skill lab kateterisasi

8/10/2019 Skill Lab Kateterisasi

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Skill Station : CatheterizationDr. dr. Didit Pramudhito, Sp.U

Surgery Dept. Moh. Hoesin Hospital/

Medical Faculty, Sriwijaya University.



Introduction

Urethral catheterization is a routinemedical procedure that facilitatesdirect drainage of the urinary bladder.

It may be used for diagnosticpurposes (to help determine theetiology of various genitourinaryconditions) or therapeutically (to

relieve urinary retention, instillmedication, or provide irrigation)



Patients of all ages may requireurethral catheterization.



Relevant Anatomy

The male urethra is a narrowfibromuscular tube that conducts urine

and semen from the bladder and

ejaculatory ducts, respectively, to theexterior of the body (see the image

below). Although the male urethra is a

single structure, it is composed of a

heterogeneous series of segments:prostatic, membranous, and spongy.



Indication

Diagnostic indications include thefollowing:

Collection of uncontaminated urine

specimen Monitoring of urine output

Imaging of the urinary tract



Therapeutic indications include the following : Acute urinary retention (BPH, Blood clot)

Chronic obstruction that causes hydronephrosis

Initiation of continuous bladder irrigation

Intermittent decompression for neurogenicbladder

Hygienic care of bedridden patients



Contraindication

Urethral catheterization iscontraindicated in the presenceof traumatic injury to the lower urinary

tract. This condition may be suspectedin male patients with a pelvic orstraddle-type injury. Signs thatincrease suspicion for injury are a

high-riding or boggy prostate, perinealhematoma, or blood at the meatus.



Preparation

Topical anesthesia is administeredwith lidocaine gel 2%

Povidone-iodine

Sterile cotton balls Sterile drapes

Sterile gloves

Urethral catheter Prefilled 10-mL saline syringe

Catheter



Catheter type

Adults - Foley (straight tip) catheter (16-18F)

Adult males with obstruction at theprostate - Coudé tip (18 F)

Adults with gross hematuria - Foleycatheter (20-24F) or 3-way irrigationcatheter (20-30F)

Children - Foley; to determine size,

divide child's age by 2 and then add 8 Infants younger than 6 months - Feeding

tube (5F)



Positioning

Supine



Procedure

Begin by introducing yourself to thepatient and clarify his identity. Explainingwhat you are going to do and obtain hisconsent.

Prepare your equipment for thisprocedure. This is: a catheterisation packa 12 – 14 Fr male Foley catheter a

catheter bag antiseptic solution sterilegloves lignocaine gel a 10ml saline-filledsyringe



Supine

Using an aseptic technique open the

catheter pack and pour antiseptic

solution into the receiver. Open therest of your equipment onto the sterile

field

Wash and dry your hands, then put onthe sterile gloves.



Drape the patient and place a collectingvessel between the patients legs.

Hold the penis with a sterile swab andclean the penis thoroughly. Remember toretract the foreskin and clean around theurethral meatus

Insert the lignocaine gel and hold the

meatus closed with pressure from theswab. Indicate that the anaestheticneeds 5 minutes to work.



Hold the penis vertically with one handand with the other hold the catheter byits sleeve. Advance the catheter tip fromits sleeve and insert into the urethra.

Progressively insert the catheter,ensuring that neither your hand nor thesleeve touch the penis until the end arm

reaches the meatus. At this point urineshould start to flow into the collectingvessel.



Inflate the balloon using 10ml ofsaline, ensuring that it does not cause

any pain. NB the volume used to fill

the balloon may vary depending uponthe size of the catheter used, check

the packaging for the exact volume to

use Attach the catheter bag.



Gently pull on the catheter untilresistance is felt. This is when theballoon will be resting on the urethralopening of the bladder. Then reposition

the foreskin. Dispose of your gloves and equipment in

the clinical waste bin. Wash your hands.

Record the volume of urine collected inthe catheter bag and ensure that thepatient is comfortable and covered.

skill lab kateterisasi

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