How to change a Foley catheter at home. Foley catheter medical

Today I made one careless gesture as a result of which I created a lot of problems for myself. As the soloist of the Gas Sector group Yuri Klinskikh-Khoi said, “It was like this ...”

But in the beginning, I still want to show HOW TO CHANGE A Cystostomy CORRECTLY. In our today's article, you will learn, and most importantly, see how to replace a cystostomy yourself at home. DO NOT FEAR the scary pictures in our article, these pictures and videos at the bottom of the article are provided for informational purposes only, with the sole purpose of warning you against such an outcome. Our first video that you are about to watch shows in detail how to replace a clogged cystostomy in just a few minutes. The first video shows the whole process of how to replace the cystostomy yourself from A to Z. I repeat again !!! The material below is not intended to scare you, but to warn you. Everything is very simple! Watch and do.
Video on how to replace a cystostomy yourself without calling a doctor at home.

Well, now, I will continue the story of how I gave myself problems because of the haste. I started the replacement of the cystostomy this afternoon, at the same time we decided to film this process on video, and it's good that the video turned out to be more than informative. And all because, as a result of the rush, I lowered the cystostomy lower than necessary, I was thinking about the video, not about how deep I insert the Foley cystostomy catheter. As you probably know, in order for the cystostomy not to fall out of the bladder through the fistula, you need to carry out one simple procedure.

After you have lowered the stoma into, through the second entrance - the valve you need to pump from ten to fifteen cubes of chlorhexidine solution and that's it! I do this procedure all the time, without going to the doctors. In theory, this is a very simple procedure that can be easily done at home, but do everything in stages and carefully and NO HURRY! I broke a rule today! I hurried, as a result of which the following happened.

Damage to the urethra as a result of improper installation of the cystostomy. I inserted the stoma into the urinary tract, I began to lower it deeper and did not notice it myself, since I completely lack sensitivity in this place, that the stoma slowly entered the urethra. Then I took a syringe with a solution of chlorhexedine and started pumping 10 cubes of chlorhexedine as the process requires, BUT!
I started to inflate the ball-holder, and I inflated it in the urethra!!! In short, as a result of this ridiculous accident, I damaged the urethra very badly, and provided myself with quite a lot of blood loss.
Replacement of the cystostomy For more than three hours, blood literally flowed from my penis in clots and streams, after which they gave me an injection in a vein in our hospital to stop the blood, and after another hour the blood began to stop. My father always told me, "Hurry is only needed when catching lice and fleas." Yes, and folk wisdom says - "Hurry, you will make people laugh." In short, we both laughed and worried! Watch the video, everything is done as expected, except for the last step, MAKE SURE THAT THE STOMA IS IN THE BLADDER, and not somewhere else! Be healthy and learn from the mistakes of others.

urinary catheter is a system of tubes placed in the body to drain and collect urine from the bladder.

The installation of the catheter and its replacement is carried out at the address: Kirov, Gostiny per. 5/1, Tel. 711-100

Urinary catheters sometimes recommended as a treatment for urinary incontinence or urinary retention in both men and women. There are several different types catheters. They can be used for many different reasons.

Urinary catheters

Urinary catheters are used to drain the bladder. Bladder catheterization is often a last resort due to possible complications from prolonged use of the catheter. Complications associated with the use of a catheter may include:

bubble stones
Blood infections (sepsis)
Blood in the urine (hematuria)
Skin damage
Urethral trauma
Urinary tract or kidney infections

There is a wide variety of urinary catheters. Urinary catheters differ in material they are made of (latex, silicone, Teflon) and type (Foley catheter, straight catheter, curved tip catheter). For example, a Foley catheter is a soft plastic or rubber tube that is inserted into bladder to drain urine.

Urologists recommend using the smallest catheter size. Some people may need large catheters to prevent leakage of urine around the catheter or if the urine is concentrated and contains blood or a large number of draft.

It must be remembered that large catheters can damage the urethra. Some people with long-term use of latex catheters may develop an allergy or sensitivity to latex. In these patients, Teflon or silicone catheters should be used.

Long-term (permanent) urinary catheters

A catheter that is inserted into the bladder long time, connected to a urinal to collect urine. There are two types of urinals.

