5B. Urine Catheterization

Question 1

What is catheterization?

Answer 1

insertion of a urinary catheter into the bladder via the urethra to remove urine
Avoid unnecessary catheterization or force when doing the procedure

Question 2

What is the advantages of catheterization?

Answer 2

less contamination then micurition
collect it when you need it
allows for continuous emptying of bladder - in event patient cannot relieve themselves

Question 3

What are the disadvantages of catheterization

Answer 3

requires two or more people (one whom must be well trained) or heavy sedation/anesthesia
May see cell clumping and increased RBC’s
May cause trauma to the urinary tract
high risk of iatrogenic urinary tract infection

Question 4

What can catheterization also be used for?

Answer 4

to instil contrast media for rads
to administer certain meds
to prevent contam of surgical site (like nephrectomy or cystotomy)
to facilitate surgical repair of the urethra or surrounding tissues
monitoring urine output
renal funct tests
relieve structural or functional obstruction

Question 5

WHat is a foley catheter?

Answer 5

A Foley catheter (has a wire stylette inside a soft tubing –
causes little injury to the urinary tract system) is used to
put air into the bladder as a contrast on radiographs

Question 6

What are some special considerations with urinary catheterization?

Answer 6

hematuria often associated w/ catheterization is self-limiting but does predispose to tissue infection
Lower urinary tract has normal flora consisting of many gram - organisms and mycoplasma (always risk of infection no matter how well the technique is performed
Need to encourage patient to urinate after catheterization to flush bladder

Question 7

What equipment do we need for catheterization?

Answer 7

Sterile gloves, lubricant, urinary catheter, flush solution (0.9 saline), syringes, container for c/s
Trained personnel
female patients as speculum improves visualization of urethral oriface

Question 8

How are catheters measured

Answer 8

on the french scale
1Fr = 1/3 mm
3Fr catheter = 1mm diameter (appropriate size of cath)
DO NOT RE-USE
Easiest to purchase single-use cath
if sterilizing, often cold sterilization solution is used so MUST FLUCH THOROUGHLY W/ STERILE WATER - cold sterilizing solutions leave a residue that causes tissue damage

Question 9

What are the different types of urinary catheters?

Answer 9

tomcat catheters (open or closed ends, open typically used for unblocking) for cats and sm dogs
Polypropylene catheter
rubber cath
foley cath
stainless steel cath (females only)
olive-tipped metal cath (removing urethral blockage only)

Question 10

What type of cath is sutured into place after relieving obstructed urine flow, why?

Answer 10

Indwelling cath to allow for healing
needs to be non-traumatic - made of soft rubber such as a rubber feeding ube

Question 11

What are general procedure know-hows for catheterization?

Answer 11

varies btw species/gender
Depending on patient, may need sedation or GA
all req cleaning of external genitalia
use of sterile gloves and maintenance of a sterile field
you must make sure to maintain aspetic technique thruout procedure

Question 12

What is the procedure for male cat catheterization?

Answer 12

Often under sed/GA
1. prep all materials
2. Place cat in lat or dorsal
3. Don sterile gloves
4. Extrude penis
5. Wash end of penis w/ antiseptic soap and risk w/ sterile saline
6. Pull penis straight back causally (towards tail) to remove curvature of urethra and make passage easier
7. Lubricate cath tip w/ sterile lube
8. Always maintain sterility of cath
9. Insert cath tip into external urethral orifice and advance until urine flows
10. Attach a sterile 3ml syringe and gently aspirate 0.5-1ml urine, detach syringe, discard
11. Attach a sterile 5ml syringe and gently aspirate remainder of urine from bladder
12. Place urine for culture in a sterile container and perform tests on remainder of sample

Question 13

How do you extrude the penis?

Answer 13

push penis caudal and pull prepuce forward
maintain this position by gently pinching the prepuce at the base of the penis.
Make sure you are not obstructing the urethra with pressure of your fingers

Question 14

What are the 3 ways you could lubicate the catheter tip with sterile lube?

Answer 14

1. from sterile single use package, place on tip of catheter from package
2. From large tube and discard initial small amount of lube and then put directly on tip of cath without touching cath
3. Put lube on a sterile 3x3 guaze and wipe lubricant on end of cath

Question 15

What happens when you inster the cath tip into the external urethral orifice and there is resistance?

Answer 15

flush cath with sterile saline
Will alter test results and MUST be reported

Question 16

How is catheterization in females done?

Answer 16

rarely done
often difficult to find urethral orifice - especially if obese
cysto easier on all involves

Question 17

What are some things about catheterization to keep in mind with male dogs?

