Bladder catheterization in newborns. Emergency care in pediatrics - bladder catheterization. Bladder catheterization technique

1. Infectious complications of bladder catheterization:
a. Urethritis.
b. Epididymitis.
in. Cystitis.
d. Pyelonephritis.
e. Sepsis.

Most frequent complication of bladder catheterization- penetration of bacteria into the urinary tract, sometimes into the bloodstream. Catheterization is the leading cause of nosocomial infection urinary tract and Gram-negative sepsis in adults. The frequency of bacteriuria with short-term catheterization (the catheter is removed immediately after receiving urine) is 1-5% in this group of patients.

Risk of occurrence infectious complications proportional to the duration of catheterization. In newborns and children, approximately 50-75% of hospital-acquired urinary tract infections are due to catheterization (the highest frequency in newborns). AT pediatric practice urinary tract infections develop in 10.8% of patients after catheterization, and secondary bacteremia in 2.9%.

Risk infections decreases with strict asepsis during the procedure, use of a closed urine collection system, and removal of the catheter as soon as possible.

Bladder catheterization is used to obtain urine from the organ. The manipulation algorithm involves the introduction of a special tube (metal or rubber catheter) into the urethra. The method is used for both therapeutic and diagnostic purposes.

Catheterization can be carried out not only through the urethra, but also through the stoma, when urine is excreted through an opening in the anterior abdominal wall. This procedure is recommended after surgical interventions, after injuries of the urethra, as well as with the need for long-term catheterization.

The maximum period for which a catheter is installed usually does not exceed 5 days. However, transvesical devices can be used for years (with monthly changes).

Indications for catheterization

acute or chronic urinary retention;
inflammation of the bladder (in order to flush the organ);
insertion into the bladder medicines;
examination of urine in the bladder for diagnosis.

Contraindications

Bladder catheterization is not performed in the following cases:

urethritis of infectious origin;
anuria;
spasmodic constriction of the urethral sphincter.

Types of bladder catheters

For catheterization, rigid and soft catheters are used. A soft catheter is usually used, which is a tube up to 30 centimeters long. From the outside, the device is equipped with a funnel or has an oblique cut.

The metal catheter has a shaft, a handle and a beak. The device is curved according to the shape of the urethra.

The most common types of catheters are Foley and Nelaton. The Foley catheter is a silicone-coated latex tube. Used for long-term catheterization. The Nelaton catheter is used for both short-term and long-term catheterization and is made from polyvinyl chloride.

The catheter for women is shorter than the male one by 15-17 centimeters.

Bladder catheterization set includes:

catheters of various diameters - 2 pieces;
cotton balls - 2 pieces;
gauze napkins - 2 pieces;
Janet syringe, glycerin, diaper, tray;
dishes for collecting urine;
solutions of chlorhexidine and furacilin;
rubber gloves;
a water bath for heating the furatsilin solution;
washing set;
dishes for storing catheters with a 3% solution of chloramine.

Catheter Insertion Technique

The catheterization algorithm provides for following antiseptic and aseptic rules in order to avoid infection of the patient's body.

Bladder catheterization in women begins with washing the external genital organs, and in men - with wiping the head of the penis antiseptic. During the procedure, the patient is in a supine position with legs apart.

The soft catheter can be manipulated by a nurse. A rigid catheter, due to the trauma of the procedure, has the right to enter only a doctor.

A calm and trusting atmosphere, contact with the patient is part of the algorithm for successful catheterization.

Catheterization in women

The algorithm for the procedure in women:

The doctor treats his hands with chlorhexidine. All devices and materials used must be sterilized.
The patient is washed.
A ship is placed between the woman's legs.
A gauze pad is placed on the patient's pubis. The urologist spreads the woman's labia with his left hand and treats the external opening of the urethra with a cotton ball held in tweezers.
The catheter is inserted into the urethra for 4-5 centimeters. The release of urine indicates that the device has reached the bladder. If urine has stopped flowing out, this indicates that the device rested against the wall of the bladder. In this case, the doctor pulls the tube towards himself by 1-2 centimeters.
After pumping out the urine, the catheter is attached to Janet's syringe. Furacilin solution is injected into the organ.
Washes are made until a clean washing liquid is obtained.
If necessary, antibacterial and anti-inflammatory drugs are introduced into the bladder.
At the end of the procedure, the device is removed from the urethra.
The urethra is treated with a furatsilin solution, and the residual moisture from the external genital organs is removed with a napkin.
For about an hour after the procedure, the patient should maintain a horizontal position.

Please note: the procedure is carried out no earlier than 1-2 hours after the last urination of the patient. Ultrasound equipment helps to determine the sufficiency of urine in the body to reduce the possibility of failed catheterization.

