A urinary catheter is a hollow, partially flexible tube that collects urine from the bladder and leads to a drainage bag.
Urinary catheters come in many sizes and types. They can be made of:
- Plástico (PVC).
Catheters are usually necessary when someone can not empty their bladder. If the bladder is not emptied, urine can accumulate and cause pressure on the kidneys. The pressure can cause kidney failure, which can be dangerous and cause permanent damage to the kidneys.
Urethral catheterization can be performed as a therapeutic or diagnostic procedure. Therapeutically, catheters can be placed to decompress the bladder in patients with acute or chronic urinary retention.
In addition, catheters can be placed to facilitate the irrigation of the bladder in patients with macroscopic hematuria.
Diagnostically, urinary catheters can be placed to obtain a non-contaminated urine sample for microbiological testing, to measure urinary output in critically ill patients or during surgical procedures, or to measure post-vacuum waste.
The only absolute contraindication for urethral catheterization is the known or suspected urethral injury, usually in the context of a pelvic fracture.
Most catheters are needed until you regain the ability to urinate on your own, which is usually a short period of time.
Older people and people with a permanent injury or serious illness may need to use urinary catheters for much longer or permanently.
There are several main types of urinary catheter, such as intermittent catheters that are temporarily inserted into the bladder and removed once the bladder is empty.
And permanent catheters that remain in place for many days or weeks and are held in place by an inflated balloon in the bladder.
If you need a long-term urinary catheter, you will be given detailed advice about your care before leaving the hospital.
This will include advice on how to obtain new supplies of catheters, reducing the risk of complications such as infections, detecting signs of possible problems and when to seek further medical advice.
You should be able to live a relatively normal life with a urinary catheter. The catheter and the bag can be hidden under clothing, and you should be able to do most of the daily activities, such as working, exercising, swimming, and having sex.
Bladder catheterization procedure
Catheterization is accomplished by inserting a catheter (a hollow tube, often with an inflatable balloon tip) into the urinary bladder.
This procedure is performed for urinary obstruction, after surgical procedures in the urethra, in unconscious patients (due to surgical anesthesia, coma, or other reasons), or for any other problem in which the bladder must be kept empty (decompressed) and urinary insured flow.
The balloon holds the catheter in place for a period of time. Catheterization in men is a little more difficult and uncomfortable than in women due to the longer urethra.
Urethral catheterization can be difficult for several reasons, including false passage during attempts placement recent or past catheter prior urethral trauma resulting in urethral strictures, enlarged prostate (eg, hyperplasia benign prostatic cancer, prostate cancer) .
In these scenarios, urologists are often called to the operating room or to the head of the bed to help with urethral catheter placement when the primary equipment is unsuccessful.
These difficult catheterizations often require additional equipment such as special wires, catheters or flexible bedside cystoscopy.
However, before the advent of flexible cystoscopy, the urologist is able to blindly place the catheter using a broader understanding of the anatomy of the urethra and greater tactile experience.
The most important in his arsenal are filiform and followers. These tools allow blind negotiation of the true path of urethral light and, finally, access to the bladder.
Filiforms are smaller than urethral catheters and are more likely to pass through the narrowing of the urethra. The followers can be used to dilate the narrowing to an appropriate size for the passage of a urethral catheter.
When this technique is successful, it eliminates the need for cystoscopy or suprapubic tube placement if a flexible cystoscope is not available.
In addition, the dilation can be therapeutic and can give the patient a better chance of being able to empty spontaneously when the catheter is removed.
In fact, filiforms and followers are still widely used for dilation in men with known urethral stricture disease.
Why are urinary catheters used?
A urinary catheter is usually used when people have difficulty urinating naturally. It can also be used to empty the bladder before or after surgery and to help perform certain tests.
The specific reasons why a urinary catheter may be used include:
- To allow urine to drain if you have a blockage in the tube that carries urine out of the bladder (urethra), for example, due to scarring or enlargement of the prostate.
- To allow you to urinate if you have weakness in the bladder or damage to the nerves that affects your ability to urinate.
- Drain your bladder during delivery if you have an epidural anesthetic.
- Drain your bladder before, during or after some types of surgery.
- To administer medications directly into the bladder, such as during chemotherapy for bladder cancer.
- As a last resort treatment for urinary incontinence when other types of treatment have not been successful.
A doctor may recommend a catheter if you:
- You can not control when you urinate.
- You have urinary incontinence.
- Tiener urinary retention.
The reasons why you can not urinate on your own may include:
- Blocking the flow of urine due to bladder or kidney stones , blood clots in the urine or severe enlargement of the prostate gland.
- Surgery in your prostate gland.
- Surgery in the genital area, such as a hip fracture repair or a hysterectomy .
