Urinary Foley Catheter Insertion

OBJECTIVES:

‡ List the indications for urethral catheterization. ‡ Describe the types of urethral catheters. ‡ Know how to prepare the patient for urethral catheterization. ‡ Describe the technique for urethral catheterization. ‡ Describe what to do in cases of difficult urethral catheterization

CATHETERIZATION
Size: 1 French (Fr) = 0.33 mm outer diameter
Rule of Thumb: To determine the diameter of a catheter divide the Fr size by 3 (i.e. 18 Fr = 6mm)

Material
Latex Rubber Silicon Simplastic

Catheter Types
A. Robinson (³red rubber´) Straight cath D. Coude-Curved Tip Difficult catheterization BPH Stricture Self-Retaining G. Pezzar E,F. Malecot Long-term H. 2-Way Foley I. 3-way Foley

Indications

Diagnosis
‡ ‡ ‡ ‡ ‡ Urine collection (sterile specimen) Post void residual (PVR) Instillation of contrast Cystogram, VCUG, RUG) Urodynamics (quantitative pressure-volume-flow (quantitative pressure-volumestudies)

Indications
‡ Therapy
1. Relief of obstruction Clots (3-way catheter) Strictures BPH Urethral inflammation 2. Monitor U/O 3. Management of neurogenic bladder 4. Stent an anastomosis in urethral or bladder surgery (i.e RRP)

Contraindications
‡ ‡ ‡ ‡ Pelvic Trauma Blood at meatus DREphigh riding prostate Perineal hematoma

Patient Prep & Technique
‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ STERILE TECHNIQUE- prep. & drape Standard Foley Catheter Kit Drape and sterile gloves Prep solution and applicator Surgi-lube jelly 16 Fr. Foley Catheter and collection bag 10 cc STERILE WATER Collection container

Catheterization

DEVICE FOR MEASURING & COLLECTING URINE

The stuff men are made of!

The stuff men are made of!

Patient Prep & Technique
‡ ‡ ‡ ‡ STERILE TECHNIQUE- prep. & drape Liberally lubricate catheter Female Urethral meatus is identified by spreading the labia ‡ Superior orifice ‡ Catheter is gently advanced until urine is seen ‡ Do not need to advance the catheter to hub

Patient Prep & Technique
‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ STERILE TECHNIQUE- prep. & drape Liberally lubricate catheter 2% lidocaine jelly Urojet Complex catheterizations Male Place penis on stretch perpendicular to body (without pressing urethra) Gentle advancement of catheter by holding cath at tip Point penis toward feet when slight resistance is first encountered (bulbomembranous urethra) ‡ Inflate balloon only when urine is noticed in catheter and catheter hub is at the urethral meatus

Complications
‡ ‡ ‡ ‡ Bleeding Infection False lumen Perforation

Difficult Catheterization
‡ BPH ‡ Coude Catheter ‡ If meeting resistance, ALWAYS go up in size (i.e 18 Fr Coude) ‡ Pushes lateral lobes of the prostate out of the way ‡ Use Urojet ‡ Stricture (Urethral or Meatal) ‡ Decrease size of catheter ‡ Silicon Catheter

Difficult Catheterization

‡ ‡ ‡ ‡ ‡ ‡

Urology Consult Councill tip catheter Filiform- followers Heyman Dilators Cystoscopy Suprapubic cystostomy

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