Urinary Catheterization

Definition

Urinary catheterization is the insertion of a catheter into a patient's bladder. The catheter is used as a conduit to drain urine from the bladder into an attached bag or container.

Purpose

Urinary catheterization is employed in hospital and nursing home settings to maintain urine output in patients who are undergoing surgery, or who are confined to the bed and physically unable to use a bedpan. Critically ill patients who require strict monitoring of urinary output are also frequently catheterized.

Intermittent insertion of a urinary catheter is a treatment option for patients with certain types of urinary incontinence. Patients who are unable to completely empty the bladder during urination (urinary retention), or patients who have a bladder obstruction, may also require intermittent urinary catheterization. Disabled individuals with neurological disorders that cause paralysis or a loss of sensation in the perineal area may also use regular intermittent catheter insertion to void their bladders.

Precautions

Because urinary catheterization carries a risk of causing urinary tract infection (UTI), precautions should be used to keep the catheter clean and free of bacteria. Patients requiring intermittent catheterization should be well trained in the technique by a qualified health care professional.

Description

Intermittent catheterization is performed a minimum of four times a day by the patient or a care giver. The genital area near the urethral opening is wiped with an antiseptic agent, such as iodine. A lubricant may be used to facilitate the entry of the catheter into the urethra, and a topical local anesthetic may be applied to numb the urethral opening during the procedure. One end of the catheter is placed in a container, and the other end is inserted into and guided up the urethra until urine flow begins. When urine flow stops, the catheter may be moved or rotated, or the patient may change positions to ensure that all urine has emptied from the bladder. The catheter is then withdrawn, cleaned, and sterilized for the next use. Recommended cleaning practices vary, from the use of soap and water to submersion in boiling water or a disinfectant solution. Some patients prefer to use a new catheter with each insertion.

Nonintermittent catheterization, which is initiated in a hospital or nursing home setting, uses the same basic technique for insertion of the urinary tract catheter. The catheter is inserted by a nurse or other health care professional, and remains in the patient until bladder function can be maintained independently. When the catheter is removed, patients will experience a pulling sensation and may feel some minor discomfort. If the catheter is required for an extended period of time, a long-term, indwelling catheter, such as a Foley catheter, is used. To prevent infection, it should be regularly exchanged for a new catheter every three to six weeks.

Use of indwelling catheters should be restricted to patients whose incontinence is caused by urinary tract obstruction that can not be treated, and for which alternative therapy is not feasible.

Preparation

If a patient wishes to perform intermittent catheterization himself, training in the technique by a qualified health care professional is required. Basic instruction in the anatomy, antiseptic techniques, catheter insertion, and proper catheter care should be provided. Patients learning chronic intermittent urinary catheterization may also benefit from an ultrasound examination to verify that they are completely emptying their bladder during the procedure.

Aftercare

Patients using intermittent catheterization as a treatment for incontinence will experience a period of adjustment as they try to establish a catheterization schedule that is adequate for their normal level of fluid intake.

Antibiotics may be prescribed as a preventative measure in long-term urinary catheterization patients who are at risk for urinary tract infection.

A patient with an indwelling catheter must be reassessed periodically to determine whether alternative treatment may be more effective in treating the problem.

Risks

Trauma to the urethra and/or bladder may result from incorrect insertion of the catheter. Repeated irritation to the urethra during catheter insertion may cause scarring and/or stricture, or narrowing, of the urethra. The catheter may introduce bacteria into the urethra and bladder, resulting in urinary tract infection. UTI can cause fever and inflammation of the bladder and urethra. Patients who practice intermittent catheterization can reduce their risks for UTI by using antiseptic techniques for insertion and catheter care.

Normal results

When used correctly, catheterization facilitates complete voiding of the bladder.

Resources

PERIODICALS

Hunt, Gillian M., Pippa Oakeshott, and Robert Whitaker. "Intermittent Catheterization: Simple, Safe, and Effective but Underused." British Medical Journal 312, no. 7023 (Jan. 1996): 103-7.

KEY TERMS

Bladder obstruction— A blockage of the bladder caused by the presence of calculi (e.g., mineral deposits) or an anatomic abnormality.

Catheter— A long, thin, flexible tube.

Foley catheter— A two-channel catheter with a balloon on the bladder end of one channel. Once inflated, the balloon keeps the catheter securely in the bladder. The other channel of the catheter facilitates the flow of urine out of the bladder.

Local anesthetic— Medication applied topically to the skin or administered through an injection that deadens a specific part of the body and inhibits the sensation of pain.

Perineal area— The genital area between the vulva and anus in a woman, and between the scrotum and anus in a man.

Ultrasound examination— A diagnostic test that uses sound waves to generate a picture of an organ or organ system.