The first type of urinal is a small bag that is attached to the leg with an elastic band. Such a urinal can be worn during the day, as it is easy to hide under trousers or a skirt. The bag is easily emptied in the toilet.

Another type of urinal is a large bag that is used at night. This urinal is usually hung on the bed or placed on the floor.

How to care for your urinary catheter

If the catheter becomes clogged, painful, or infected, the catheter must be replaced immediately.

To care for an indwelling catheter, it is necessary to wash the urethra (the exit site of the catheter) daily with soap and water. Also clean the genital area completely after each bowel movement to prevent infection of the catheter. Urologists no longer recommend the use of antibacterial ointments for cleaning catheters, as their effectiveness in preventing infection has not been proven.

Increase your fluid intake to reduce the risk of complications (if you can drink plenty of fluids for health reasons). Discuss this issue with your doctor.

The urinal should always be located below the bladder to prevent urine from flowing back into the bladder. Empty the bag either every 8 hours or as it fills up.

Make sure that the outlet valve of the urinal remains sterile. Wash your hands before and after handling the bag. Do not let the outlet valve touch anything. If the outlet valve is dirty, wash it with soap and water.

How to handle the urinal?

Clean and deodorize the bag by filling the bag with a solution of two parts vinegar to three parts water. You can replace the aqueous solution of vinegar with chlorine bleach. Soak the urinal in this solution for 20 minutes. Hang the bag with the outlet valve open to dry.

What to do if the catheter is leaking?

Some people may experience leakage of urine around the catheter. This phenomenon may be due to a small catheter, an inappropriate balloon size, or bladder spasm.

If bladder spasm occurs, check to see if the catheter is draining urine properly. If there is no urine in the urinal, then the catheter may be blocked by blood or coarse sediment. Or, the catheter or drainage tube has tucked up and formed a loop.

If you have been taught how to flush the catheter, then try to flush the catheter yourself. If you cannot flush the catheter, contact your doctor immediately. If you have not been instructed how to flush the catheter and urine does not enter the bag, then you need to contact your doctor immediately.

Other causes of urine leakage around the catheter include:

Constipation
Urinary tract infections

Potential Complications of Using Urinary Catheters

Contact your doctor if you develop any of these complications:

Bleeding in or around the catheter
The catheter is draining a small amount of urine, or there is no urine despite adequate fluid intake
Fever, chills
Large amounts of urine leaking around the catheter
Urine with strong smell or urine is cloudy or thick
Swelling of the urethra around the catheter

Suprapubic urinary catheters

Suprapubic urinary catheter is an indwelling catheter that is inserted directly into the bladder through the abdomen above the pubic bone. This catheter is inserted by a urologist in the conditions of either a clinic or a hospital. The catheter exit site (located on the abdomen) and the catheter should be cleaned daily with soap and water and covered with dry gauze.

Replacement of suprapubic catheters is carried out by qualified medical personnel. The suprapubic catheter can be connected to the standard urinals described above. The suprapubic catheter is recommended:

After some gynecological operations
For patients who need long-term catheterization
For patients with trauma or blockade of the urethra

Complications caused by the use of a suprapubic catheter may include:

Bladder stones
Blood infections (sepsis)
Blood in the urine (hematuria)
Skin damage
Urine leakage around the catheter
Urinary tract or kidney infections.

After prolonged use of the catheter, the development of bladder cancer is possible.

How to put a urinary catheter in a man?

Wash your hands. Use betadine or a similar antiseptic (unless specifically instructed) to clean the urethra.
Put on sterile gloves. Make sure you do not touch the outer surface of the gloves with your hands.
Lubricate the catheter.
Take the penis and hold it perpendicular to the body. Slightly pull the penis towards the navel.
Begin gently inserting and advancing the catheter.
You will meet resistance when you reach the external sphincter. Ask the patient to take a few deep breaths to relax the muscles blocking the urethra and continue advancing the catheter.
If urine appears, continue advancing the catheter to the "Y" level of the connector. Hold the catheter in one position while you inflate the balloon. Inflating the catheter balloon in the urethra causes severe pain and may result in injury. Check if the catheter is in the bladder. You can try flushing the catheter with a few milliliters of sterile water. If the solution does not return easily, the catheter may not have been inserted far enough into the bladder.
Fix the catheter and attach the urinal to it.