Catheterization in men

In men, the manipulation technique is complicated by a physiologically longer urethra, which can reach 25 centimeters. There are also constrictions that prevent the introduction of the catheter.

Bladder catheterization in men with a metal catheter is used only when a soft device cannot be inserted. We are talking about an adenoma or strictures of the urethra of various origins.

Places of physiological constriction are detected by a slight resistance when advancing the device. To relax smooth muscles, the patient should take several deep breaths. As a result, it becomes possible to advance the catheter further.

Catheterization in children

The technique of catheterization in children is the same as in adults, but takes into account age features patients.

newborn girls

When the catheter is inserted, the doctor carefully pushes the labia minora apart so as not to damage their frenulum.
To avoid injury, a catheter of the smallest diameter is used. For lighter children, devices with a smaller diameter are used.
The introduction of the boat is carried out without effort. If this fails, the procedure is cancelled.
If there is no urine flow, the position of the device is rechecked visually or by x-ray.
The catheter is removed as quickly and effortlessly as possible. If there is resistance during extraction, knotting is likely.

newborn boys

If the boy is not circumcised, the foreskin is moved gently until the urethral opening is exposed. This takes into account that newborn male children have physiological phimosis.
To avoid reflex urination, the base of the penis is slightly compressed.
When the device is inserted, the body of the penis is pulled up to avoid bending the urethra.
If the external opening of the urethra is not visible, the catheter is inserted through the preputial ring.
When there is resistance in the external sphincter, slight pressure is allowed. If the spasm has passed, you can continue the manipulation. Otherwise, there is a possibility of obstruction, so the procedure is terminated.

Complications

As a result of catheterization, complications are possible:

bladder infection;
infection of the urethra;
damage to the mucous membrane of organs.

Complication results:

cath fever;
urethritis;
pyelonephritis;
cystitis;
rupture of the urethra.

Bladder catheterization in most cases can be performed without infection and injury. To do this, the doctor must strictly follow the algorithm for the procedure.

This procedure is necessary for washing the bladder, drug administration. This process has certain characteristics. The patient is first of all prepared for the procedure, examined, examined for contraindications.

Bladder catheterization is an effective procedure in the treatment of many pathologies. We will consider the algorithm for its implementation later in the article.

When is it necessary?

The procedure is applied in the following cases:

Clots of pus and blood in.
The impossibility of emptying the organ due to an unstable nervous state.
Adenoma.
Adenocarcinoma.
The introduction of drugs after surgery on the organ.
Taking urine for research.
Counting the quantity and quality of urine excreted.
Pinched excretory organ.
Prostatitis.

Contraindications

Despite the effectiveness and usefulness of the method, there is a number of contraindications:

Inflammation of the prostate.
Inflammation of the testicles and their appendages.
Prostate abscess.
Traumatic injuries of the urethra.
Tumors of the genitourinary system.
Orchitis.
Epididymitis.
Marked constriction of the urethra.

In addition, after the procedure the following complications may occur:

Infectious inflammatory processes.
Physical damage to the urethra by a catheter.
Perforation of the urethra.
Bleeding.

If bladder flushing through a catheter is performed in a hospital by a qualified and experienced specialist, there are no complications. They can happen if a person, in the absence of the necessary knowledge and skills, tries to carry out the procedure.

Preparing for installation

Preparation for the procedure includes next steps:

A few days before the procedure, the patient is examined by a doctor to make sure that there are no contraindications.
1-2 days before the procedure, it is better to refuse spicy, fatty foods, alcoholic and sweet carbonated drinks.
Wash your face a few minutes before the procedure.
Then the patient goes to the treatment room, where he is even more carefully prepared by a specialist.
The doctor treats the genitals with an antiseptic, tells the patient about the upcoming actions.

After that, the patient is ready for the procedure, for the introduction of the catheter.

What is included in the catheterization kit?

The set for the procedure includes:

Sterile catheter. It can be either metal or silicone (Foley catheter).
Antiseptic solution for the treatment of the genitals.
Tweezers.
Sterile vaseline oil.
capacity for .
Sterile wipes.
Oilcloth.
Sterile gloves.

How to install a catheter?

The process varies slightly depending on by sex and age of the person.

Among women

The algorithm consists of the following steps:

The patient lies on the couch, takes the desired position.
The nurse prepares tools, puts a container for urine, treats the genitals with an antiseptic.
Next, a sterile napkin is placed on the pubis, the nurse pushes the labia apart.
The opening of the urethra is exposed.
Then the sterile catheter is lubricated with petroleum jelly, inserted very carefully into the urethra, the other end of the catheter is sent to the urine container.
Urine usually comes out of the catheter immediately after. This indicates the correct insertion and position of the catheter.
The catheter is then carefully removed. Urine, if necessary, is taken for examination.

