Published on September 9, 2016
1. CATHETER USE IN GYNAECOLOGICAL PRACTICE Dr. Hashem Yaseen Supervision by : Dr. Rawan Obaidat Review
2. Key Contents Indications for catheter use in gynaecological practice. Types of catheters and catheterisation. Evidence for early versus delayed removal of catheters postoperatively. Complications.
3. Introduction Three main groups: 1. Indwelling urethral catheterisation 2. suprapubic 3. clean intermittent self-catheterisation (CISC). The indications for catheter use in gynaecological practice.
4. Indwelling urethral catheterisation
5. Indwelling urethral catheterisation The first indwelling urethral catheter (IUC) was described in 1973 by Foley. The two most common types: 1. Polytetrafluoroethylene,(PTFE) latex 2. 100% silicone (non-latex) •PTFE or Teflon which makes the latex more inert and gives it a smooth surface. This reduces the incidence of urethritis and encrustation. •The coating used for long-term latex and 100% silicone catheters is a hydrophilic polymer. The catheter surface absorbs a small amount of bodily fluid which lubricates its surface and reduces the friction between the catheter and urethral wall. This helps to reduce the risk of bacterial colonisation and encrustation.
6. Indwelling urethral catheterisation Factors that influence indwelling urethral catheter (IUC) selection: 1. Length: Female catheters are typically 26 cm in length and male 42 cm. The latter may occasionally be preferable for obese female patients
7. Indwelling urethral catheterisation Factors that influence indwelling urethral catheter (IUC) selection: 2. External diameter: Catheter size is identified by Charriere (Ch) or French gauge (Fg) or French (F). These represent the external diameter of any catheter. It is recommended to use the smallest size; for women (for example 12–14 Ch). However a bigger size is to be used to drain and clear the urinary bladder when urine contains heavy grit (encrustation) or debri
8. Indwelling urethral catheterisation Factors that influence indwelling urethral catheter (IUC) selection: 3. Catheter balloon infill volume The manufacture of each catheter recommends how to inflate the catheter balloon. The usual practice is to use 10 ml of sterile water for both latex and 100% silicone catheters in adults, and 3–5 ml in children. An alternative solution used to inflate a 100% silicone catheter is 5% aqueous glycerine in 10 ml sterile water. This helps to reduce catheter balloon diffusion. Sodium chloride 0.9% should not be used as this crystallises in the inflation channel and may result in deflation failure. Similarly, air should not be used as it causes the balloon to float on the surface of urine.
9. Indwelling urethral catheterisation Factors that influence indwelling urethral catheter (IUC) selection: 4. Lubrication An appropriate lubricant from a single-use container should be used to minimise urethral trauma and infection.
10. Steps in female catheterization
11. Steps in female catheterization Place the patient in the supine position with the knees flexed and separated and feet flat on the bed, about 60 cm apart. If this position is uncomfortable, instruct the patient either to flex only one knee and keep the other leg flat on the bed, or to spread her legs as far apart as possible. A lateral position may also be used for elderly or disabled patients. With the thumb, middle and index fingers of the non-dominant hand, separate the labia majora and labia minora. Pull slightly upward to locate the urinary meatus. Maintain this position to avoid contamination during the procedure. With your dominant hand, cleanse the urinary meatus, using forceps and chlorhexidine soaked cotton balls. Use each cotton ball for a single downward stroke only. Place the drainage basin containing the catheter between the patient’s thighs. Pick up the catheter with your dominant hand. Insert the lubricated tip of the catheter into the urinary meatus. Advance the catheter about 5-5.75 cm, until urine begins to flow then advance the catheter a further 1-2 cm.
12. Steps in female catheterization~ cont Note: If the catheter slips into the vagina, leave it there to assist as a landmark. With another lubricated sterile catheter, insert into the urinary meatus until you get urine back. Remove the catheter left in the vagina at this time. Attach the syringe with the sterile water and inflate the balloon. It is recommended to inflate the 5cc balloon with 7-10cc of sterile water, and to inflate the 30cc balloon with 30-35cc of sterile water. Improperly inflated balloons can cause drainage and leakage difficulties. Gently pull back on the catheter until the balloon engages the bladder neck.
14. Complications 1
15. Complications 2