How to put a urinary catheter in a woman?

Collect all equipment: catheter, moisturizing gel, sterile gloves, clean wipes, syringe with water to inflate the balloon, urinal.
Wash your hands. Use betadine or another antiseptic to treat the external opening of the urethra. In women, it is necessary to treat the labia and the opening of the urethra with gentle movements from top to bottom. Avoid the anal area.
Put on sterile gloves. Make sure that you do not touch the outer surface of the gloves with your hands.
Lubricate the catheter.
Part the labia and locate the opening of the urethra, which is located below the clitoris and above the vagina.
Slowly insert the catheter into the opening of the urethra.
Gently advance the catheter.
If urine appears, advance the catheter another 2 inches. Hold the catheter in one position while you inflate the balloon. Check if the catheter is in the bladder. If the patient feels pain when the balloon is inflated, it is necessary to stop. Deflate the balloon and advance the catheter another 2 inches and try to inflate the catheter balloon again.
Fix the catheter and attach the urinal.

How to remove a urinary catheter?

Indwelling catheters can be removed in two ways. The first method is to attach a small syringe to the opening of the catheter. Remove all liquid. Slowly withdraw the catheter.

Caution: Never remove your indwelling catheter unless your doctor has instructed you. Remove the catheter only after the permission of the doctor.

Some urologists instruct their patients to cut the catheter balloon inflation tube above the main tube. After all the water has drained out, slowly withdraw the catheter. Be careful not to cut the catheter elsewhere.

If you cannot remove the urinary catheter with little effort, inform your doctor immediately.

Tell your doctor if you don't pass urine within 8 hours after the catheter is removed, or if your stomach is swollen and hurts.

Short term (intermittent) catheters

Some patients require intermittent bladder catheterization. These people need to be taught how to insert a catheter on their own to drain the bladder when needed. They do not need to wear a urinal all the time.

People who may use intermittent catheterization include:

Any patient who is unable to properly empty their bladder
men with large prostates
People with defeat nervous system(neurological diseases)
Women after certain gynecological surgeries

The process is similar to the procedures described above. However, the balloon does not need to be inflated and the catheter is removed immediately after the flow of urine has stopped.

The Pezzera catheter is used only for drainage of the bladder through a cystostomy fistula, that is, as a cystostomy drainage. The Foley catheter can be used for a variety of purposes. It is traditionally used in men and women to drain the bladder through the urethra. At the same time, in men, a regular latex Foley catheter can be left in the urethra, even with "cover" with antibiotics or uroseptics, for no longer than 5 days.

With its longer use, there is a greater likelihood of developing purulent urethritis - prostatitis - orchi-epididymitis - pyelonephritis - urosepsis. Those. the consequences can be quite severe. If the need to continue drainage of the bladder persists (if spontaneous urination has not been restored, or cannot be restored), it is necessary to use silver-coated Foley catheters, with nitrofuran coating or with silver impregnated into the material of the catheter.

These catheters can be used to drain the bladder in men for a long period of time, changing them at least once a month. In women, bladder drainage through the urethra can be done for a long time even with a conventional latex Foley catheter. However, it is also worth changing it at least once a month.

Cystostomy in women is used to ensure the outflow of urine from the bladder is extremely rare and only if catheterization through the urethra is impossible (for example, with severe injuries of the urethra and their consequences). In men, if long-term drainage of the bladder is necessary, cystostomy (open, trocar, puncture) is most often used.

In this case, both the Pezzer catheter and the Foley catheter can be used as cystostomy drainage. The Pezzera catheter is better suited for these purposes, but it is more difficult to change it, it is necessary to use a special conductor to stretch its "cap" that fixes the catheter in the bladder lumen.

The Foley catheter for use as a cystostomy drain is less suitable, more often "clogged", more irritating to the bladder, but it is much easier to change it. The conductor, as a rule, is not needed, it easily "passes" through the cystostomy fistula. Removing it and reinstalling it in the bladder is more painless for the patient. The correctness of its installation is easier to control, fixation in the lumen of the bladder is achieved by simply inflating a special canister of 5.0-10.0 ml of saline, injected with a syringe through the valve.

Thus, the Foley catheter still has more advantages over the Pezzer catheter, and it is used to drain the bladder through a cystostomy fistula much more often.

