Overview of Bladder Catheterization
Urinary bladder catheterization is a process where a tube, known as a catheter, is inserted into the bladder. This is done for both treatment and testing purposes. Depending on how long the catheter needs to stay in, it can either be intermittent (short-term) or indwelling (long-term).
There are three main types of urinary catheters, which are categorized based on how they are inserted.
* External catheters stick to the external genital area in men or the pubic area in women and catch the urine. These are useful when managing urinary incontinence, which means when someone cannot control their urine.
* Urethral catheters are inserted through the urethra, this is the tube where urine comes out from the body, and the top is pushed into the base of the bladder.
* Suprapubic catheters are put into the bladder surgically through an approach above the pubic area (the lower part of the abdomen).
Urethral catheterization is the most frequently used method in routine hospital practices, and this article focuses on that.
Anatomy and Physiology of Bladder Catheterization
The urinary system, which includes parts like the kidneys, ureter, bladder, and urethra, is responsible for making, storing, and getting rid of urine. Typically, an adult’s kidneys make about 1500 ml or 1.5 liters of urine every day. Once the urine has moved down through the tubes called ureters, it gets stored in the bladder. The bladder can hold about 350 to 500 ml of urine.
The process of moving urine from the bladder into the urethra, which is the final tube that carries urine out of the body, is managed by three sets of muscles. The first one, the internal sphincter, is at the base of the bladder and works automatically – we don’t control it ourselves. The external sphincter muscles which we can control, are located around the starting part of the urethra. There’s also a third set of muscles, found in the pelvic floor, which provide extra support and help us control the flow of urine.
Why do People Need Bladder Catheterization
A bladder catheter is a small, flexible tube that’s inserted through the urethra into the bladder to drain urine. There are several reasons why someone might need a bladder catheter:
For Healing Purposes:
1. Trouble emptying the bladder (Urinary Retention): This can happen suddenly or over a longer period of time. Reasons for this can include:
– The urinary system is blocked due to oversized prostate, stones, narrow areas, or a tumor.
– An infection or inflammation, like bladder or urethra infection, prostate infection in men, or vaginal inflammation in women.
– Certain medicines can affect bladder emptying.
– Brains or spinal cord injury, stroke, progressive diseases like multiple sclerosis or Parkinson’s disease, and mental disorders can lead to urinary retention.
– Other reasons can include injuries, psychological conditions, or a condition called Fowler syndrome that only affects women.
2. Surgery-related: Many surgeries near the urinary tract will need catheterization. For instance, bladder catheter is often used in urological and gynecological procedures. Catheterization could also be needed if the patient requires monitoring of urine output during surgery, to manage urine retention after surgery due to anesthesia, or for more effective post-surgery pain management.
3. Other conditions including:
– Neurological issues with the bladder.
– Urine incontinence or lack of control over urine release.
– For hygiene-related reasons in patients having difficulty maintaining personal cleanliness.
– Seriously ill patients who need to have their urine output closely monitored.
– To administer chemotherapy drugs.
– For bladder irrigation, which means washing out the bladder.
For Diagnosis:
– To measure urodynamics, which is the study of how the urinary system stores and releases urine.
– To collect a urine sample for lab testing.
– For some types of medical imaging tests.
The decision to remove the bladder catheter should be made daily after assessing the patient’s condition. It should be removed as soon as it’s no longer required. For example, after some types of surgery, the catheter is generally removed within a few days to encourage the patient to begin walking and aid their recovery. For patients who have chronic urinary retention and difficulty emptying their bladder, occasional catheterization could be helpful.
When a Person Should Avoid Bladder Catheterization
There are certain situations when a doctor should not perform a bladder catheterization, which is a process involving the insertion of a tube into the bladder to remove or collect urine. These situations are:
If blood is seen at the opening of the urethra (the tube leading from the bladder that urine passes through), inserting a catheter may make an existing injury worse.
