Transcript Catheterisation History and indications for….

Catheterisation
History and indications
for….
Ellie Stewart
CNS Urogynaecology
Guys and St Thomas NHS Foundation
Trust
History of catheterisation….
The word ‘catheter’ comes from Greek
meaning to ‘let or send down’
 They were used as early as 3000 BC to
relieve urinary retention
 Catheters at that time were made of rolled
up palm leaves, hollow tops of onions,
gold, silver, copper and brass
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History continued…..
Latex rubber became available on 1930sand in 1935 Dr Frederic Foley introduced
the latex balloon catheter
 Charriere’s French scale was used to
describe the external diameter of a
catheter.
 After WW2 Sir Ludwig Guttman introduced
the concept of sterile intermittent
catheterisation
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What is catheterisation?
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Urinary catheterisation is the process by
which a tube (catheter) is inserted into the
bladder for the purposes of draining urine,
instilling irrigating fluids or drugs, or for
urodynamic investigations
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Royal Marsden Clinical Guidelines 2002
Indications for catheterisation
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Urinary retention:
– Acute- painful
– Chronic
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Caused by obstruction:
Bladder outlet obstruction
Stricture
First trimester pregnancy
Chronic constipation
Prolapse/ procidentia
Acute monitioring
Surgery: To monitor accurate urine output
post op
 To monitor output in acute conditions
 Urology surgery- TURP, TURBT, etc
 Urogynaecology surgery- TVT, prolpase
repair
 Empty bladder during labour
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Instillations
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BCG
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Mitomycin- chemotherapy
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Bladder irrigation post TURP, TURBT,
haematuria
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Drug therapy for interstitial cystitis etc
Investigations
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Urodynamics
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Obtain an uncontaminated urine specimen
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Monitor a post void residual in absence of
bladder scanner
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X-ray investigations
Atonic bladder
Atonic -no tone, unable to contract
 Neurogenic -damage to nervous system
making it under active or overactive
 Inability to empty bladder
 Symptoms- overflow incontinence,
recurrent UTIs
 Treatments: anticholinergics, ISC, bladder
augmentation
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Atonic/ Neurogenic bladder- causes
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Central nervous system (CNS):
– Cerebrovascular event.
– Spinal injury.
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Peripheral nervous system (PNS):
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Diabetes.
AIDS.
Alcohol.
Vitamin B12 deficiency neuropathies.
Herniated disc.
Damage due to pelvic surgery.
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Parkinson's disease.
Multiple sclerosis.
Syphilis.
Tumours.
Mixed CNS and PNS:
Incontinence and catheterisation
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It is not appropriate to catheterise a person who is incontinent
without first trying to identify the cause of the incontinence.
Catheters can:
Cause infections
Cause trauma
Decrease the person’s bladder functions
The decision to catheterise should be discussed with the multi
disciplinary team and the person if appropriate.
There are occasions when catheterisation is the correct course of
action, for example:
If all other options have been explored and incontinence remains a
problem
If the incontinence is affecting a person’s ability to participate in
rehabilitation
If the person’s skin is becoming damaged as a result of incontinence
Contraindications…….
Caution with bladder and prostate
cancers, strictures or very large prostates
 Incontinence- before pt has been
investigated and treated, if appropriate
consider SP catheterisation/ ISC
 Convenience!!!
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