- Injury to the nerves of the bladder.
- Injury spinal cord .
- A condition that affects your mental function, such as dementia.
- Medications that impair the ability of the bladder muscles to contract, which keeps the urine trapped in the bladder.
- Spina bifida.
Depending on the type of catheter you have and why it is being used, the catheter may be removed after a few minutes, hours or days, or may be necessary in the long term.
What are the types of urinary catheters?
Many people prefer to use a permanent catheter because it is more convenient and avoids the repeated insertions needed with intermittent catheters.
However, permanent catheters are more likely to cause problems, such as infections.
Inserting any type of catheter can be uncomfortable, so anesthetic gel is used to reduce pain.
You may also experience some discomfort while the catheter is in place, but most people with a long-term catheter get used to it over time.
There are three main types of catheters: permanent catheters, external catheters and short-duration catheters.
Intermittent urinary catheters:
In most cases, intermittent urinary catheters are recommended. These catheters are inserted several times a day, long enough to drain the bladder, and then removed.
They should teach you how to insert the catheter yourself. It is usually inserted into the bladder through the urethra (the tube that carries urine out of the body).
The sterile catheter is usually pre-lubricated to reduce the risk of discomfort when inserted.
One end of the catheter is left open to allow drainage in a toilet or is attached to a bag to collect urine. The other end is guided through the urethra until it enters the bladder and urine begins to flow.
When the flow of urine stops, the catheter can be removed. A new catheter is used each time.
Permanent catheters (urethral or suprapubic catheters):
A permanent urinary catheter is inserted in the same way as an intermittent catheter, but the catheter is left in place.
The catheter is held in the bladder with a balloon filled with water, which prevents it from falling. These types of catheters are often called Foley catheters. This type can be useful for short and long periods.
The urine is drained through a tube connected to a collection bag, which can be attached to the inside of the leg or attached to a support on the floor.
A nurse usually inserts a permanent catheter into the bladder through the urethra. Sometimes, a health care provider will insert the catheter into the bladder through a small hole in the abdomen. This type of permanent catheter is called a suprapubic catheter.
A small balloon at the end of the catheter is inflated with water to prevent the tube from leaking out of the body. The balloon can be deflated when it is necessary to remove the catheter.
Permanent catheters are sometimes equipped with a valve. The valve can be opened to allow urine to drain into a toilet, and closes to allow the bladder to fill with urine until drainage is convenient.
Most permanent catheters should be changed at least every three months.
The catheters should be kept in place only for as long as necessary. Permanent catheters placed in patients undergoing surgery should be removed as soon as possible after surgery.
The use of urinary catheters for the treatment of incontinence in patients and residents of nursing homes should be avoided.
The 2009 Infectious Diseases Society (IDSA) guidelines for urinary tract infections associated with the catheter indicate that a permanent catheter can be used at the patient’s request in exceptional cases and when other approaches to the management of incontinence do not They have been effective.
Long-term catheterization increases patient satisfaction but also increases mechanical complications. Contraindications include bleeding disorders, surgery or previous irradiation of the lower abdomen and morbid obesity.
Intermittent catheterization is an option, but most patients become bacteriuric in a few weeks; The incidence of bacteriuria is 1-3% per insertion.
According to the 2009 guidelines of the Society of Infectious Diseases, if a permanent catheter has been in operation for more than 2 weeks at the beginning of urinary tract infections associated with the catheter and remains indicated, the catheter should be replaced to promote resolution continuous of the symptoms.
In two weeks, the bacteria inside the tube and the bag have had ample opportunities to create a biofilm, providing a safe haven against most antibiotics.
The improved management of urinary tract infections related to the catheter was approved as a national goal of patient safety for 2012.
A suprapubic catheter is a type of catheter that is left in place.
Instead of inserting it through the urethra, the catheter is inserted through a hole in the abdomen and then directly into the bladder. This procedure can be done under general anesthesia, epidural anesthesia or local anesthesia.
A suprapubic catheter is used when the urethra is damaged or blocked, or when someone can not use an intermittent catheter.
The catheter can be attached to the side of your body and attached to a collection bag attached to your leg. Alternatively, a valve that opens to allow urine to drain into a toilet can be attached and closed to allow the bladder to fill with urine until drainage is convenient.
This type of catheter is usually changed every six to eight weeks.
External catheters (condom catheters):
A condom catheter is a catheter placed outside the body. It is usually necessary for men who do not have problems with urinary retention but who have severe functional or mental disabilities, such as dementia.
A device that looks like a condom covers the head of the penis. A tube leads from the condom device to a drainage bag.
These catheters are generally more comfortable and have a lower risk of infection than permanent catheters. Condom catheters should usually be changed daily, but some brands are designed for long-term use.
