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Urology (Catheterisation (Mx of Non-draining catheter (Bypassing catheter:…

- - - - Measure urine output
      - Sterile urine sample
      - Renal tract imaging
    - - Urinary retention
      - Immobile patients
      - Bladder irrigation
      - Intermittent decompression of neuropathic bladder
  - - - One port for drainage and one to fill the distal balloon c¯
        sterile water.
      - Distal balloon sits in the bladder and prevents
        displacement of the catheter.
      - Material
        
        Usually latex
        
        Silastic better for long-term placement
        ↓ blockage and ↓ infection
    - - Consent and explain the procedure to the patient.
      - Use smallest diameter possible to achieve adequate
        drainage
        
        French = circumference of catheter in mm
        
        Male: 16-18F
        
        Female: 12-14F
      - Clean perineal area
      - Use ANTT and insert the catheter c¯ the aid of instilagel
      - Ensure that urine is draining before inflating the balloon
        (10ml of water)
      - Replace foreskin to prevent paraphimosis
      - May give a STAT dose of Gentamicin IV to prevent
        transient bacteraemia.
    - - Early
        
        Creation of false tract
        
        Urethral rupture
        
        Paraphimosis
        
        Haematuria
      - Delayed
        
        Infection
        
        Blockage
    - - Urethral trauma
        
        Blood @ urethral meatus
        
        High-riding prostate
        
        Scrotal haematoma
        
        Pelvic fracture
  - - - Refractory skin breakdown
      - Palliative care
      - Pt. preference
  - - - Chronic retention
      - Neuropathic bladder
        
        MS
        
        DM neuropathy
        
        Spinal trauma
- - - - Analgesia
      - Privacy
      - Walking
      - Running water or hot bath
    - - Use correct catheter: e.g. 3-way if clots
      - STAT gent cover
      - Hrly UO + replace: post-obstruction diuresis
      - Tamsulosin: ↓ risk of recatheterisation after retention
      - TWOC after 24-72h
        
        May d/c and f/up in OPD
        
        More likely to be successful if predisposing factor and lower residual volume (<1L)
    - - Failed TWOC
      - Impaired renal function
      - Elective
- - - - Balloon inflation
      - Drainage (middle)
      - Irrigation