Urinary Catheterization

Indications

• Sterile urine sampling

• Unblocking obstructions

• Prevent exposure to noxious/infectious agents

• Monitor urine production for in-patients

• Patient comfort

• Prevent atony (over-distension)

Indications - Sterile Urine sample

• convenience

• urine culture

• urinalysis

Indications - unblocking obsturctions

• Mucus plugs

• Neoplasia

• Calculi

Indications - Prevent exposure to noxious/infectious agents

• Chemotherapy

• Leptospirosis (zoonotic)

Indications - Monitor urine production for in-patients

• Urethral obstuction

• Determine hydration status

• AKI

Indications - Patient comfort

• Orthopedic surgery

• IVDD

Indications - Prevent atony(over-distension)

• Prevents overflow

• Less likely to have urine scald

Types of Catheters

• Foley

• Red rubber

• Slippery sam

• Tomcat

Foley catheter

• Most common in dogs for indwelling use

• sterile procedure

• Not used in cats

• Takes 3 people

• TEST before placement!

  • balloon keeps catheter in place

• Rigid to place, soft in body

• Various sizes and lengths

Red rubber catheter

• Most common in cats

• REQUIRES suturing in cats

• Sterile samples and intermittent emptying bladder in dogs

• Simple procedure (2 ways)

• Takes at least 2 people

• flexible

• various sizes and lengths

Slippery-sam Catheter

• ONLY CATS

• Rigid

• Non-pliable

• Requires securing

• Can be uncomfortable

• Typically narrow diameter

• Urethral tears

Tomcat catheter

• ONLY CATS

• flexible

• Requires securing

• More comfortable than Slipper-sam

• Narrow diameter

Catheter sizing

• Sized by “French”

• Red rubber sizes

  • 16”

  • 22” (only 8 fr.)

• Mila foley

  • 60-90cm

Sizing by “French”

• Works opposite of IVC sizes

• so, Larger number = larger bore

• vs. an IVC which is bigger number, smaller bore

Supplies

• Chlorhexidine solution

• Sterile catheter, gloves, and lube

• Collection device

  • Syringe or collection bag

• Culture tube

• Assistance

• ± vaginal speculum

• ± sedation

• E-Collar!!

Closed System

• Extension sets!

• Christmas tree

• Collection bag

Never do with collection bag

• hold is above the patient without it being clamped!!

  • urine can go back into the patient from the bag

Male cat anatomy

• Penis angled ventrally

• Need to pull caudally and dorsally to straighten urethra

• Limited space to work with

• Patient in dorsal recumbency

Procedure for Male cat catheterization

• Sedate patient if safe to do so

• Push penis caudally, pull prepuce cranially

• Pinch base of prepuce to expose penis

• Wash with antiseptic and saline

• Lube and insert catheter (STERILE)

• advance catheter slowly until urine flows

• DO NOT FORCE THE CATHETER IN!

• Check placement

Securing catheter in place for male cats

• Various techniques

• Typically require suture in cats

• Important to decrease tension

• Tail tape

Male dog anatomy

• Curved angle

• Catheter must make it around pelvic flexure

• Will feel catheter as it passes

Positioning and Prep for Male dog

• Needs to be in lateral recumbency

• ± sedation

  • based on patient attitude, pain level, behavior

  • Most do will without

• Gently bring the prepuce caudally, exposing the penis

• Clean with chlorhexidine solution

What do we not clean the penis with

ALCOHOL

Male dog catheterization procedure

• Pre-measure length of catheter

• If using Foley, fill balloon with saline to check for leaks. Deflate before placement

• Flush the catheter and agitate wire

  • lube in catheter

• Lube on catheter

• Pass catheter gently until urine flowing

• obtain sample or attach collection system

Sliding Flap Technique

• Used to obtain sterile sample

• Not indwelling

• Used when cystocentesis not feasible

• Very common

Sliding Flap technique procedure

• Obtain supplies

  • Lube, red rubber, exam gloves, scissors

• Have assistant extrude penis

• Cut a piece of catheter wrap from 1.3-3” in both sides, but leave in place to keep catheter clean. This is the flap

• Push ONLY catheter tip out of the package

• Apply sterile lube

• Using just the flap, advance the catheter gently until urine flows

• Once sample is obtained, pinch catheter and remove

• NO PAPER CUTS

Female Dog anatomy

• Two cavities

  • Caudal: vestibule

  • Cranial: vagina

• Urethral opening is on ventral vestibule floor

• Vestibular-vaginal junction feels like a round thickening that narrows

Female Dog positioning and prep

• MUST be sedated unless unstable

• Sternal or lateral recumbency

• Clip/clean perivulvar region

• Flush vestibule (vaginal vault) with dilute chlorhex

Female Dog catheterization procedure

• STERILE GLOVES

• Lube sterile finger and catheter

• Slide finger dorsally and along the vestibule

• Cover opening of vagina with finger

• Insert catheter ventrally under finger

• Insert catheter ventrally under finger and push on ventral floor of vestibule

• Catheter should enter ureteral orifice

• Speculum can be used to visualize anatomy