What’s involved in getting a urinary catheter? Do they lubricate it before insertion? How do they keep the infection rate down? Is the catheter treated to prevent or limit infection?
Are there recent published materials that I can read and cite that can give me details such as how it is done, what the rates of infection are; and what is done to limit infection?
[EMAIL=http://www.nlm.nih.gov/medlineplus/ency/article/003981.htm]Urinary Cath
See the link for some general info.
As far as infection, inserting a catheter is a sterile procedure, however infections can (and sometimes do) still occur.
And yes, the catheters are lubricated before being inserted.
Hope this is helpful.
The catheter is packaged with an insertion kit. The whole thing is sterile.
The nurse will open the outside package, then put on sterile gloves.
She/he will clean the area surrounding the meatus (the outside opening to the urethra, or channel connecting the bladder to the outside world.)
She/he will check the balloon for leaks, filling it with sterile water.
Then she/he will lubricate the catherter along its full length, and possibly squirt a little into the meatus. Some places go the extra mile, and use Lidocaine jelly.
On a male patient, the penis is held at right angle to the body, as the catheter is gently inserted. At the level of the prostate, there will be slight resistance. You may feel a bit of pressure, but it shouldn’t be painful.
Once past the prostate, urine will flow. She/he will then inflate the balloon, and connect the catheter to a collection bag.
The catheter should then be secured to the lower abdomen to prevent pulling and possible injury.
If the patient has a chronic illness, or the catheter is expected to be in more than a few days, it will be made from a non-latex material to avoid any problems with undocumented latex allergies.
I’ve been cathed a number of times, and I’ve never had them check the balloon on the Foley catheter before it’s inserted, since the person inserting it would then need to get all the water out again. YMMV I guess.
You can also get a straight (or “French”) cathether that doesn’t have a balloon and isn’t meant to stay in. It’s harder plastic, making it easier to insert if there’s any scarring or obstruction. I’m paraplegic and need to self-catheterize; those are what I use. It’s simply a case of being very sanitary (and I frequently go on antibiotics for bladder infections anyway).
I thought the norm was not to inflate the balloon, as they don’t return fully to the smooth, uninflated state, and the resulting bump or ridge can cause irritation along the urethra.
I suppose that’s one of those “check with your hospital’s policy” things.
To the OP - if done correctly, the infection rate is zero. You didn’t exactly ask, but , if done right, insertion is not any more than somewhat uncomfortable, (more psychologically unpleasant, actually, as in “you’re putting that thing where?”) and should not be painful.
A filiform (“wire”) catheter is sometimes placed inside a Foley cath to make it easier to insert. The filiform is removed after the catheter is in place.
A catheter with a Coude tip (slightly curved - see picture may be a little easier to insert if the urethra has a curve that isn’t amenable to the more rigid straight cath.
I know this is GQA and serious (or at least informative) replies are called for, but holy shit, I had to stop reading this.
ow.
Where I’m trained we use lignocaine gel, and for male patients you’re supposed to squirt 10mls into the urethra, wait for 1 min, and then proceed with the catheterisation. In my hospital nurses do the female catheterisations and doctors do the male.
For patients in urinary retention, catheterisation isn’t so much a painful necessity as a blessed relief.
Catheters are changed every 3 days, if the total amount of time the patient is expected to be catheterised is longer than 5 days they’ll use Silastic, all patients catheterised for longer than 5 days are on prophylactic anitbitics, and if necessary a suprapubic catheter will be substituted for a urethral one.
As an aside, people who have to use intermittent cath for an extended period are taught clean, not sterile, technique. For example, people with spinal cord injuries typically cannot urinate with cathing. They are taught to wash and reuse catheters (Medicare only gives you a few a month), wash their hands, and wash their genitals. They do this several times a day (usually every 4 to 6 hours). With intermittent cathing, you insert the catheter, drain the bladder, and then take it out. Done properly, the rate of infection is low, but not non-existent.
The nurses were really nice to me and didn’t place my Foley until the spinal block kicked in - not because I needed a spinal for that, but I was getting surgery (c-section) anyway.
The only discomfort I experienced was when the stupid thing got kinked or laid “uphill” and wouldn’t drain. It was like I had to go to the bathroom SO BAD, but I couldn’t do anything about it - “pushing out” like I normally urinate wouldn’t work with a catheter.
I soon learned how to press down sequentially on the tube to make it drain faster, but I always sort of felt as though I had to urinate. Made me more sympathetic to men with prostate troubles.
Removal felt oddly good, not unpleasant at all.
Is there a possibility of damaging the muscle or whatever keeps the urine in the bladder if a catheter is inserted numerous times?
I’ve had a few catheter insertions and expect many more in the future.
I’m a male.