If you need to enter the medicine, the catheter is not in a hurry to remove, the drug is administered with its help. In this case, the catheter is removed after drug administration.

The external genitalia are again treated with an antiseptic. A napkin removes the remaining moisture on them.
The patient can lie down for 5-10 minutes, then get up and dress. The procedure is considered completed.

Bladder catheterization soft catheter women in the video:

Click to view (impressionable do not watch)

In men

Algorithm of actions during the procedure:

The man lies on the couch, the genitals are treated with an antiseptic.
The doctor prepares tools, puts a container for urine.
The glans penis is then very carefully opened to expose the urethra.
The urethra is once again treated with an antiseptic, and the catheter is lubricated with petroleum jelly.
Next, the catheter is very carefully inserted into the urethra.
The catheter enters the urethra.
Gradually, urine is excreted through the catheter.
If necessary, drugs are administered.
Then the catheter is very carefully removed from the urethra, from the penis.
The head of the penis is once again treated with an antiseptic, excess fluid on the genitals is removed with a napkin.
A man can lie down for 5-10 minutes, then he can get up and get dressed. Procedure completed.

More like inserting a catheter into a man see in the video:

In children

The child may also need to flush the bladder through a catheter. The procedure is as follows:

The child goes into the office, lies down on the couch, the genitals are treated with an antiseptic.
The doctor selects the necessary instruments, the smallest catheter.
The catheter is treated with petroleum jelly, it is inserted into the urethra by only 2 cm. For adults, it is inserted by 4-5 cm. For children, it is enough to insert the catheter to a shallow depth.
Urine is usually expelled immediately. For a long time, children cannot keep the instrument in the urethra.
As soon as the urine is excreted, if necessary, the medicine is immediately injected, and then the instrument is very carefully removed.
The genitals are again treated with an antiseptic.
The child may need more recovery time: 15-20 minutes. He is allowed to lie down. Then the child can dress. Procedure completed.

In the first week after the procedure, the child is not recommended increased physical activity.

Suprapubic bladder catheterization

This procedure is much more difficult and serious. The catheter is inserted into the suprapubic part and remains there on an ongoing basis.

How long can the catheter be kept in bladder only the doctor decides.

A catheter is inserted during a small operation in a clinic setting. The catheter is fixed, leaving only a small hole in the abdomen for the catheter to exit. It's practically invisible. Urine will be regularly expelled through it.

The hole is regularly treated with an antiseptic, covered with gauze. When recovering, specialists very carefully take out the catheter in the clinic.

Suprapubic catheterization of the bladder is used only as a last resort, if the patient himself cannot empty himself.

Usually assigned this procedure after injuries of the bladder, operations. The catheter helps in the recovery process.

How is an ultrasound of the bladder read in our article.

How to restore the bladder after a catheter?

After the procedure comes recovery period. The procedure itself can cause discomfort and even pain.

The recovery process includes patient rest in the first two weeks. It is shown to lie down a lot, because. physical overwork can lead to complications. It is also impossible to lift weights for the first month.

The patient needs to try to empty the bladder himself, even if at first it will not be easy. Fluid may come out in small amounts at first. We must try to relax him as much as possible, not to be nervous and not to worry.

Gradually, the functions of the bladder and urinary tract are normalized. Usually, patients recover in the first days, any pain and discomfort disappear on the 3-4th day, urine is excreted correctly, and the amount is within.

In severe cases, the patient may need diapers. Liquid can come out very unexpectedly. This is completely normal during the recovery period.

Gradually, the functions of the bladder are normalized, the person learns to control the process of urination.

The first week you need at least 2-3 times a day treat the urethra with antiseptics so that the inflammatory process does not occur.

Bladder catheterization is a serious procedure that helps in the treatment of the bladder, the study of its condition. Properly performed procedure will help the patient to recover.

How and how to flush the catheter in the bladder, if it is clogged, find out from the video:

CHAPTER 25

In the practice of children's work medical institutions great importance is attached to such medical manipulations as setting enemas, gas removal, gastric lavage, bladder catheterization, duodenal sounding, etc. Their implementation requires careful preparation, knowledge of the characteristics of each specific manipulation in children of different ages.

Setting an enema. With the help of an enema, various liquids can be introduced into the large intestine for therapeutic or diagnostic purposes. There are cleansing, medicinal, nutritious enemas.

Cleansing enemas prescribed to relieve the intestines from stool and gases. They are used for constipation, food poisoning, to prepare the patient for endoscopic examination methods (rectoscopy, colonofibroscopy), X-ray examination of the stomach, intestines, kidneys, to perform ultrasound bodies abdominal cavity, before operations, introduction medicines. Contraindications are inflammatory changes in the lower segment of the colon, hemorrhoids, prolapse of the rectal mucosa, suspicion of appendicitis, intestinal bleeding.