Urinary incontinence— The inability to control one's urine flow.

bladder The bladder is a storage vessel for urine and is lined by a special waterproof skin called transitional cell epithelium. There is a similar lining in the ureters (the tubes from each kidney to the bladder) and urethra (the tube from the bladder to the outside). The bladder is enveloped in a criss-cross of muscle fibres, the detrusor muscle. As the bladder fills, these muscle fibres relax in such a way that the pressure within the bladder remains constant at less than 10 cm of water. The normal adult bladder holds approximately 400 ml of urine and when more than this amount has entered the bladder the pressure starts to rise and the desire to void urine is felt. If this cannot be conveniently done and bladder filling continues the feeling becomes very urgent and eventually uncontrollable. Normally, adults are able to hold on after the first feeling of urgency, but children find this more difficult and in babies the bladder empties automatically. The nerves controlling the bladder belong to the autonomic nervous system and, although such nerves usually function automatically, the bladder is a special situation where voluntary control is superimposed on autonomic. Babies have to learn to control the automatic bladder (potty training) and this is usually achieved by the age of 5 years but may take longer, particularly in boys, and also in some families. Failure to override fully the autonomic nerves to the bladder results in urinary frequency and the need to void urine at night, or bedwetting (enuresis). Most children eventually become dry at night but if problems continue beyond the normal age when potty training should be complete then it is important to exclude other problems such as urinary tract infections.

In adults there are two main causes of incontinence: either weakness of the pelvic floor and sphincter muscles (which act normally to prevent passage of urine into the urethra) or over-activity of the detrusor muscle, so that the bladder behaves rather like that of a baby (this latter problem is called instability). Difficulties in controlling the bladder can also occur in older age, and the number of elderly people with continence problems is a major burden on social services. In this group of people it is important to exclude other causes of incontinence such as cancer, infection, or stones in the bladder. With proper medical, nursing, and physiotherapy measures, many elderly people with problems of incontinence can be helped.

Tim Hargreave

urinary bladder muscular sac located in the pelvis that stores urine and contracts to expel it from the body. Urine enters the bladder from the kidneys through the ureters and is discharged from the body via the urethra . The bladder of the adult human can hold over a pint (0.6 liters) of urine. When the level of urine reaches about half this amount, pressure of the accumulating fluid stimulates nervous impulses that relax the external sphincter, a muscle that forms a dense band around the urethra at the base of the bladder. This muscle can be controlled voluntarily in most mammals. The muscles in the wall of the bladder also contract, forcing urine out through the urethra. The bladder is subject to infection (commonly called cystitis ) and the formation of stones. Its normal function may also be affected by nervous disorders or by external pressure, as from prostatic enlargement or pregnancy. See urinary system .

bladder
1. (in anatomy)
a. A hollow muscular organ in most vertebrates, also known as the urinary bladder, in which urine is stored before being discharged. In mammals urine is conveyed from the kidneys to the bladder by the ureters and is discharged to the outside through the urethra.

b. Any of various other saclike organs in animals for the storage of liquid or gas. See gall bladder; swim bladder.


2. (in botany)
a. A modified submerged leaf of certain aquatic insectivorous plants, such as the bladderwort (Utricularia). It forms a hollow with a single opening that is sealed by a valve to trap small aquatic invertebrates after they have been sucked in.

b. An air-filled cavity in the thallus of certain seaweeds, such as the bladderwrack (Fucus vesiculosus).

bladder A bag, formed from plant tissue, in which metabolic products, or air, may be stored. In some plants, e.g. Fucus vesiculosus (wrack), air held in bladders causes parts of the plant to float. In others, e.g. Utricularia species (bladder-worts), bladders borne on the leaves are traps that can be expanded rapidly in response to the stimulation of a trigger hair, drawing in small aquatic animals which are then digested.

bladder Large, elastic-walled organ in the lower abdomen in which urine is stored. Urine passes from each kidney by way of two narrow tubes (ureters) to the bladder, where it is stored until it can be voided. When pressure in the bladder becomes too great, nervous impulses signal the need for emptying. Urine leaves the bladder through a tube called the urethra.

u·ri·nar·y / ˈyoŏrəˌnerē/ • adj. of or relating to urine. ∎  of, relating to, or denoting the system of organs, structures, and ducts by which urine is produced and discharged, in mammals comprising the kidneys, ureters, bladder, and urethra.

bladder (blad-er) n.
1. (urinary bladder) a sac-shaped organ that has a wall of smooth muscle and stores the urine produced by the kidneys. b. neck incision see incision. b. outflow obstruction see BOO.

