Cath & Surgery

Catheterization Routes

  • Urethral Catheterization

    • Most common route.

    • Catheter inserted through external meatus into the urethra, past internal sphincter, into the bladder.

  • Ureteral Catheterization

    • Involves direct access to the ureters.

  • Suprapubic Catheterization

    • Involves surgical placement above the pubic bone.

  • Nephrostomy Tube

    • Used for drainage directly from the kidney.

Self-Retaining Ureteral Catheter

  • Inserted post-lithotripsy or in case of ureteral obstruction.

  • Can be short or long term.

  • Replaced every 3 to 6 months for long-term use.

  • Double-J Catheter: One end coils in the kidney pelvis, the other in the bladder, allowing ambulation.

  • Care: Avoid dislodgement; notify HCP if output decreases.

    • Insertion can be done via cystoscopy or surgically through the abdomen.

Ureteral Catheter Uses

  • Used during surgery or post-surgery to prevent obstruction from edema.

  • Known as a ureteral stent, placed in the renal pelvis.

Suprapubic Catheterization

  • Oldest urinary diversion method.

  • Inserted via an open or percutaneous approach.

  • Uses include:

    • Acute urinary retention

    • Urethral trauma

    • Long-term diversion needs

    • Complicated UTI management

  • Change catheters at least monthly.

Catheter Insertion Techniques

  • Under general anesthesia or local anesthetic at the bedside.

  • Can be sutured to prevent dislodgement and secured with tape.

Patient Education

  • Stay hydrated and learn to monitor for:

    • Infection signs

    • Obstruction or kinking

    • Leakage around catheter

  • Catheter care: Important for avoiding infections and ensuring functionality.

Suprapubic Catheter Challenges

  • May face poor drainage due to mechanical obstruction.

  • Ensure tube patency by coiling excess tubing and gravity drainage.

    • Have the patient turn or “milk” the tube for maintenance.

Intermittent Catheterization

  • Alternative to indwelling catheters.

  • Focuses on preventing urinary retention and stasis.

  • Used for conditions like neurogenic bladder dysfunction.

  • Common barriers include:

    • Obesity

    • Patient reluctance

    • Discomfort from catheterization

    • Urinary obstruction or limited mobility.

Intermittent Catheterization Technique

  • Insert catheter every 4 to 6 hours; may start upon waking and before bed.

  • Varies in technique and usage:

    • Sterile (single-use) vs. clean (multiple-use).

    • Promote comfort and minimize trauma with lubrication.

Clean Catheterization at Home

  • Proper home cleaning does not increase UTI risk.

  • Patrol for UTI signs; some may require prophylactic antibiotics.

  • Potential complications include urethritis and damage.

Preoperative Care for Renal Surgery

  • Ensure fluid intake and normal electrolyte levels.

  • Highlight position effects due to surgery impacting comfort post-op.

Postoperative Care Considerations

  • Monitor urine output carefully.

  • Assess respiratory status to support ventilation.

    • Encourage deep breathing and pain management for comfort.

  • Abdominal distention common due to surgery effects; manage fluid intake accordingly.

Urinary Diversion Procedures

  • Indicated for bladder cancers, neurogenic bladder, strictures, and chronic inflammation.

  • Types of Diversions:

    • Incontinent: Diversion needs external collection.

    • Continent: Includes internal pouches that the patient catheterizes.

    • Orthotopic: Create a new bladder using intestinal segments, allowing urethral voiding.

Patient Teaching for Cystectomy

  • Assess readiness to learn and provide information to ease anxiety.

  • Engage family members in teaching.

  • Discuss psychosocial impacts:

    • Clothing options

    • Body image changes and sexual activity concerns

  • Counsel patients on post-operative life and manage issues with WOCN support.