For a cleansing enema, water at room temperature is used, which is administered using a balloon with a soft tip. Do children use pear-shaped balloons for administering an enema for the first 2-3 months of life? 2 (capacity - about 50 ml), 6 months -? 3 or 4 (75-100 ml), one-year-olds -? 5 (150 ml), children 2-5 years old -? 5-6 (180-200 ml), 6-12 years - ? 6 (200-250 ml). For cleansing enemas, older children use Esmarch's mug.

Before use, the pear-shaped balloon is sterilized by boiling. Fill it with liquid (water or medicinal solutions), remove air by slightly squeezing the balloon until liquid appears from the tip facing upwards. The tip is lubricated with Vaseline. child infancy usually laid on the back with legs raised up, older children - on the left side, with pulled up to the stomach lower limbs. tip bal-

the womb is introduced carefully. In the position of the patient on the back, the tip is directed forward and somewhat anteriorly, then, without effort, overcoming the external and internal sphincters of the anus, slightly backward. The tip is inserted to a depth of 3-5 cm in children younger age, 6-8 cm older and gradually compress the balloon. After emptying the balloon, without opening it, carefully remove the tip. To hold the injected fluid in the intestines, the child's buttocks are squeezed by hand for several minutes, after which defecation (emptying) occurs. The amount of liquid for a cleansing enema depends on the age of the child and the indications for its implementation.

Permissible one-time volume of fluid administered when administering an enema in children.

To introduce more liquid, especially for older children, use the Esmarch mug. The procedure is performed in the position of the child on the left side with legs bent and pulled up to the stomach. An oilcloth is placed under the buttocks, the free edge of which is lowered into the pelvis in case the child cannot hold the liquid. Esmarch's mug is filled with water at room temperature up to 1 liter and hung on a tripod to a height of 50-75 cm. Having opened the tap, air and a small amount of water are released from the rubber tube. The rubber tip is lubricated with petroleum jelly and, spreading the child's buttocks, is inserted into the anus. The first 2-3 cm of the tip is advanced anteriorly towards the navel, then backwards parallel to the coccyx to a depth of 5-8 cm.

The rate of fluid introduction is regulated by a valve on a rubber tube. If it is difficult for fluid to enter, for example, if the feces are hard, the tube is removed by 1-2 cm and Esmarch's mug is raised by 20-30 cm. The direction of the tip is also changed, the child is asked to bend his legs more, bring them to the stomach, which leads to relaxation of the anterior abdominal wall. If in the process of setting a cleansing enema there is a feeling of fullness due to accumulated gases, then the mug should be lowered below the level

beds; after the passage of gases, the mug is gradually raised. After completion of the procedure, the tip is carefully removed. The patient is in the supine position for 8-10 minutes until intestinal motility increases and the urge to defecate appears.

To enhance intestinal motility, various substances are added to the liquid: sodium chloride (table salt, 1-2 tablespoons per 1 liter of water), glycerin or vegetable oil (1-2 tablespoons), chamomile infusion or decoction (1 cup). With atonic constipation, a laxative effect occurs at a fluid temperature of 18-20 ° C, with spastic constipation - 37-38 ° C.

At the end of the procedure, pear-shaped balloons and rubber tips are washed hot water and boil. Esmarch's mug is washed, wiped dry and covered with gauze.

Cleansing enemas include oil, hypertonic, siphon.

oil enemas used for mild bowel cleansing, as well as for persistent constipation. Vegetable oils are used (sunflower, linseed, olive, hemp and vaseline), which are preheated to a temperature of 37-38 ° C. A rubber tip is put on a pear-shaped balloon, it is carefully inserted to a depth of 10-12 cm into the rectum. You can use a syringe with a rubber catheter put on it. For the procedure, from 20 to 80 ml of oil is used, depending on the age of the child. After the introduction of the oil, it is necessary to lay the child on the stomach for 10-15 minutes so that the oil does not leak out. Since the cleansing effect occurs after 8-10 hours, the procedure is recommended to be done in the evening.

Hypertensive enemas used to stimulate intestinal motility. Indications for hypertonic enema are atonic constipation, contraindication - inflammatory and ulcerative processes in the lower colon. Used for enema hypertonic solutions: 5-10% sodium chloride solution (1 tablespoon per glass of water), 20-30% magnesium sulfate solution. Using a rubber bulb with a tip, 50-70 ml of the solution is injected into the rectum at a temperature of 25-30 ° C, depending on the age of the child. The laxative effect usually occurs after 20-30 minutes, during which time the patient should lie down.

