Catheterization of the bladder
Catheterization of the bladder - insertion of a catheter into the bladder to remove urine from it, wash the bladder, administer a drug or extract urine for examination. Catheterization requires special precautions not to infect the bladder infection, since its mucosa has a weak resistance to infection. The catheterization is not safe for the patient and should only be carried out if necessary.
For catheterization, soft and hard catheters are used.
The soft catheter is an elastic rubber tube 25-30 cm in length and 0.39 to 10 mm in diameter( No. 1-30).The outer end of the catheter that is inserted into the bladder is obliquely cut or funnel-shaped to make it easier to insert the tip of the syringe when a drug solution is injected into the bladder.
A solid catheter( metallic) consists of a handle, stem and beak. The urethral end is blind, rounded, with two oval orifices. The length of the male catheter is 30 cm, female - 12-15 cm with a large beak.
Soft and hard catheters are sterilized by boiling. The rubber catheters are stored in long enamel and glass boxes with a lid filled with a 2% solution of boric or carbolic acid, or in special sterilizers for storage of rubber catheters, at the bottom of which formalin tablets are placed - its vapors provide sterility of the catheters. Before use, the acid solution must be removed from the catheter by washing with water and then boiling.
At present, disposable catheters stored in hermetic packages are more often used. Their use is possible only at the time specified on the package. With any mechanical or chemical damage to the vacuum package, catheters should not be used without prior sterilization.
Before the catheterization, the hands are treated as before any manipulation or surgery. Women are preliminarily undermined( any disinfectant solution can be used, but a solution of furacilin 1: 1000 is often used), sprinkled if there are vaginal discharge.
The nurse becomes on the right, the left hand spreads the labia, and the right( top down towards the anus) thoroughly wipes the external genitals with a disinfectant solution. After this, a catheter is taken into the right arm, the inner end of which is treated with sterile vaseline oil, and, finding the external opening of the urethra, the end of the catheter is carefully inserted into it. The appearance of urine from the external catheter canal indicates that the catheter is in the bladder.
Catheterization of the bladder in women is easy enough to perform both a soft and hard catheter. Most often, soft catheters are used for this purpose. When the urine stops coming out on its own, you can gently push through the abdominal wall in the bladder area to isolate the residual urine. The urethra in women is short( 4-6 cm), so all manipulations are not very difficult, although the medical staff must possess certain technical skills.
Damage to the wall of the bladder is possible if it is insufficiently filled, so it is necessary to perepukutirovat bladder in the suprapubic area. In the absence of such a skill, bladder catheterization should be performed only under the supervision of a physician. Another most serious complication is the development of an ascending infection, for the prevention of which the nurse must strictly follow the rules of asepsis and antiseptics.
Introduction of a catheter to men is much more difficult, since the urethra has a length of 22-25 cm and forms two physiological constrictions that create an obstruction for the passage of the catheter. The nurse is allowed to catheter the men's bladder only with a rubber catheter. If catheterization with this catheter fails, it is necessary to inform the physician who will perform the catheterization with a metal catheter.
The technique of introducing a soft catheter into the bladder. The patient lies on his back with legs slightly bent at the knees. Between the feet is placed a vessel for collecting urine. Sister the penis in the left hand and wipes his head with cotton wool soaked with a disinfectant solution. With your right hand, use a pair of tweezers to take the catheter, placing the tweezers closer to the inner end of the catheter. The outer end of the catheter is clamped between the V and IV fingers of the same hand. Lubricating the inner end of the catheter with sterile vaseline oil, it is gently injected into the external opening of the urethra and gradually, without sharp force, is advanced along the channel. The penis should be directed anteriorly. If the lumen of the urethra is not changed, catheterization can be carried out relatively easily. The appearance of urine from the outer end of the catheter indicates that the catheter is in the bladder. The catheter should not be removed after the urine has come out, but a little earlier, so that the urine stream rinses the urethra after the catheter is removed.
Produced for mechanical removal of pus, tissue decay products or small stones, as well as before the introduction of a cystoscope. Bladder rinsing is usually done with a rubber catheter. Pre-establish the capacity of the bladder by measuring the amount of urine released per one urination. The patient's position is on the back with legs bent at the knees, dilated hips and raised pelvis.
This procedure can be performed in the urological chair. Rinse the bladder from Esmarch's mug, the rubber tube of which is put on a catheter. Use a solution of boric acid( 2%), potassium permanganate( 1:10 LLC).Instruments must be sterile.
Introduce the catheter and, lowering the urine, connect it with a rubber tube from the mug Esmarha. Wash the bladder until a clear liquid appears, and if after that you do not need to inject a cystoscope, the bladder is half filled with the solution and the catheter is removed.
After washing, the patient should be in bed for 30-60 minutes. If the rinsing is done with medicinal substances, it is done every day or every other day( depending on the condition of the patient and the clinical course of the disease).