Foley, Pezzer catheter replacement technique and care.

I want, in addition to describing the procedure for replacing the catheter, to dwell on the discussion of the existing practice flushing catheters and cystostomy drains at home. Do not do this!!! The need to flush the catheter occurs only in the presence of bleeding or after operations on the urinary tract, when the catheter can become clogged with blood clots or stone fragments. This usually happens in a hospital. Washing is carried out by the medical staff of the clinic and is done correctly.

At home, washing of catheters and drains is carried out, as a rule, in order to clean their internal lumen from plaque and mucus containing a large amount of pathogenic bacteria and prolonging the life of these same catheters. It doesn't lead to anything good!

As a rule, the formation of bacterial resistance to the antiseptics that you use to wash the catheters and the lumen of the bladder occurs fairly quickly. Therefore, when flushing, you wash away bacterial plaque from the walls of the catheter and drainage tube and drive it into the lumen of the bladder.

If the cystostomy has been in place for quite a long time, more than one month, then the bubble is "wrinkled" in a significant number of cases, i.e. its walls have lost elasticity and the ability to stretch when the bladder is filled with fluid. Therefore, when washing, it is rarely possible to inject more than 50.0 - 100.0 ml of an antiseptic solution into the lumen of the bladder, or pain appears, or fluid begins to flow out in addition to the cystostomy. Does it happen? So, the loss of elasticity of the bladder wall leads to the failure of the mechanism that prevents the reverse flow of urine from the bladder to the ureters and kidneys. And if the urine is infected with bacteria that you washed off the walls of the catheter? Moreover, if the liquid is injected under pressure, under such a good "pressure"? Such washing will end sooner or later with reflux pyelonephritis and urosepsis.

So rinsing, without special need, costs nothing. Need timely replace catheters and urinals, i.e. at least once a month, and timely and adequately treat inflammatory processes in the urinary tract and stop bleeding.

As for the catheter replacement procedure itself, in women, the replacement of a urethral catheter is nothing complicated. I just want to draw attention to the need to treat the external opening of the urethra and vulva with an aqueous solution of an antiseptic, for example, Octenisept and use anatomical tweezers and Cathejel or another similar gel with lidocaine and chlorhexidine when inserting a catheter.

When replacing a urethral catheter in men, it can be difficult, and sometimes very difficult. Therefore, ideally, before replacing the Foley catheter, it is necessary to make sure that there are several catheters of different diameters, a metal guidewire of a suitable diameter, a guidewire, a ureteroscope with a urethrotome or a cystoscope with a working channel, etc. To remove the Foley catheter, it is necessary to "blow off" with a syringe through a special valve the balloon located at its end in the bladder. The catheter is removed from the urethra, its external opening is treated with an aqueous antiseptic solution, Cathegel or sterile vaseline oil is inserted into the urethra, the catheter itself is lubricated with Cathegel or sterile vaseline oil and inserted using anatomical tweezers or a "soft" clamp along the urethra into the bladder. 5.0 - 10.0 ml of saline is injected into the balloon at the end of the catheter through a special valve using a syringe without a needle. The catheter is "pulled up", a urinal tube is attached to it.

As for the replacement of the Foley catheter, which is used as a cystostomy drainage, then everything happens in the same sequence as described above, just do not forget about the need to treat the skin around the cystostomy fistula with antiseptic solutions, which can be alcohol-containing, and about the need to use for fixation aseptic bandage applied to the skin of the anterior abdominal wall around the catheter in the form of "pants", a hypoallergenic patch.

In addition, both when replacing a Foley catheter installed as a cystostomy drainage, if less than 1 month has passed since the installation of the cystostomy, and when replacing a Foley catheter installed in the bladder through the urethra, if this doctor changes the catheter for this patient for the first time, I I highly recommend using a string conductor. This will save you a lot of problems and grief.

Preparation for the replacement of the Foley catheter, Pezzer.

As a rule, no special preparation for the replacement of the Foley, Pezzer catheter, other than ensuring the presence of the catheter itself and the instruments used to replace it, is required.

Insertion of a urinary catheter- a procedure performed in a hospital by a nurse and urological doctors. Bladder catheterization in women, men and children is different, as are the devices themselves.

