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Introduction

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Urinary catheter insertion is performed to drain urine from the bladder (Figure 48-1) in patients who are incontinent or have urinary obstruction or to frequently monitor urine output as a proxy for renal function. Long-term catheterization is associated with increased risk of urinary tract infection.

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Definitions and Terms

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  • ▪  French (Fr): The unit of measurement used in sizing urinary catheters—where 1 French equals 1/3 of a millimeter.
  • ▪  Intermittent straight catheterization: A technique used for intermittent bladder drainage wherein the catheter is inserted and removed periodically to decompress bladder.

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Techniques

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  • ▪  Indications:
    • —Perioperative urinary drainage
    • —Urinary tract outflow obstruction
    • —Urinary volume measurement in the intensive care unit (ICU)
  • ▪  Contraindications:
    • —Urethral disruption
  • ▪  Method:
    • —Prior to urinary catheterization, patient consent should be obtained, the urethra and surrounding areas prepped and draped (Figure 48-2), and the universal protocol should be performed as described in Section I.
    • —Prior to catheterization, the operator should wash hands and wear sterile gloves.
    • —According to Centers for Disease Control guidelines:
      • • Catheters should only be inserted by trained personnel.
      • • Catheters should only be inserted when necessary, rather than for the convenience of patient-care personnel, and should only be left in place as long as necessary.
      • • Alternative methods of urinary drainage should be entertained (ie, condom catheter, suprapubic drain).
    • —The smallest appropriate catheter should be selected for insertion, and the balloon checked for patency.
      • • Medium catheters (16-18 Fr) are typically used in adult females.
      • • Larger catheters (20-24 Fr) may be used in patients with hematuria.
    • —The labia should be spread, the urethra identified, and the catheter should be lubricated and inserted into the urethra (Figure 48-3).
    • —After urine has drained from the catheter, the balloon should be inflated.
    • —The catheter is attached to a closed drainage system and the drainage bag is positioned below the level of the bladder to prevent urinary reflux into the bladder.
  • ▪  Complications:
    • —Urethral trauma
    • —Infection

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Clinical Pearls and Pitfalls

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  • ▪  Urethral identification may be difficult in obese patients, patients with prior surgery, following childbirth or with prolapsed of vagina and/or urethra.
  • ▪  If no urine drains from the catheter after insertion to an appropriate length, the catheter may be irrigated with sterile saline—free saline return suggests that the tip is in the right location.

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Suggested Reading

Leone M. Garnier F. Avidan M. Martin C. Catheter-associated urinary tract infections in intensive care units. Microbes Infect. 2004;6:1026–1032.  ...

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