Answer 17

very easy and often done (without sedation most times)
Place in lateral recumbency ( can be placed in dorsal recumbency)
estimate length of catheter
hold cath above dog, measure from penile tip around the ischial arch to the likely bladder position, maintain sterility of the catheter

Question 18

What is the procedure for catheterization a male dog?

Answer 18

1. don sterile gloves
2. extrude penis
3. clean periurethral area w/ a mild antibacterial soap then rinse w/ sterile saline
4. Lubricate cath tip w/ sterile lubricant
5. maintain sterility of cath
6. Gently insert cath tip into the urethra and advance to point where urine flows freely (don’t go too for and don’t force it)
7. Attach sterile 3ml, aspirate 0.5-1ml urine, detatch and discard*
8. attach 5-10ml syringe, apsirate remainder of urine
9. place urine in for culture in sterile container and perform tests on remainder of sample

Question 19

What is the special anatomy of a female dogs?

Answer 19

external urethral orifice loc on ventral floor of caudal vagine - in mature sm and med sized dogs, 3-5cm cranial to vulvar opening (further internal to clitoral fossa)
Caudal portion of vagina is directed dorso-cranial (to spine/head) - make sure to direct cath near dorsal commissure of vulva to avoid sensitive clitoral fossa

Question 20

What are some general notes of female dog catheterization

Answer 20

usually performed w/ sedation
place dog in standing position if not sedated or in sternal recumbency w/ hind feet draped over edge of table
best done w/ use of speculum but can be performed without one

Question 21

What is the procedure for catheterization of a female dog?

Answer 21

1. clean perivulva skin and vulva w/ antiseptic solution and rinse w/ sterile saline
2. Don sterile gloves
3. Flush vagina and vestibule w/ sterile saline using sterile 5-10ml syringe
4. once passed thru vulva lips, insert speculum dorso-cranial (avoids clitoral fossa)
5. Spread speculum open to visualize the vestibule and vagina -
6. Identify urethral orifice
7. Lube tip of urinary catheter
8. Insert cath into urethral orifice and advance slowly into lumen of bladder
9. Attach sterile 3ml syringe and gently aspirate 0.5-1ml urine, detach, discard
10. Attach sterile 5-10ml syringe and gently aspirate remainder of urine from bladder
11. Place urine for culture in sterile container and perform tests on remainder of sample

Question 22

What is the blind digital technique?

Answer 22

generally used for lg dogs
first 6 steps same regardless of which technique is used

Question 23

What is the procedure of blind digital technique.

Answer 23

Same as all the others
1. lube index finger of non-dom hand w/ sterile lube
2. Insert index finger into vagina - may be able to palpate urethral orifice
3. lube tip of urinary cath
4. Gently insert cath thru dorsal commissure of vulva - avoid clitoral fossa
5. Guide the urinary cath under inserted index finger and along ventral floor into urethral orifice
6. Gently advance cath into lumen of bladder
7. Collect 0.5-1ml urine
8. Collect 5-10ml urine
9. place urine for culture and perform test

Question 24

How do we preserve samples?

Answer 24

urine considered unstable so look ASAPA (30-60 m)
Longer sits @ room temp, more ureases-prod bacteria proliferate so sample = more alkaline
Record whens ample collected and analyzed
refrige common short-form storage and preservation, can be used 6-12 hrs

Question 25

How do you preserve a sample for more than 6-12 hours?

Answer 25

1 drop of 40% formalin to 29.6ml of urine - must do chem analysis first
Toulene sufficient to form a layer on top
one thymol crystal
on part 5% phenol to nine parts urine
No single preservative agent is satisfactory for all routine U/A tests

Question 26

Why do we need to let urine warm to room temp?

Answer 26

too cool = USG increased, enzyme-based reactions dec, crystals form
abnormalities found on stored samples should be retested on fresh sample

Question 27

What is the closed collection system?

Answer 27

Cath will be sutured/anchored to patient once in place
Attach cath to sterile extension set
attach extension set to sterile drip/infusion set
attach drip set to sterile IV bag - air must be forced out of bage BEFORE attaching drip set - allows bag to work as vacuum
Ensure adequate amount of drip set is left inside kennel w/ patient - will allow them to move around w/o causing traction, drip set will need to be anchored to kennel wall or door in some fashion so it does not slide down
Collection bag is appropriately suspended below lvl of patient’s bladder, must not rest on floor
Bag can be marked appropriately to monitor collection/drainage

Question 28

How do we don sterile gloves via the open method?

Answer 28

Req for urinary catheterization
Choose and disinfect bench area - flat, away from drafts, and ample workspace
Make sure glove package free from tears, water marks, wet spots and not EXP
open outer packaging of gloves and discard it
place inner package on flat surface w/ cuff end towards you