Siphon enemas given mainly to older children. Indications are the need to remove all fecal

masses or poisonous products that have entered the intestines as a result of poisoning with chemical or vegetable poisons. Such enemas are recommended when conventional cleansing enemas are ineffective, as well as when intestinal obstruction is suspected. Siphon enemas are contraindicated in case of appendicitis, peritonitis, gastrointestinal bleeding, diseases of the rectum, in the first days after surgery on the abdominal organs.

Through a rubber tube with a diameter of 0.8-1.0 mm and a length of up to 1.5 m (one end of the tube ends with a funnel, the other with a tip), from 5 to 10 liters of pure water, heated to 37-38 °C, or a disinfectant liquid (weak potassium permanganate solution, sodium bicarbonate solution). The end of the tube lubricated with petroleum jelly is inserted through the anus into the intestine to a depth of 20-30 cm. The funnel is filled with water from a jug and raised to a height of 50-60 cm above the bed, and then lowered to the level of the child's pelvis without removing the rubber tube from the rectum. According to the law of communicating vessels, water with the contained feces returns to the funnel, and the contents are poured into the basin (Fig. 66). The procedure is repeated several times in a row until clear water appears. Then the rubber tube is carefully removed, the entire system is washed and boiled.

It is necessary to carefully observe all technical rules, and when setting "high" enemas, remember such a formidable complication as fecal intoxication. The latter occurs in patients with intestinal obstruction and with untimely evacuation of the injected fluid. The setting of a siphon enema is carried out under the obligatory supervision of a doctor.

Medicinal enemas indicated when it is impossible to administer drugs through the mouth. They are divided into enemas of local and general action. In the first case, medicinal enemas are used for inflammatory processes in the large intestine, and in the second - for the absorption of drugs through the mucous membrane of the rectum and their entry into the blood.

Medicinal enemas are placed 10-15 minutes after cleansing enemas, less often after spontaneous bowel cleansing. Since all medicinal enemas are microclysters, a conventional 20-gram syringe or a rubber “pear” balloon with a capacity of 50 to 100 ml is used. The administered drug should have a temperature of 40-41 ° C, since at a lower

Rice. 66.Setting a siphon enema. Explanation in the text

temperature, there is an urge to defecate, and the drug is not absorbed. The volume of medicinal enemas depends on the age of the children: patients of the first 5 years of life are administered 20-25 ml, from 5 to 10 years - up to 50 ml, older children - up to 75 ml.

Medicinal enemas may contain various drugs, including sedatives, sleeping pills, and the like. The following enemas are most commonly used: starch enemas (1 teaspoon per 100 ml of water); from chamomile (15 g of chamomile is boiled for 2 minutes in 250 ml of water, cooled to 40-41 ° C, filtered); from sea buckthorn oil, rose hips. With convulsions and strong arousal, chloral hydrate enemas are indicated - a 2% solution of chloral hydrate is used.

Nutrient enemas are rarely used, since only water, isotonic sodium chloride solution (0.85%), glucose (5%), proteins and amino acids are absorbed in the large intestine - in a very limited amount. Perform nutritional enemas after cleansing using a dropper (in young children) or Esmarch's mug (in older children). The rate of fluid administration is regulated by a screw clamp: children in the first months of life are injected with 3-5 drops per minute, from 3 months to 1 year - 5-10, older ones - 10-30. This method, called a drip enema, improves the absorption of fluid through the mucous membrane of the rectum, does not increase intestinal peristalsis, does not overfill it, and does not cause pain. Thus, 200 ml of liquid or more can be introduced into the child's body.

Gas removal. Most often, gas removal is carried out for children early age, newborns and infants. However, the removal of gases is also indicated for older children with intestinal diseases accompanied by flatulence or delayed elimination of gases. Before the procedure, put a cleansing enema. The gas outlet tube with a diameter of 3-5 mm and a length of 30-50 cm is pre-lubricated with vaseline oil and inserted into the rectum with a rotational motion as high as possible so that the outer end of the tube protrudes from anus by 10-15 cm. The tube is left for 20-30 minutes, less often - for more long time. The procedure can be repeated after 3-4 hours. The gas outlet tube is thoroughly washed warm water with soap, wipe and sterilize by boiling.

Gastric lavage. It is used for therapeutic or diagnostic purposes, as well as to remove poor-quality food from the stomach, pesticides, medicines, toxins of bacterial and plant origin that have entered the child's body. The procedure requires a gastric tube with two holes on the side walls and a funnel (previously sterilized by boiling), as well as a basin. For gastric lavage in older children

age, you can use a thick probe 70-100 cm long and 3-5 mm in diameter. For an approximate determination of the length of the probe inserted into the stomach, the distance from the bridge of the nose to the navel is measured in a child. For a more accurate determination of the length of the probe, equal to the distance from the teeth to the entrance to the stomach, apply the formula: 20 + and, where n- the age of the child.

