Retention, Trauma , Catherization and Dialysis Flashcards
Urinary Retention:
the inability to voluntarily void urine
Categories of Urinary Retention:
- Obstructive
- Infectious & Inflammatory
- Pharmacologic
- Neurologic
- Other
Causes of Urinary Retention
Obstructive:
- Benign prostatic hyperplasia
- Strictures
- Bladder calculi
- Faecal Impaction
- Phimosis
- Benign/malignant pelvic masses
Causes of urinary retention obstructive:
Organ prolapse eg: cystocele, rectocele, uterine prolapse
• Pelvic mass – gynaecological malignancy
• Uterine fibroid / ovarian cyst
• Retroverted impacted gravid uterus
• Foreign bodies
Infectious and Inflammatory
Causes:
- Prostatitis
- Prostatic abscess
- Balanitis
- Cystitis
- Acute vulvovaginitis
- Herpes simplex virus
Pharmacologic causes
• Drugs with anticholinergic properties eg: tricylic antidepressants (amitriptyline) • Opioids • Sympathomimetic drugs eg: oral decongestants with Ephedrine ( Sudafed) • NSAIDs • Antiparkinsonian agents (levodopa) • Antipsychotics (chlorpromazine) • Muscle relaxants (Baclofen)
Neurologic cause
AUTONOMIC OR PERIPHERAL NERVE
• Diabetes mellitus, Guillain-Barre syndrome Pernicious anaemia, radical pelvic surgery
CNS
• CVA, MS, Tumour, Parkinson’s disease, concussion
SPINAL CORD
• Haematoma / abscess / tumour, Cauda equine, spina
bifida
Other causes
- Post-op complications
- Pregnancy- associated retention
- Trauma eg: penile fracture or laceration
- detrusor muscle failure
Presentation of acute urinary retention:
- Sudden inability to pass urine
- Suprapubic pain which typically causes spasm
- Patient is acutely distressed
- Often longer history of bladder outflow symptoms
- Bladder is visible, tender and palpable
- Patient is typically male
Chronic Retention of Urine:
- Completely different – maybe painless
- Incomplete emptying
- Large bladder, uraemic,anaemic, fluid overloaded ?
- Large residual volume
- Bladder drainage may cause haematuria
Management can include urethral
catheterisation
• Check for sepsis prior to catheterisation
• Ensure correct catheter selection
• Always use an aseptic procedure
• Never force catheter against resistance
• Never inflate balloon in urethra
• Always record details and residual
volume
Renal trauma
- Renal Trauma
- Ureter Trauma
- Bladder Trauma
- Urethral Trauma
- External Genitalia Trauma
Renal Trauma - mechanism:
- Blunt Trauma (90%)
- MVA, falls
- May cause contusion, laceration, avulsion
- Usually conservative treatment
Renal Trauma - Mechanism:
- Penetrating Trauma (10%)
- “Blast effect” - radiating current of energy
- Adjacent tissue necrosis
- Often are associated injuries
- Selective observation vs operative treatment
Renal Trauma:
Clinical Clues, Signs and Symptoms
- Hematuria **
- Flank Pain**
- Sudden deceleration/fall
- Flank bruising•
- Broken ribs (11th and 12th)
- Lower chest/upper abdomen trauma
American Association of Trauma
Surgery:
- Grade I - Contusion (normal imaging); subcapsular hematoma
- Grade II – Non -expanding perirenal hematoma; <1cm cortical laceration
- Grade III - >1cm cortical laceration (no collecting system injury)
- Grade IV - > 1cm laceration extending into medulla and collecting system; Artery or vein injury (controlled hemorrhage)
- Grade V - Completely shattered kidney; Hilar avulsion (devascularized kidney)
Renal Trauma - Summary
Found in ~ 10% of abdominal trauma
• Hematuria is the cardinal symptom
• 90% blunt
• Greatest determinant of mortality is severity of concurrent injuries
• Accurate staging (CT) is very important
Urinary Catheters:
CATHETER - A TUBE USED TO DRAIN OR INJECT FLUID THROUGH A BODY OPENING • INSERTED THROUGH THE URETHRA, INTO THE BLADDER TO DRAIN THE URINE. • CAN BE TEMPORARY OR LEFT IN PLACE • A BALLON IS INFLATED TO HOLD THE CATHETER IN PLA
patients who need a urinary catheter?
- TOO WEAK
- DISABLED
- POST SURGICAL
- PROTECT WOUNDS OR PRESSURE ULCERS
- FREQUENT URINARY MEASUREMENTS
Catheter Care:
• THE CATHETER SITE WILL NEED REGULAR CLEANING TO PREVENT INFECTION • WEAR GLOVES AND FOLLOW STANDARD PRECAUTIONS • CLEAN FROM THE MEATUS DOWN THE CATHETER • USE A DIFFERENT PART OF THE WASHCLOTH OR A CLEAN WIPE FOR EACH STROKE
Peritoneal dialysis (PD):
- Instillation of dialysis fluids into the peritoneal space via a surgically-inserted catheter
- Most catheters are silicone
- Fluid is removed to take out toxins
- Most common types include:
- Chronic ambulatory
- Continuous cyclical
- Chronic intermittent
Potential Adverse Events:
- Peritonitis
- Due to contamination at time of exchange or infection of the exit site
- Loss of access site
- Due to infection and fibrosis
- Death
- If sepsis develops
Haemodialysis (HD)
- Dialysis machine and a dialyser clean the blood
- Blood and dialysis fluids do not mix
- Can take up to 3- 6 hours
- Usually 3 times per week
- Either inpatient or outpatient by trained staff
Central catheter?
- For short term access use for HD
* Standard catheter care procedures must be followed
Fistula?
- A surgically-created connection between an artery and vein (usually in the arm)
- Accessed via for needle for HD
Vascular graft?
- Intermediate risk of infection
- A surgically placed artificial tube between a vein and artery (usually in the arm).
- Accessed via needle for HD
Dialysate:
A balanced electrolyte solution on one side of the semi-permeable membrane to exchange solutes with blood during HD
• Dialysis water
• Purified water that is used to:
• mix dialysate
• to disinfect, rinse, or reprocess the
dialyser
Dialyser:
• Part of the HD machine • Two sections separated by a membrane • Patient’s blood flows through one side and dialysate flows through the other
