In General Practice, catherisation is often required to relieve acute retention, usually in old patients with enlarged prostate, when routine measures like Hot waater bag, privacy, sound of running water etc. do not help. Preparation: Collect in a sterile tray, sterile towel, swabs, simple rubber catheter, liquid paraffin or xylocaine jelly, a 10cc syringe and kidney tray. If a self retaining catheter is required take a No. 16 Foley’s catheter, 20cc syringe filled with sterile water and a urine bag. Patient’s perineum should be shaved. But in emergency, shaving is not mandatory. Technique:
Wash the hands and put on gloves.
Clean the penis with savlon and water. Retract the prepuce and clean the glans gently. Clean all smegma. Povidone Iodine (Betadine) may be used, but never use iodine or spirit.
Spread a sterile towel to cover the surrounding area.
Take 5-6 ml of Lignocaine jelly I 10ccc syringe. Hold the tip of the syringe firmly against the urethral opening. Inject the jelly slowly into the urethra. After injecting, withdraw te syringe pinching the tip of the penis with left hand to prevent lignocaine flowing out. Wait for 3-5 minutes for lignocaine to act.
Lubricate the catheter tip with same jelly or liquid Paraffin. Hold the catheter in the right hand and with left hand, hold the penis with prepuce retracted.
Ask the patient to breathe quietly through open mouth – to relax the pelvic muscles. Insert the tip of the catheter into the urethra and advance it very slowly.
if it gets obstructed at any point, do the patient to relax, and advance it again with a slight rotatory motion. Such gently manipulations are usually successful. Use of force can make a false passage and bleeding. If a soft foley’s catheter fails to go, try smaller rubber catheter (which is stiffer and is passed more easily)
A loss of resistance is felt, when the catheter enters the bladder, and urine starts flowing out. Leave the outer end of the catheter into a kidney tray and empty the bladder by pressing on the suprapubic area.
after bladder is emptied, gently withdraw the catheter, Dry the penis and pull the prepuce forwards.
Fole’s catheter: Take the Foley’s catheter in sterile inner wrapping and exposethe tip by tearing the plastic cover at the perforation. Lubricate the tip and inset it into the urethra. As the catheter is advanced, withdraw the plastic covers that you do not touch the catheter at all. Once the catheter enters the bladder, and urine starts flowing out, advance it further 3” – 4” into the bladder. Then inflate the balloon with 15-20 cc of water and gently pull on the catheter, till the balloon sits on the internal sphincter. Connect the catheter to a urine bag immediately. Remember to pull the prepuce forwards. Technique of catherisation in female patient.
Give correct position. The legs are flexed and drawn apart to expose the vulva.
Wear gloves. With left hand, spread the lips of labia majora and minora, to expose the urethral opening.
With right hand, clean the area with savlon & water, and then catheterize.
Length of the female urethra is short. Only 3”-4” length of catheter is introduced till urine starts flowing out.
If catheterization fails! :Then refer the patient to a surgeon or Urologist immediately. If such referral is likely to take time in travel, then a temporary relief may be provided by suprapubic aspiration of the bladder.Remember however that catheterization is a must after suprapubic aspiration, other wise when bladder distends again, urine will start leaking into the tissues from the puncture point. Technique of suprapubic puncture:
clean the suprapubic ara upto umbilicus with savlon and paint it with Povidone – Iodine,
Take 3-4 cc Lignocaine in syringe, and infiltrate a point in the midline, 5 cms above the pubic symphysis.
Take a 20cc aspiration syringe, with a 3-way and a 20 No. disposable needle. Insert the needle directed vertically and towards the pelvis, till it enters the bladder.
Hold it in position, andaspirate out as much urine as possible.
When all urine is aspirated, withdraw the needle and apply a Tincture Bensoin seal to the skin.