The position of children during gastric lavage depends on age, and in some cases - on the severity of the patient's condition. Infants are most often laid on their side with their faces slightly turned down. Preschool child nurse or her assistant picks him up, wraps him with a sheet (diaper), the child’s legs are tightly clamped between their legs, press his head to his shoulder. Another nurse asks the child to open his mouth or opens it with a spatula and quickly inserts the probe behind the root of the tongue. He asks the child to make several swallowing movements, during which the nurse, without violent movements, advances the probe along the esophagus to a previously made mark. Confirmation that the probe is in the stomach is the cessation of vomiting. Older children are seated on a chair for gastric lavage, the chest is covered with an oilcloth apron or sheet (diaper).

After inserting the probe into the stomach, a glass funnel with a capacity of about 500 ml is attached to its outer end and filled with the liquid prepared for washing: water, 2% sodium bicarbonate solution or a light pink solution of potassium permanganate at room temperature. Using the siphon principle, the funnel is lifted up and liquid is injected into the stomach (Fig. 67, a). When the liquid reaches the throat of the funnel, the latter is lowered below the level of the stomach and wait until the gastric contents pour out of the probe through the funnel into the pelvis (Fig. 67, b). The funnel is again filled with clean water and the procedure is repeated until clean lavage water flows from the stomach (Fig. 67, c). In young children, gastric lavage can be performed using a 20-gram syringe.

After the end of the procedure, the funnel is removed and the probe is removed with a quick movement. The funnel and the probe are washed with a strong jet of hot water, and then boiled for 15-20 minutes. If necessary, the collected wash water is poured into clean boiled dishes and sent for laboratory testing. Often, gastric lavage, especially in case of poisoning, is combined with intestinal lavage, i.e. make a siphon enema.

Rice. 67.Gastric lavage. Explanation in the text

Gastric sounding(Fig. 68). Are thin probes used for probing? 10-15 with a diameter of 3-5 mm and a length of 1.0-1.5 m. They end blindly, and have two holes on the side. The technique of introducing a thin probe is similar to the introduction of a thick probe during gastric lavage. A 20-gram syringe is put on the free end of the probe to suck gastric contents. The procedure is carried out in the morning on an empty stomach. To stimulate the secretion of the stomach, various test breakfasts are used: meat broth, 7% cabbage broth,

Rice. 68.Taking gastric juice:

a - inventory: a rack with test tubes, a syringe, a thin probe; b - the position of the child during manipulation

coffee breakfast, etc. The most commonly used histamine test is the subcutaneous injection of a 0.1% histamine solution at the rate of 0.008 mg per 1 kg of body weight. Other physiological stimuli are also used: pentagastrin, histology.

duodenal sounding(Fig. 69). For probing, a thin probe with a metal olive at the end and several holes is used. The study is carried out in the morning on an empty stomach in the treatment room. In the patient's standing position, the distance from the incisors to the navel is measured with a probe. Make a mark on the probe. The child is seated on a hard trestle bed, a metal olive is taken under the third finger of the right hand and inserted at the root of the tongue, while the patient makes several swallowing movements and breathes deeply through the nose. When the urge to vomit appears, the child should squeeze the probe with his lips and breathe deeply through the nose. After passing through the pharynx, the olive and the probe move independently due to the peristalsis of the esophagus.

Rice. 69.Duodenal sounding:

a - inventory: rack with test tubes, 25% magnesium sulfate solution, duodenal probe, syringe; b - the position of the child during manipulation

After the probe enters the stomach, the patient is placed on the right side, on the roller. A hot heating pad wrapped in a towel should be placed on top of the roller. The patient's legs are bent at the knees.

The location of the probe is judged by the content received. When the probe is in the stomach, clear or slightly cloudy juice is secreted. To obtain bile, the patient slowly and gradually swallows the probe to the mark. After 30-60 minutes, bile appears, as evidenced by a change in the color of the secreted contents. There are several portions obtained by duodenal sounding.

Portion 1 (A) is the content duodenum, light yellow, transparent, has an alkaline reaction. Portion II (B) appears after the introduction of an irritant (20-50 ml of a 25% solution of magnesium sulfate or xylitol) to relax the sphincter of the common bile duct; gallbladder fluid is clear

dark brown. Portion III (C) appears after complete emptying of the gallbladder, is a light bile coming from the bile ducts; it is light lemon color, transparent, without impurities.

Duodenal sounding lasts an average of 2-2.5 hours. After receiving all three portions, the probe is carefully removed.

