra, pull the penis toward the patient's abdomen, the tube can easily enter the posterior urethra; Bring the catheter forward to let the water out; When the urine is completely drained, fold the tube, withdraw it, and place it in the medical tray; Dry the genitals, dress and lay the patient in a comfortable position; Urinary catheterization with metal catheter: Right hand holds a metal catheter with a slightly curved tip, left hand holds the penis to the side, inserting the catheter horizontally to the end of the movable urethra; The left hand brings the catheter and penis back to the midline, initially parallel to the abdominal wall, then lift the penis straight up, the catheter will automatically drift into the posterior urethra. If not, you need to do it again; Bend the penis down to the 6 o'clock position, the metal catheter will drift into the bladder; Remove the catheter by doing the opposite. Urinary catheterization with a rigid rubber catheter, curved tip: Do the same as a metal catheter and pay attention when catheterizing to point the curved end of the tube to the 12 o'clock position.

Female urinary catheterization: Medical staff disinfect female patient's genitals with antiseptic solution, red or purple medicine; Stretch fabric with holes to cover both thighs and genitals; open urethral opening; Apply lubricant to the tip of the catheter; Hold the tube and slowly insert it into the urethra, to a depth of about 4-5cm, urine will come out. If there is an indication to collect urine for testing, remove the first and last urine, collect the middle urine into the test tube; When the urine is completely drained, bend the tube, pull it out, and put it in the medical tray; Dry the genitals, get the patient dressed, and lie down in a comfortable position. Clean up tools: Take the tools to be washed, dried, and stored in the right place; Write a medical record, including information: Date and time of catheterization, urine quantity and color, urine collection tests to send, patient condition before, during and after catheterization,...