If there’s a large amount of blood in the urine, known as gross hematuria, the catheter should not be placed.
Signs of infection in your urethra also mean you shouldn’t have this procedure. This could be due to an underlying issue that needs to be addressed first.
If you’re experiencing noticeable pain or discomfort in your urethra, a catheterization could lead to further problems or complications.
A low bladder volume or compliance, which describes how well the bladder can hold and release urine, can make the procedure difficult or potentially harmful.
Lastly, if a patient refuses the procedure, their wishes should always be respected and the doctor should explore other treatment options.
Equipment used for Bladder Catheterization
Putting in a bladder catheter, which is a short tube inserted into the bladder to drain urine, needs the following items:
- Gloves that are germ-free
- Clean water
- One-time use lubricant and gel that numbs the area
- The catheter, which is the tube itself
- A bag that will collect the urine from the catheter
- A disposable waterproof pad
Now, there are a few different types of catheters. Here are some of the ways they might be different:
- Material: Some are made out of silicone, latex, or PVC (a type of plastic).
- Coating: Some have a Teflon, hydrogel, or antimicrobial coating, or a latex coating with a silicone elastomer coat (this makes them smoother).
What type of catheter is used depends on why the patient needs it, how long it will be in, and what the patient’s individual risks are. If putting in a normal catheter doesn’t work, a trained doctor will need to use a more complex method, using either a Coude (a type of catheter with a bent tip) or suprapubic (inserted above the pubic bone) catheter. A catheter that has silver alloy impregnated in it is the preferred type if the catheter is not going to be in for more than 14 days. This is because the silver helps reduce the chance of getting a urinary tract infection (UTI) or bacteremia (bacteria in the blood).
Preparing for Bladder Catheterization
There are certain steps doctors follow to prepare for a procedure called catheterization:
1. They first need to make sure the procedure is necessary and won’t cause harm. This decision is based on the patient’s health history and may require sending them to a urologist (a doctor specialized in urinary healthcare).
2. Next, doctors explain the procedure to the patient and make sure to answer any questions they might have.
3. It’s important to have a good light source to clearly see what they’re doing.
4. Doctors respect the patient’s privacy during the procedure.
5. The patient will be asked to lie down on a flat, firm surface with their head on a pillow.
6. The patient’s position during the procedure depends on their gender. Men are typically positioned on their back, while women are asked to adopt a ‘frog-leg’ position.
7. A disposable pad is placed under the patient to keep the area clean.
Before the procedure starts, doctors wash their hands and put on sterile gloves. They also ensure the patient is draped to maintain privacy. The specific area to be catheterized, the glans penis in men and the urethral opening in women, is cleaned in a sterile manner. For women, the doctor will expose the urethral opening by separating the labia and will clean the area with an antiseptic solution.
How is Bladder Catheterization performed
In Men:
The doctors use local anesthesia and a special gel to make the procedure comfortable. This gel is carefully applied along your urethra, the tube from which urine is passed out, while the lower part is gently pressed to stop the gel from going out. The penis is gently held upwards or towards your belly button. The catheter, which is a thin flexible tube, is inserted into the urethra until a certain point, marked by a letter Y on the catheter. When you see urine coming out into the attached bag, it’s a sign that the catheter is in the bladder correctly. Then, a small balloon on the catheter is filled up with sterile water. The volume of water used depends on the specific catheter used.
In Women:
Once the opening of the woman’s urethra is exposed, a lubricated tipped catheter is carefully pushed in until urine starts to come out, which shows it is correctly placed in the bladder. Then, the small balloon on the catheter is filled as per the specific instructions of the manufacturer. In women who are significantly overweight, it may require another person’s help or adjusting her body position to better access the urethra. Cleaning the area with an antiseptic solution like povidone-iodine can help see the urethra better. In the event that a catheter is accidentally put into the vagina, it should be left there until a new sterile one is correctly inserted into the urethra. Pain relief medication doesn’t really help in this procedure for women. A lubricating jelly is applied to the tip of the catheter, but applying this jelly to the opening of the urethra can make the catheter insertion difficult.