Bladder catheterization. The introduction of a catheter into the bladder is carried out in order to remove urine from it in the absence of independent urination, washing and administering drugs, obtaining urine directly from the urinary tract.

Catheterization is carried out with a soft catheter, which is a tube 25-30 cm long and up to 10 mm in diameter. Depending on the size of the catheters are divided by numbers (from? 1 to 30). The upper end of the catheter is rounded, on the lateral surface there is an oval hole. The outer end of the catheter is cut obliquely or funnel-shaped to accommodate the tip of the injection syringe. medicinal solutions and bladder lavage.

Before use, the catheters are boiled for 10-15 minutes. After use, they are thoroughly washed with soap and water, wiped with a soft cloth. Store catheters in an enamel or glass container with a lid, usually filled with a 2% solution of carbolic acid.

Before the procedure, the nurse washes her hands with soap, wipes the nail phalanges with alcohol and iodine, puts on disposable gloves.

Girls are pre-washed. For bladder catheterization, the nurse stands slightly to the right of the child. The baby is placed on the changing table. With the left hand, the nurse pushes the labia apart, with the right hand, from top to bottom, wipes with cotton wool moistened with a disinfectant solution (furatsilin), the external genitalia and the opening of the urethra.

The catheter is taken with tweezers, the upper end is doused with sterile vaseline oil, the catheter is inserted into the external opening of the urethra and slowly moved forward (Fig. 70, a). The appearance of urine from the catheter indicates that it is in the bladder. The outer end of the catheter is placed below the level of the bladder, therefore, according to the law of communicating vessels, urine flows out freely; when urine ceases to stand out on its own, the catheter is slowly withdrawn.

Rice. 70.Bladder catheterization in a girl (a) and a boy (b)

The introduction of a catheter for boys is technically more difficult, since their urethra is longer and forms two physiological constrictions. The patient during catheterization lies on his back with legs slightly bent at the knees, a urinal is placed between the feet. Nurse takes in left hand the penis, the head of which is carefully wiped with cotton wool moistened with a solution of furacilin and another disinfectant. Right hand takes a catheter poured with sterile vaseline oil or glycerin and slowly, with little effort, introduces it into the urethra (Fig. 70, b).

General childcare: Zaprudnov A.M., Grigoriev K.I. allowance. - 4th ed., revised. and additional - M. 2009. - 416 p. : ill.

Bladder catheterization is a necessary medical intervention carried out for therapeutic or diagnostic purposes for certain diseases of the genitourinary system. It is necessary to understand specifically what are the indications for bladder catheterization, the types and methods of its implementation, the process of removing the catheter.

In some diseases of the genitourinary system (prostate adenoma, oncological processes, various pathologies kidneys) there are serious difficulties with the excretion of urine from the patient's body.

Bladder catheterization is a medical procedure in which a special hollow device is inserted into the cavity of the urethra to force the drainage of urine. This manipulation requires certain knowledge and skills from the doctor performing it. The procedure can be performed in a planned or in urgent order.

The goals of bladder catheterization are:

medical;
diagnostic;
hygienic.

The diagnostic orientation of the use of a catheter allows you to accurately determine the root cause of any genitourinary pathology. Sterile urine, directly taken from the indicated organ, is considered the most reliable material for conducting a certain kind of analysis. This technique makes it possible to diagnostic measures with the introduction of a contrast agent into the bladder.

Hygienic catheterization allows for proper care of critically ill patients who cannot empty their bladder on their own.

For therapeutic purposes, to eliminate stagnation of urine, these manipulations are performed in the following cases:

for emergency forced excretion of urine when the process of urination is delayed for more than 12 hours, which occurs due to various diseases genitourinary system;
in rehabilitation period postoperative intervention on the urinary organs;
with various pathologies of the innervation of the bladder (disturbances of the urinary functions).

Timely and competent conduct of catheterization will allow the patient to avoid deterioration in health, and sometimes death.

Classification of catheters

The use of a catheter for bladder catheterization involves the installation of a curved or straight hollow tube with holes at the ends into the urethra.

Such conductors may be intended for short-term or long-term use. When performing surgery on the organs of the urinary system, disposable short-term catheters are often used. In chronic urinary retention, the installation of this long-acting device connected to the urinal is required.

Depending on the material of manufacture medical practice probes are used:

hard;
elastic.

Rigid structures are made of non-ferrous alloys, are very traumatic and are used only in severe cases of drainage. Metal constructions due to physiological characteristics have different configurations for men and women. Their installation is carried out only by an experienced specialist.

Elastic catheters are more comfortable to install and use. They can be made of modern silicone, flexible plastic, special soft rubber.

Drainage devices can be:

urethral (internal);
suprapubic (external).

