What is Urinary Catheterization?

Urinary catheterization is the process of inserting a catheter into a person’s bladder through his or her urethra. Urinary catheters then act as the medium through which urine from the bladder collects in bag or a container attached to the catheter.

Urinary catheterization is performed for a variety of reasons—to maintain urine output in patients who are undergoing some surgical procedure, to monitor the output of urine in severely ill patients, and on bed-ridden patients who are unable to physically use the bedpan. In particular, urinary catheterization is done on patients suffering from chronic or acute urinary retention problems, benign prostatic hyperplasia, and other bladder and prostate conditions. Certain other medical conditions like dementia, multiple sclerosis, and injuries to the spinal cord also demand the use of urinary catheters on patients. They are also inserted on patients to inject them with liquids used for treating or diagnosing bladder conditions.   

Urinary catheters may be permanent (indwelling catheters) or temporary ones that are removed after every catheterization process. A Foley catheter is an indwelling type which sits in place with the aid of a balloon at the tip. The balloon contains sterilized water and is usually made of silicone or natural rubber. On the other hand, the Robinson catheter is a temporary or intermittent catheter that does not have a balloon at its tip and hence cannot stay in place.

Urinary catheterization is considered a sterile medical procedure and hence must be performed only by qualified medical professionals or care givers. Self-catheterization is also possible and is in fact, a viable option for patients who require intermittent catheterization. However, these patients must be thoroughly trained in the process by a qualified professional.

Urinary catheterization comes with the risk of patients developing urinary tract infection (UTI). So health care professionals and the patients themselves must ensure that the catheter is kept clean and absolutely free of bacteria at all times. In fact, health care professionals should make it a point to educate the patients on the maintenance and care routine, like cleansing the region from which the catheter exits the body, the catheter itself, and cleaning the hands before disconnecting the drainage bag or container from the catheter.

Proper insertion of the most suitable catheter and careful maintenance ensures that urinary catheterization is a painless process.

Understanding CAUTI

CAUTI stands for Catheter Associated Urinary Tract Infection. CAUTI is a common affliction today and is the second most common cause of bloodstream infection. The diagnosis of CAUTI is based on finding bacteriuria; along with an enhanced white blood cell count (WBC) based examination and analysis of the patient’s urine.

Symptoms of CAUTI –

• Increased serum WBC

• Burning pain in the area of the urethra, flank or the bladder
• Fever or chills
• Malaise
• Offensive urine odour
• Change in color and character of urine, it might become cloudy or have more sediments
• Hematuria
• Bladder spasms / leakage
• Catheter obstruction
• The increase in weakness or spasticity in patients who are already suffering from any neurological disease or disorder
• Change in mental frame of mind in young as well as old, but more in the latter, such as, lethargy, , delirium, or subtle changes in behavior
• Bacteraemia (especially after trauma to the urinary mucosa)

So what are the risks associated with CAUTI?

Research studies have indicated that factors like history of previous catheter use, the duration the catheter is in situ , the length of hospital stay before catheter insertion, the reason for and location of catheter insertion are all risks associated with this infection. The direct relation between the duration the catheter is in suit and the development of CAUTI is quite well established and accepted. Some other innate risk factors such as increasing age, gender and general debilitation are also associated with this infection.

CAUTI can be prevented by implementing the following initiatives:

• Insert catheters only for appropriate indications.
• Remove unnecessary catheters.
• Perform hand hygiene in compliance with CDC or WHO.
• Provide education on proper insertion and maintenance.
• Limit insertion of catheters to trained personnel.
• Insert catheters using aseptic technique and sterile equipment.
• Ensure that the indwelling catheters are secured well after insertion so that it does not move or shift and to prevent urethral traction.
• Make sure that the drainage is closed.
• Maintain unobstructed urine flow.
• Cleaning the metal area with antiseptic solutions and ensure routine hygiene.
• Make sure that the catheter is removed within 48 hours of surgery
• Implement and promote alternatives to indwelling urinary catheterization

The world has woken up to this infection that’s spreading like wild fire and has started taking some positive steps in the awareness initiative. Awareness is leading to prevention tips that if followed will help reduce the occurrence of CAUTI to a great extent.

Read more about portable ultrasound treatment.