Possible Complications of Bladder Catheterization
Some people may face a number of complications when they have a catheter inserted into their bladder, also known as urethral catheterization.
The most common issue is a urinary tract infection (UTI), which can happen if the catheter is left in place for a long period of time. Normally, our bodies prevent infections by flushing out harmful bacteria during urination. However, having a catheter in place can disturb this natural defense mechanism, thus increasing the risk of UTIs. The most common bacteria causing these infections are named Escherichia coil and Klebsiella pneumonia. Repeated UTIs can lead to the bacteria becoming resistant to antibiotics.
Another issue can be a continuous bladder infection, which can happen when urine gets stuck at the bottom of the bladder. The catheter balloon can block this area.
Pain can also happen, because of a pulling sensation on the drainage bag. Men may experience a temporary sting when the catheter is lubricated, but this can be lessened by cooling the lubricating gel. Other possible problems include injury to the urethra, or urethral injury and a condition called paraphimosis, which affects uncircumcised males.
Another problem can be the catheter becoming blocked because of a buildup of sediment. This is typically seen in patients who already had bacteria in their urine without showing any symptoms. Flushing the catheter can often clear the blockage, but if that doesn’t work, the catheter may need to be replaced. In some cases, people may experience urine leakage from around the outside of the catheter because the bladder is spasming. Fortunately, these spasms can be managed with medication, such as oxybutynin.
Having a catheter can also affect a person’s quality of life, especially if they need to have it in for a long time. Because of these risks, doctors carefully consider the need for bladder catheterization before proceeding with the procedure.
What Else Should I Know About Bladder Catheterization?
Having a catheter in your bladder, a common procedure in hospitals, involves inserting a tube into your bladder to help drain urine. It’s important, especially for doctors and nurses, to know when this procedure is needed, when it isn’t appropriate, and when they might need to consult a urologist (a doctor specialized in urinary health). It should be reviewed daily if this catheter needs to stay in or can be removed, as having it in for fewer days can lower your risk of getting a urinary tract infection (UTI).
Catheter-related UTIs are pretty common in hospitals and increase the medical costs annually by over $131 million. Approximately 70% of UTIs that occur in a healthcare setting are due to catheters. If the catheter is in place for a longer time, the risk of bacteria growing on it and potentially causing an infection increases; it can range from 3-10% per day, reaching up to 100% risk for long-term use. An infection is considered when a patient with a catheter for at least two days starts to have a fever and bacteria in their urine. However, the Infectious Diseases Society of America recommends only considering a catheter-related UTI as a diagnosis when other possibilities have been ruled out. Moreover, using antibiotics to treat bacteria in urine that are not causing any symptoms isn’t advised, as it can lead to drug-resistance and an increased risk of other severe infections. If a catheter-related UTI needs to be treated, catheters that have been in place for more than two weeks should be removed. The best approach to prevent these infections is to avoid putting in a catheter unless it’s truly needed, and if it is, trying to remove it as soon as possible.
Urinary retention, which is when you are unable to empty your bladder usually caused by urethral strictures (narrowing or blockage of the tube that carries urine out of the body), is a medical emergency that requires immediate urinary catheterization. Catheterization can be difficult in these cases and should be done cautiously with a specific size (14 French) catheter. The catheter should not be forced if an obstruction is met. If blood is noticed at the opening of the urinary tract, it may suggest trauma caused by the catheter. Repeated failed attempts can cause further injury and potentially create a false route. A urologist should be consulted urgently in these difficult situations.
Asymptomatic bacteriuria (ASB), a condition where bacteria are found in the urine but do not cause any symptoms, should not be treated with antibiotics due to the risk of the bacteria developing resistance and side effects. However, testing for and treating ASB is recommended for pregnant women and for patients who are about to have a urinary procedure that could injure the inner layer of the urinary tract.
