View source for Bladder catheterisation

<section begin="urology" />'''Bladder catheterisation''' refers to insertion of a catheter (a tube) into the urinary bladder to drain urine. The catheter may be inserted into the urethra (urethral catheterisation) or through the skin (suprapubic catheterisation).

== Indications ==
* Diagnostic
** Acquire urinary sample
** Monitor urinary output
*** Especially important in critically ill patients
** To allow instillation of diagnostic agents
* Therapeutic
** Alleviation of [[acute urinary retention]]
** To allow instillation of therapeutic agents

== Types ==
* Straight catheter
** For acquiring urinary sample
** Inserted into the urethral opening
** Not for indwelling
* Foley catheter or standard balloon catheter
** Most common indwelling urinary catheter
** Has two lumens
*** One lumen opens to the end of the catheter and allows urine to flow out
*** One lumen opens to a deflated balloon at the end of the catheter
**** Saline is injected into the other end, which inflates the balloon inside the bladder and prevents it from being dragged out
** Inserted into the urethral opening
** Contraindications
*** Acute prostatitis
*** Urethral trauma
* 3-way catheter
** Like a Foley catheter, but has one additional lumen
** This additional lumen is connected to a large bag of saline on one end, and it empties into the bladder
** This provides continuous irrigation of the bladder, which prevents formation of clots
** Used after certain urological surgeries where there is bleeding or for bladder tamponade
* Suprapubic catheter
** Bladder should be full – to prevent going through the bladder, and to prevent the peritoneum from covering the bladder
** Has two lumens, like Foley
** The patient’s haemostasis parameters should be known and considered
** Inserted 2 cm above pubic symphysis
** Indications
*** Contraindications to Foley, like urethral trauma, acute prostatitis
*** Inability to place Foley

== Technique ==
* Ask for latex or lidocaine allergy
* Patient lies on their back
* The area of the urethral opening should be disinfected 2 – 3x, working from the centre and outwards
* Cover the patient with sterile isolating sheet, with a hole for genitalia
* Insert lidocaine gel
** This gel lubricates, disinfects, and anaesthetizes the urethra
** Give it a few minutes to take effect
* Insert the catheter into the urethra, keep the kidney bowl at the other end of the catheter
** When urine starts to drain the correct position is achieved
* Inflate the balloon with saline through the other lumen
** This usually requires 5 – 10 mL of saline
* Pull the catheter back until it stops
* Attach a urine collection bag to the urine-draining lumen of the catheter
* Potential difficulties
** The first pubic flexure in men is straightened by elevating the penis during initial insertion
*** The perineal flexure is unavoidable
** The female urethral orifice may be difficult to find

== Catheter size ==
* Measured in French (Fr)
* 1 Fr = 0,33 mm
* Standard sizes are 14 – 18 Fr
* The smallest size which is adequate for the indication should be used
** Larger sizes have higher risk of erosion or stricture formation
* Larger sizes are used to drain blood clots
<section end="urology" />
[[Category:Urology]]