These can cause less skin irritation than condom catheters that require daily removal and reapplication. A wound, ostomy and continence nurse (WOCN) can help make these recommendations.
Short-term catheters (intermittent catheters):
A person may only need a catheter for a short period of time after surgery until the bladder empties.
After the bladder empties, it is necessary to remove the short-term catheter. Health care providers refer to this as a catheter in and out.
In a house, people are trained to apply the catheter themselves or with the help of a caregiver. It can be done through the urethra or through a hole created in the lower abdomen for catheterization.
The Centers for Disease Control and Prevention guidelines of 2009 recommend that physicians avoid the routine use of systemic antimicrobials to prevent catheter-associated urinary tract infections in patients requiring short or long-term catheterization.
Filiform urethral catheterization and follower:
Filiform and followers are indicated primarily for non-routine urethral catheterization when false pass or urethral stricture is suspected and previous attempts to pass a Foley catheter have failed.
Filiforms are offered in various sizes and tip shapes (straight, spiral, coude). They can be made of a flexible polyurethane or woven fiberglass. Softer materials are preferred for the filiform to easily curve in the bladder while the follower passes.
The followers are offered in flexible plastic, woven material or metal, in different sizes. The wide variety of sizes allows for sequential dilation of the urethra. They can also come in 2 forms (straight or elbow).
The tip of the follower often has a drainage hole that allows the urine to drain when it reaches the bladder, confirming the true passage.
For convenience, some manufacturers offer urethral catheterization kits that package a set of filiforms and followers along with a catheter, cleaning the skin, materials and lubricant.
They should be considered as an alternative to flexible or rigid cystoscopy with the placement of a guide under direct vision. The blind insertion of filiforms and followers should be reserved for situations in which cystoscopy is not available.
Filiforms and followers are widely used as first-line treatment for men with known urethral stricture disease.
In these cases, the placement of a catheter is not always necessary. Chronic stenoses can be safely managed with repeated dilations.
Filiform and followers should not be used in the context of trauma when a urethral condition is suspected.
If a retrograde urethrogram shows extravasation of contrast, the blind passage of filiform should not be attempted.
What are the potential complications of urinary catheters?
The main problems caused by permanent urinary catheters are infections in the urethra, bladder, or, less commonly, the kidneys. These types of infections are known as urinary tract infections (UTIs) associated with health care and usually , they should be treated with antibiotics.
You can get a short or long-term urinary tract infection of the catheter. However, the longer a catheter is used, the greater the risk of infection.
That is why it is important that the catheters are correctly inserted, maintained properly and only used for as long as necessary.
Catheters can also sometimes cause other problems, such as spasms of the bladder (similar to stomach cramps), leaks, obstructions, and damage to the urethra.
Therefore, it is important to clean catheters routinely to prevent infections. Symptoms of a urinary tract infection may include:
- Cloudy urine due to pus.
- Burning of the urethra or genital area.
- Leakage of urine out of the catheter.
- Blood in the urine.
- Bad smelling urine
- Low back pain and pain.
Other complications of urinary catheter use include:
- Allergic reaction to the material used in the catheter, such as latex.
- Bladder stones.
- Blood in the urine.
- Injury in the urethra.
- Renal damage (with long-term permanent catheters).
- Septicemia or infection of the urinary tract, kidneys or blood.
Urinary tract infection related to the catheter:
Urinary tract infection (UTI) related to the catheter occurs because urethral catheters inoculate organisms in the bladder and promote colonization by providing a surface for bacterial adhesion and causing irritation of the mucosa.
The presence of a urinary catheter is the most important risk factor for bacteriuria.
Once a catheter is placed, the daily incidence of bacteriuria is 3-10%. Between 10% and 30% of patients who undergo short-term catheterization (ie, 2-4 days) develop bacteriuria and are asymptomatic.
Between 90% and 100% of patients who undergo long-term catheterization develop bacteriuria. About 80% of nosocomial urinary tract infections are related to urethral catheterization; only 5-10% are related to genitourinary manipulation.
The presence of potentially pathogenic bacteria and a permanent catheter predispose to the development of a nosocomial urinary tract infection.
The bacterium can gain entry to the bladder during catheter insertion, during manipulation of the catheter or drainage system, around the catheter and after extraction.
Enteric pathogens (eg, Escherichiacoli) are most commonly responsible, but it is known that Pseudomonas species, Enterococcus species, Staphylococcus aureus, coagulase negative staphylococci, Enterobacter species and yeasts also cause infection.
The species of Proteus and Pseudomonas are the organisms most commonly associated with the growth of biofilm in catheters.
