MAX FIC pt 2 Flashcards
Methods for Urethral Unblocking
- Retrograde urethral catheterization
- Retrograde urethral hydropulsion
- Antegrade or voiding urohydropropulsion
- Percutaneous antegrade urethral catheterization
- Surgical antegrade urethral catheterisation
Methods for Urethral Unblocking
- Retrograde urethral catheterization: when do we use this?
- First approach
- Most urethral obstruction secondary to urethral spasm or proteinaceous plugs
Methods for Urethral Unblocking
* Retrograde urethral hydropulsion: when do we use this?
- If urethroliths or clots
- To expel the stone back in the bladder
Methods for Urethral Unblocking
* Antegrade or voiding urohydropropulsion: when to use
- If urethroliths are small or in female cats or male cats with urethrostomy
Methods for Urethral Unblocking
* Percutaneous antegrade urethral catheterization OR Surgical antegrade urethral catheterisation: when to use
- If urinary catheter cannot be placed, or stones cannot be expelled →referral
Urinary Catheter for Unblocking Cats
- how to select a catheter
- Non traumatic
- Open ended
- 14cm long
- Remove the stylet if applicable
- 3.5Fr (less recurrence of obstruction? vs 5Fr)
- Adjustable for bigger cats
- In some cases: very small catheter (lacrimal catheter)
how to prep for feline urinary catheter placement
1.Selecting a catheter
2.Gloves for person handling catheter
3.Clip + wash area with chlorhexidine soap
4.Assistant pull penis straight back in caudal direction
> Penile urethra is parallel to spine) to reduce the curvature of the urethra
Size of catheters for feline urinary catheter, why
- 5F
- Decrease risk of kinking or luminal obstruction from clots,
debris.. - Less likely to urinate around
- But larger so possibly more irritating
- Increased risk of reobstruction when compared to smaller catheter (19% vs 6.7%)
- 3.5Fr first choice according to study….
Urinary Catheter for Unblocking Cats
- how to place, when to change, care
- what to do when unblocking
- Advance lubricated catheter, small flushes of saline when resistance is felt
- Often using a separate catheter once unblocked, if leaving catheter system in place.
- Daily catheter care (cleaning perineal region, wiping down the catheter tubing)
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When unblocking: while holding the prepuce and penis – direct it caudally and somewhat dorsally while advancing the catheter – straighten out the urethra to facilitate catheter passage!
Retrograde Urethral Hydropulsion
- technique
insert catheter, put funger per rectum behind stone
- inject water, wait for it to build up, then release finger
Bladder Flush or not?? for block
- Sterile saline flush to remove residual debris
- Removing plasma proteins, inflammatory cytokines, cellular debris,
blood clots and crystals - +/- repeated until the returning fluid is clear
- No strong evidence of better prognosis or shorter hospitalisation time
Obstructed Cat
Catheter left in place or not?
Indicated if
* severe azotemia
* abundant debris and hemorrhagic urine
* detrusor atony
* obstructive calculi
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Cons
* irritating to the urethra and potentiate urethral spasms
and reobstructions once removed
* Predisposition to infection
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Tips
* Secure catheter to perineum
Obstructed cat
When to Remove the U Catheter?
- Criteria to consider: resolution of bioch abnormalities, postobstructive diuresis, color of urine (clear vs hemorrhagic)
- If easy placed, with no resistance and no evidence of remaining obstruction
> Remove catheter after lavaging the bladder
> Monitor patient (pass urine?)
> Incontinence pads weighed = surrogate marker for urine production - Remove U catheter when urine clear
> But may stay discolored because of inflammation secondary to ucatheter
> Usually able to remove catheter within 12 hours to 3 days after placement - Note: reobstructions more common within 7 days after
Obstructed cat:
Less expensive alternative
But risky so alternative to euthanasia…
Decompressive cysto
* Acepromazine, buprenorphine
* Decompressive cystocentesis every 8 hours
* Low stress environment
* Risk: uroabdomen
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Temporary catheterization
* Flush bladder and relieve obstruction
* Pain medication
* Risk: possible damage or irritation of urethra, contributes to urethral spasm and reobstruction
obstructed cat patient monitoring, how to adjust IV fluids
Monitoring of fluid balance (post obstructive diuresis)
* Hydration status
* Packed cell volume, total solids, azotemia, electrolytes
* Weighing patient every 8-12hours
* Recording ins (ie, voluntary intake, wet food and IV fluids, including any infusions)
* Recording outs (ie, urine production, vomit, diarrhea)
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IV fluid rate tailored to match that of the urine output
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Once the ins are matching the outs, rate of IV fluids can be reduced