The placement of a urinary catheter can only be done in a hospital.

Indications for a urinary catheter

The installation of a urinary catheter is indicated in the following conditions:

Urinary retention due to infection and surgery.
Unconscious state of the patient with uncontrolled outflow of urine.
Acute inflammatory diseases urinary organs requiring lavage and insertion medicines into the bladder.
Injury to the urethra, swelling, scars.
General anesthesia and postoperative period.
Spinal injuries, paralysis, temporary incapacity.
Severe circulatory disorders of the brain.
Tumors and cysts of the urinary organs.

Also, catheterization is carried out if it is necessary to take urine from the urinary bladder.

Types of catheters

The main type of device used in urology is the Foley catheter. It is used for urination, flushing the urinary bladder for infections, to stop bleeding, and to administer medicines into the urinary organs.

What this catheter looks like can be seen in the photo below.

Foley catheter comes in different sizes

There are the following subspecies of the Foley device:

Two-way. It has 2 holes: through one, urination and washing is performed, through the other, liquid is injected and pumped out of the balloon.
Three-way: in addition to standard moves, it is equipped with a channel for insertion medical preparations into the patient's urinary tract.
Foley-Timman: has a curved end, is used for prostate catheterization in men with benign tumor organ.

A Foley catheter can be used for procedures on any urinary tract. Duration of operation depends on the material: devices are available in latex, silicone and silver-plated.

The following devices can also be used in urology:

Nelaton: straight, with a rounded end, consists of a polymer or rubber. It is used for short-term bladder catheterization in cases where the patient is unable to urinate on his own.
Timman (Mercier): silicone, elastic and soft, with a curved end. Used to drain urine in male patients suffering from prostate adenoma.
Pizzera: A rubber appliance with a bowl-shaped tip. Designed for continuous drainage of urine from the bladder through a cystostomy.
Ureteral: a long PVC tube 70 cm long placed with a cystoscope. It is used for catheterization of the ureter and renal pelvis, both for the outflow of urine and for the administration of drugs.

Nelaton's catheter is used for short-term bladder catheterization

All types of catheters are divided into male, female and children:

female - shorter, wider in diameter, straight shape;
male - longer, thinner, curved;
children - have a smaller length and diameter than adults.

The type of device to be installed depends on the duration of catheterization, sex, age and physical condition patient.

Types of catheterization

According to the duration of the procedure, catheterization is divided into long-term and short-term. In the first case, the catheter is installed on a permanent basis, in the second - for several hours or days in a hospital.

Depending on the organ undergoing the procedure, the following types of catheterization are distinguished:

urethral;
ureteral;
renal pelvis;
bladder.

Urethral catheter in men

Further instructions depend on how long the catheter is placed. For short-term use, after the outflow of urine or the introduction of drugs, the device is removed. With prolonged use, catheterization ends after insertion.

If the procedure has been carried out correctly, pain missing.

How is a catheter placed in children?

The general algorithm for installing a catheter for children does not differ from the adult instructions.

Exist important features when performing the procedure in children:

The urethral catheter for children should have a small diameter so as not to damage the genitourinary organs of the child.
The device is placed on a full bladder. You can check the fullness of the organ using ultrasound.
Treatment with medicines and strong antibacterial compounds is prohibited.
Pushing the labia in girls should be done carefully so as not to damage the frenulum.
The introduction of the tube should be soft, slow, without force.
It is necessary to remove the catheter as soon as possible so as not to provoke inflammation.

The procedure in children, especially in infants, should be handled by a urologist with a pediatric education.

Caring for your urinary catheter

To avoid urinary tract infections for permanent urinary catheter should be carefully looked after. The processing algorithm looks like this:

Lay the patient on his back, place an oilcloth or vessel under the buttocks. Drain the drain fluid and carefully remove the device.
Drain the urine from the drainage bag, rinse it with water, treat with an antiseptic: Chlorhexidine, Miramistin, Dioxidine, boric acid solution.
Flush the catheter with a 50 or 100 mg syringe. Pour an antiseptic into it, and then rinse with running water.
In case of inflammatory processes of the urinary tract, treat the catheter with a solution of furacilin, diluting 1 tablet in a glass of hot water.