2. any of several other hollow organs containing fluid, such as the gall bladder.

blad·der / ˈbladər/ • n. 1. a membranous sac in humans and other animals, in which urine is collected for excretion. 2. anything inflated and hollow: an air bladder in the arch and collar of the shoe.

bladder OE. blǣdara, later blæddre = OS. blādara, OHG. blātara (G. blatter), ON. blaðra :- Gmc. *blǣ- BLOW1 + *-dro-, instr. suffix corr. to L. -trum, Gr. -trā, -tron, Skr. -tram.

bladder A bag in which metabolic products, or air, may be stored.

urinary bladder (yoor-in-er-i) n. see bladder.

bladder •adder, bladder, khaddar, ladder, madder •Esmeralda, Valda •scaffolder • lambda •Amanda, Aranda, Baganda, Banda, brander, candour (US candor), coriander, dander, expander, gander, germander, goosander, jacaranda, Leander, Luanda, Lysander, meander, memoranda, Menander, Miranda, oleander, panda, pander, philander, propaganda, Rwanda, sander, Skanda, stander, Uganda, understander, Vanda, veranda, withstander, zander •backhander • Laplander • stepladder •inlander • outlander • Netherlander •overlander • gerrymander •pomander •calamander, salamander •bystander •ardour (US ardor), armada, Bader, cadre, carder, cicada, Dalriada, enchilada, Garda, gelada, Granada, Haggadah, Hamada, intifada, lambada, larder, Masada, Nevada, panada, piña colada, pousada, promenader, retarder, Scheherazade, Theravada, Torquemada, tostada •Alexander, commander, demander, Lahnda, slander •Pravda • autostrada

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pulsatory, purificatory, reificatory, revelatory, rotatory •natatory • elucidatory • castigatory •mitigatory • justificatory •imprecatory • equivocatory •flagellatory • execratory • innovatory •eatery, excretory •glittery, jittery, skittery, twittery •benedictory, contradictory, maledictory, valedictory, victory •printery, splintery •consistory, history, mystery •presbytery •inhibitory, prohibitory •hereditary • auditory • budgetary •military, paramilitary •solitary • cemetery • limitary •vomitory • dormitory • fumitory •interplanetary, planetary, sanitary •primogenitary • dignitary •admonitory, monitory •unitary • monetary • territory •secretary • undersecretary •plebiscitary • repository • baptistery •transitory •depositary, depository, expository, suppository •niterie •Godwottery, lottery, pottery, tottery •bottomry • watery • psaltery •coterie, notary, protonotary, rotary, votary •upholstery •bijouterie, charcuterie, circumlocutory •persecutory • statutory • salutary •executory •contributory, retributory, tributary •interlocutory •buttery, fluttery •introductory • adultery • effrontery •perfunctory • blustery • mediatory •retaliatory • conciliatory • expiatory •denunciatory, renunciatory •appreciatory, depreciatory •initiatory, propitiatory •dietary, proprietary •extenuatory •mandatary, mandatory •predatory • sedentary • laudatory •prefatory • offertory • negatory •obligatory •derogatory, interrogatory, supererogatory •nugatory •expurgatory, objurgatory, purgatory •precatory •explicatory, indicatory, vindicatory •confiscatory, piscatory •dedicatory • judicatory •qualificatory • pacificatory •supplicatory •communicatory, excommunicatory •masticatory • prognosticatory •invocatory • obfuscatory •revocatory • charlatanry •depilatory, dilatory, oscillatory •assimilatory • consolatory •voluntary • emasculatory •ejaculatory •ambulatory, circumambulatory, perambulatory •regulatory •articulatory, gesticulatory •manipulatory • copulatory •expostulatory • circulatory •amatory, declamatory, defamatory, exclamatory, inflammatory, proclamatory •crematory • segmentary •lachrymatory •commentary, promontory •informatory, reformatory •momentary •affirmatory, confirmatory •explanatory • damnatory •condemnatory •cosignatory, signatory •combinatory •discriminatory, eliminatory, incriminatory, recriminatory •comminatory • exterminatory •hallucinatory • procrastinatory •monastery • repertory •emancipatory • anticipatory •exculpatory, inculpatory •declaratory, preparatory •respiratory • perspiratory •vibratory •migratory, transmigratory •exploratory, laboratory, oratory •inauguratory • adjuratory •corroboratory • reverberatory •refrigeratory • compensatory •desultory • dysentery •exhortatory, hortatory •salutatory • gustatory • lavatory •inventory •conservatory, observatory •improvisatory •accusatory, excusatory •lathery •feathery, heathery, leathery •dithery, slithery •carvery •reverie, severy •Avery, bravery, knavery, quavery, Savery, savory, savoury, slavery, wavery •thievery •livery, quivery, shivery •silvery •ivory, salivary •ovary •discovery, recovery •servery • equerry • reliquary •antiquary • cassowary • stipendiary •colliery • pecuniary • chinoiserie •misery • wizardry • citizenry •advisory, provisory, revisory, supervisory •causerie, rosary