Candida, especially Candida albicans, is the second most common organism that can cause catheter-associated urinary tract infection or asymptomatic colonization, although fungal isolation from urine rarely indicates active infection.
The use of clinical signs such as fever, leukocytosis and decreased renal function can not reliably distinguish between asymptomatic funguria and actual infection.
The risk factors of bacteriuria in patients with catheterization include a longer duration of catheterization, colonization of the drainage bag, diarrhea, diabetes, absence of antibiotics, female sex, renal failure, errors in catheter care, late catheterization in the course hospital and immunosuppression .
The guidelines of the Centers for Disease Control and Prevention (CDC) for 2009 for the prevention of urinary tract infections (UTIs) associated with the catheter recommend the use of the catheter only for the appropriate indications.
The use and duration of the catheter should be minimized in all patients, especially those at higher risk of urinary tract infections associated with the catheter (eg, women, the elderly, and patients with impaired immunity).
Single-use catheters and reusable catheters are available. For reusable catheters, be sure to clean both the catheter and the area where it enters the body with soap and water to reduce the risk of a urinary tract infection.
Single-use catheters come in sterile containers, so only your body needs cleaning before inserting the catheter.
You should also drink plenty of water to keep the urine clear or slightly yellow. This will help prevent infection.
Empty the drainage bag used to collect urine at least every eight hours and as long as the bag is full. Use a plastic jet bottle that contains a mixture of vinegar and water or bleach and water to clean the drain bag. Read more about clean intermittent self-catheterization.
Living with a urinary catheter
It is possible to live a relatively normal life with a long-term urinary catheter, although it may take time to get used to it at first.
Your doctor or a specialist nurse will give you detailed advice on caring for your catheter.
When you leave the hospital, you will be given a supply of catheter equipment and will be told where you can get more supplies. Catheter equipment is usually available by prescription from pharmacies.
You will also be shown how to empty and change your equipment.
Intermittent catheters are usually designed to be used once and then discarded.
How to use them varies from person to person. You may be advised to use them at regular intervals evenly spaced during the day, or only when you feel you need the toilet.
Permanent catheters can be drained in a bag attached to your leg, which has a tap on the bottom so that it can be emptied, or they can be emptied into the appropriate toilet or receptacle directly with a valve.
You should empty the bag before it is completely full (about half or three quarters full). Valves should be used to drain urine at regular intervals throughout the day to prevent urine from accumulating in the bladder.
The bags and valves of the legs should be changed every seven days.
The bag can be attached to your right or left leg, depending on which side you find most comfortable.
At night, you must place a larger bag. Your overnight bag should be attached to your leg bag or catheter valve. It should be placed on a stand next to your bed, near the floor, to collect urine while you sleep.
Depending on the type of overnight bag you have, you may need to discard it in the morning or it may be emptied, cleaned and reused for up to a week.
The catheter should be removed and replaced at least every three months. This is usually done by a doctor or nurse, although sometimes it is possible to teach you or your caregiver how to do it.
Preventing infections and other complications:
Having a long-term urinary catheter increases the risk of developing urinary tract infections (UTIs) and can also cause other problems, such as blockages.
To minimize these risks, you must:
- Wash the skin in the area where the catheter enters your body with water and mild soap at least twice a day.
- Wash your hands with warm water and soap before and after touching the catheter equipment.
- Make sure you stay well hydrated, you should try to drink enough fluids to keep your urine pale.
- Avoiding constipation , staying hydrated can help with this, as can eating foods rich in fiber, such as fruits and vegetables and whole foods.
- Avoid having folds in the catheter and make sure urine collection bags are kept below the level of your bladder at all times.
Your regular activities:
Having a urinary catheter should not prevent you from doing most of your normal activities. You will be informed when it is safe for you to go to work, exercise, go swimming, go on vacation and have sex.
If you have an intermittent catheter or a suprapubic catheter, you should be able to have sexual intercourse normally.
Permanent catheters can be more problematic, but it is still possible to have sex with them instead. For example, men can bend the catheter along the base of their penis and cover both with a condom.
In some cases, you may be taught how to remove and replace the catheter so you can have sex more easily.
When to get medical advice
Contact your treating doctor or the hospital if:
- You develop severe or continuous bladder spasms (similar to stomach cramps).
- Your catheter is blocked, or urine is leaking around the edges.
- Your urine is stained with blood or has blood stains (the catheter may have been accidentally put in); contact your community nurse if you continue to pass urine or bloody urine with blood spots.
- You are passing bright red blood.
- You have symptoms of urinary tract infections, such as lower abdominal pain, high fever, and chills
- Your catheter falls (if you are buried and you have not been taught how to replace it). Go to the nearest accident and emergency department if the catheter goes down and you can not contact a doctor or nurse right away.