Related Subjects:
|Acute Urinary Retention
|Chronic Urinary Retention
|Urinary Catheterisation
🧾 About Urinary Catheters
- Materials: Latex (short-term) vs silicone (preferred for long-term, more expensive).
- Pelvic trauma: ❌ Avoid unless approved by a specialist.
- Antibiotics: Gentamicin 80 mg IV sometimes given before insertion (limited evidence).
- Sizes: 12Ch = small, 16Ch = large, 20Ch = irrigation.
- Principle: Use the smallest catheter for the shortest necessary time ⏳.
- Foreskin care: In uncircumcised males, always return foreskin post-insertion to avoid paraphimosis.
📌 Indications for Catheterisation
- Acute or chronic urinary retention 🚽.
- Monitoring urine output in critically ill patients.
- During or after surgery (esp. urological/gynaecological).
- Neurogenic bladder or severe incontinence.
- Severe immobility or palliative care.
- Bladder outlet obstruction not correctable.
- Intractable skin breakdown from incontinence.
- Occasionally for patient preference (if refractory to other measures).
🔄 Alternatives
- Bedside commode, urinal, continence pads/garments.
- Bladder scanner before catheterising suspected retention.
- Straight (intermittent) catheterisation.
- External condom catheter (cooperative men without obstruction).
🛠️ Types
- Intermittent: Inserted & removed each use (e.g. neurogenic bladder).
- Indwelling (Foley): Continuous drainage for surgery/critical care.
- Suprapubic: Through abdominal wall; long-term option if urethral route not viable.
- External Condom Catheter: Non-invasive, for incontinence only.
⚠️ Complications
- UTIs (most common) 🦠.
- Urethral trauma/false passage.
- Bladder spasms (→ leakage).
- Catheter blockage (debris, clots, encrustation).
- Long-term: stones, strictures, fistulae.
✅ Best Practice
- Aseptic insertion technique 🧤.
- Monitor for infection, blockage, or trauma.
- Maintain perineal hygiene.
- Secure catheter to prevent traction.
- Remove as soon as no longer needed ⏳.
🙋 Intermittent Self-Catheterisation
- Gold-standard for some spinal cord injury & neurogenic bladder patients.
- Steps: Handwash → clean catheter → lubricate → insert → drain → clean & store.
⚖️ Urethral vs Suprapubic
- Suprapubic often better tolerated (comfort, self-image, easier changes).
- Lower infection risk (abdominal wall cleaner than perineum).
- Risks: cellulitis, haematoma, procedural anxiety.
🎯 Catheter Choice
- Smallest suitable gauge (♀ 12Ch, ♂ 12–14Ch).
- Avoid larger catheters unless specialist indication → ↑ risk trauma & ulcers.
💧 Drainage Systems
- Leg bags (changed weekly) or night bags.
- Valves (instead of continuous drainage) help preserve bladder tone.
🚨 Troubleshooting
- No drainage: Check for kinks, constipation, bag above bladder, dehydration, or blockage (use bladder scan).
- Bypassing: Encrustation, spasms, constipation, or bladder stones (confirm with imaging).
- Blockage: Replace catheter, inspect debris, log pattern of blockages.
- Bladder spasms: Antimuscarinics (Oxybutynin, Solifenacin, Tolterodine) – but monitor cognition in elderly.
- Blood/debris: Often benign, but large clots/obstruction → urgent review.
📉 Failed Trial Without Catheter (TWOC)
- Attempt removal early morning 🌅 after optimising mobility & constipation.
- For repeated failures: consider long-term silicone catheter & urology referral.