Miramistin - antiseptic for the treatment of the urinal

The urinal must be emptied 5-6 times a day, and washed with antiseptics at least 1 time per day. The catheter should be processed no more than 1-2 times a week.

In addition, it is necessary to thoroughly wash the patient's genitals.

How to change the catheter yourself at home?

Performing a catheter replacement at home is a dangerous procedure that can cause serious injury to the urinary organs. Self-administration of the procedure is only permissible for a soft urethral device, and with a serious need.

To replace the device, the old catheter must be removed:

Empty the urinal. Wash your hands with soap and put on gloves.
Lie in a horizontal position, bend and spread your legs to the sides.
Flush the tube of the device and genitals with an antiseptic or saline solution.
Locate the bottle opening of the device. This is the second hole not used for urine output and bladder lavage.
Empty the balloon with a 10 ml syringe. Insert it into the hole and pump out the water until the syringe is completely filled.
Gently pull the tube out of the urethra.

Correct position for catheter replacement

After removing the device, a new one is inserted into the urethra, according to the above instructions for representatives of different sexes.

The nurse should change the ureteral and renal pelvic catheters. The replacement and removal of the suprapubic (bladder) device is handled by the attending physician.

Possible complications after the procedure

Pathologies resulting from catheterization include:

damage and perforation of the urethral canal;
trauma to the urethral bladder;
urethral fever;
urinary tract infections.

Incorrect catheterization may cause inflammation of the urethra

These complications can be avoided by using a soft catheter and performing the procedure in medical institutions, with help nurse or the attending physician.

Bladder catheterization is used for stagnation of urine and infections of the genitourinary system. With a properly selected device and compliance with its setting, the procedure is unable to harm the patient and cause discomfort.

The patient is 78 years old. In connection with prostate adenoma (and, apparently, in vain), a transurethral resection of the prostate was performed. A lot of problems after the operation (complete disorientation, fever, irritable bowel syndrome on the background of antibiotics, weight loss - from 78 to 49 kg, with a height of 178, low blood pressure - 90/50, etc., a sharp deterioration in general condition). District hospital in St. Petersburg, the lack of qualified honey. help and living conditions of the last century (and simply - bestial, so much so that at the moment the patient categorically refuses hospitalization). At the moment at home, the diagnosis on discharge: BPH, epicystostomy, chronic pyelonephritis (there were no signs before the operation). A couple of times a month fever(37.5), general weakness. Analysis of urine: elevated white blood cells(29.0), accumulations of leukocytes - negligible. number, crystals of calcium oxalate - negligible. qty. Blood test: leukocytes 7.7, hemoglobin - 102, hematocrit - 33.3, MSN - 27.4, MCHC - 305, lymphocytes 59.0, segmented neutrophils - 31, ESR - 51, cretinin - 131. Weight ranges from 54-57 kg (Peptamen is used) . Attempts to take antibiotics immediately lead to intestinal problems (diarrhea, constipation) and weight loss. Actually, two practical questions. Foley catheter: from 3 urologists in the hospital and polyclinic at the place of residence (causing mistrust simply on formal grounds), opposite recommendations for care were received: two recommend daily flushing (with variations: furatsilin or chlorhexidine and potassium permanganate solution) with replacement once a month, one - only change once a month. There are no reliable recommendations in the network (eg modern monographs with links to clinical studies). And the second question, are there qualified urologists in St. Petersburg? Most of the recommendations are either negative or are clearly commercial in nature.

Doctor's answer

Good evening! 1. According to modern clinical guidelines a Foley catheter or any other catheter placed in the bladder should never be flushed with ANYTHING. When flushing, all bacteria and bacterial films washed off from the inner surface of the catheter enter the bladder and activate inflammatory process in the last. It is necessary to change the catheter not once a month, but as needed. Different patients have different replacement times. If the patency of the catheter is impaired, the urine becomes cloudy with impurities or flakes, then the catheter must be changed, even if it has stood for only a few days. 2. Of course, there are excellent urologists in St.Petersburg who can be consulted. In your situation, you need to deal with general condition patient. Prostate adenoma and TUR cannot lead to such a condition. Try contacting Sergei Valerevich Popov http://endourocenter.ru/specialists/popov-sergey-valerevich/. You can refer to me personally. Sincerely.