A urinary catheter is a flexible, hollow tube made up of rubber, plastic, or silicone which helps in draining the urine from the urinary bladder up to the urine bag. The urinary catheters are safe and frequently used medical devices in hospitals or clinics.
Urinary catheter insertion is usually not necessary when a patient can pass urine by him/herself. These catheters are used when a patient:
– Has difficulty in passing the urine (urinary retention).
– Has difficulty holding the urine (urinary incontinence).
These kinds of situations usually occur in the following conditions:
1. Major surgeries: During the major surgical procedures, the patient is anesthetized for many hours, and during this time the patient is unable to pass urine by themselves. Here, urinary catheterization helps by allowing easy passage of urine. A good amount of urine during major surgeries means the kidneys are working well. This helps the doctors in caring for the patient during the surgery.
The patient finds it difficult to pass urine after the major surgeries or surgeries which require bed rest like the trauma surgeries. Urinary catheterization during this time makes it easy for the patients as well as the care providers.
2. Blockage to urine flow: Urine flow might be blocked when there are kidney stones, bladder stones, and blood clots within the urinary tract. Similarly, the prostate gland is enlarged in elderly patients which can block the passage of urine. Placing a urinary catheter is an easy and temporary solution to these problems.
3. Spinal cord injuries: Patients with spinal cord injuries or other spine problems have difficulty passing the urine by themselves (retention) or they may have difficulty holding the urine (incontinence). Urinary incontinence or retention might be permanent problem to the patients.
4. Dementia: Dementia in elderly people is a common cause of urinary incontinence. Placing a urinary catheter helps to prevent the soiling of clothes and improves the standard of living.
A urinary catheter may also be required:
To measure the urine output in critically ill patients
To drain the bladder before, during, or after the surgery
During childbirth, to drain the bladder after the epidural anesthesia is given.
To deliver medication directly into the bladder.
Urinary catheters can be divided into three main types: Indwelling catheters, external catheters, and short term catheters
Indwelling catheters are the ones that will remain within the urinary bladder for either a short or longer period. The catheter is commonly known as a Foley catheter and is inserted through the urethra commonly. Occasionally, the catheter is inserted through the abdomen by making a small incision over the abdomen. This type of catheter is known as Supra-pubic catheter and is done when the urethra is traumatized.
External catheters are placed over the head of the penis and do not pass to the urinary bladder. Shaped and placed like a condom these types of catheters are commonly called condom catheters. These types of catheters are useful in men with dementia where urinary incontinence is a concern. Condom catheters are changed daily so there are fewer chances of urinary tract infection.
Another type of catheter is a short-term catheter also known as intermittent catheters. This type of catheter is inserted into the bladder through the urethra. This type of catheter is removed as soon as the urine is drained and is useful for one-time use.
A hematuria catheter is a type of Foley catheter for post-TURP hemostasis. It is also useful following endoscopic surgical procedures and in cases with gross hematuria. They can be both two-way and three-way catheters (double and triple lumen respectively).
A urinary catheter is available in sterile packaging. A nurse or a health care worker inserts an indwelling type of catheter through the urethra after lubricating the tube taking care to maintain the sterility technique. After insertion, the catheter is fixed by inflating the catheter with distilled water and also on the skin with adhesive tape.
The indwelling type of catheter is changed every 2weeks to prevent infection of the urinary tract. The external type of catheter is changed daily. The catheter should be changed immediately if there is blood coming out from the tube or if there is excess pain.
Catheter diameters are sized based on the French catheter scale (F). The most common sizes used are between 10 F (3.3 mm) to 28 F (9.3 mm). The doctor selects the size of the tube large enough to allow free flow of urine and should be large enough to control the leakage of urine.
The catheter is a foreign body to the urethra as it enters the urethra from the outside world. So, catheter care is very important. It can lead to complications if not properly looked into. Certain measures to be taken for catheter care are:
1. Regular cleaning of the catheter, changing the urinary bags, and washing the drainage bags regularly.
2. Some blood or urine around the catheter is normal. As long as urine collects in the bag, it is normal.
3. The tube should be checked once in a while for any bends or kinks that prevent the urine from flowing out.
4. Lotions or powders should strictly be avoided around the catheter area.
5. You must keep yourself well hydrated while you have your catheter. Drink at least 2 glasses of liquids every 2 hours.
6. You can take your shower with the catheter in place. However, taking a bath should be avoided until the catheter is removed.
7. Catheter cleaning is also equally important. You must wash your hands with soap and water before cleaning the catheter site. In men, the foreskin should be pulled back and the catheter area is cleaned. In women, the labia should be separated first, and then the area should be cleaned properly.
8. The drainage bag should be changed two times a day. It should be kept below the bladder level so that it drains well.
If you have a suprapubic catheter, the opening in the belly and the tube should be cleaned with soap and water regularly.
Having a catheter in situ can have complications like:
1. Allergy and sensitivity to the latex of the tube.
2. Blood in the urine (Hematuria)
3. Urinary bladder stones
4. Bladder spasms which feel like stomach cramps
5. Urethral injury
6. Narrowing of the urethra later because of scar tissue due to repeated catheter use.
7. Urinary tract infections or Pyelonephritis (Infection in the kidney)
8. Damage to the kidney (if long-term indwelling catheters)
9. Bladder cancer (rare, in long-term urinary catheter use)
10. Septicemia (spread of the infection to the blood).