Each of these types of catheters has its pros and cons. The suprapubic conductor exits through abdominal wall bypassing the urethra. It is easier to install, less traumatic, more affordable quality care. A person remains sexually active, which is important for long-term use of a catheter.

The urethral type device can easily damage the walls of the bladder, neck during installation. When the device fails, the leaking urine infects the patient's genitals, causing severe inflammation.

According to the design features, they distinguish the following types catheters:

Nelaton (Robinson) disposable device;
Tiemann stent;
the Foley system (which some erroneously call Faley);
Pezzer's device.

Each of these drainages should be considered in detail.

Common types of drains

The Nelaton (Robinson) device is presented in the form of a soft tube of small diameter with a rounded end and is distinguished by a simple mechanism of action. Used for rapid catheterization of the bladder in men and women during surgery or diagnostic urine sampling.

In some diseases of the genitourinary system with a complicated course, a rigid Tiemann stent with an elastic curved tip is used, with which it is possible to reach the bladder through the damaged and inflamed walls of the urethra.

In medical practice, it is most convenient to use a Foley catheter designed for long-term installation. It is a multifunctional 2-way or 3-way device, consisting of a flexible tube with several holes, a special reservoir, with which the system is held inside the body. A catheter of this type can be used to administer drugs, flush the bladder from pus and blood, and release blood clots.

Less common Pezzera catheters are used only for cystostomy drainage, most often for kidney failure. Such systems are a flexible tube with 2-3 functional holes that extends to the outside.

All of these types of drainage have a different diameter. The specialist, depending on the appointments in each case, will select a catheter for the patient on an individual basis.

Drainage scheme in women

Indications and contraindications for the use of bladder catheters

When appointed medical procedure when installing a catheter, the doctor must take into account the indications and contraindications for its implementation. Common indications for bladder drainage are:

any emergency conditions associated with forced diversion of urine due to a violation of the natural process of urination (bladder paresis, adenocarcinoma, prostate adenoma, etc.);
diagnostic measures, when for the correct diagnosis and appointment effective treatment it is necessary to take a portion of bladder urine;
specific diseases of the urethra and bladder, requiring the introduction of drugs into their cavity, washing from pus and blood.

Contraindications to bladder catheterization should be considered:

urinary tract infections (acute and chronic urethritis);
injuries of the urethral canal and bladder;
spasm of the urethra;
lack of urine in the bladder (anuria).

Signs of contraindications to bladder catheterization may occur suddenly, during the illiterate conduct of this procedure due to trauma to the urinary tract.

Preparing to install a drain

In order for the catheterization of the bladder to pass without complications, it is necessary to carefully prepare for it. Necessary conditions the procedure is:

attentive attitude to the patient;
observance of sterility;
perfect technique of bladder catheterization;
high-quality materials for the manufacture of the catheter.

Before manipulation, the patient should be washed from front to back, so as not to bring intestinal flora into the urethral canal. To do this, you can use a weak solution of any antiseptic (Furacilin).

All catheterization equipment must be sterile

Bladder catheterization set includes:

soft or hard catheter;
container for collecting urine;
anesthetic (Lidocaine);
glycerin or vaseline oil to facilitate the installation of a drainage device;
set consumable(cotton balls, napkins, diapers);
tools (syringe for drug installations, tweezers, etc.).

In order to provide the most convenient access to the insertion site of the probe, the patient lies on his back, bends his knees and moves them slightly to the sides. For the successful completion of these medical actions, the patient must be in a relaxed and anesthetized state, and the doctor and nurse must have the necessary experience.

It is worth noting that the male algorithm for carrying out this procedure is the same as the female one. But due to some physiological features of the body structure, catheterization of the bladder in men is much more difficult.

Catheter Insertion Technique

The complexity of the installation of a cystic catheter in men is that their urethral canal is much longer than in women, and has some physiological narrowing. In most cases, a soft catheter is used for this procedure. The technique for performing this procedure requires certain skills and abilities of the doctor and nurse. After the preparatory activities Bladder invasion includes the following main steps:

the surface of the patient's penis is treated with an antiseptic, the head is especially carefully smeared with a cotton swab and anesthetized;
a sterile lubricant is instilled into the opening of the urethra to facilitate the manipulations;
the inserted device is lubricated with glycerin or petroleum jelly;
elastic drainage is inserted by a doctor with tweezers into the external urethral canal;
the catheter is gradually brought to the man far deep into the urethra, slightly turning the device around its axis;
the patient is considered fully catheterized when urine appears in the drainage tube.

Further actions are performed depending on the doctor's prescriptions, in accordance with the technique of bladder catheterization in men. After emptying the urinary organ, it is washed with an antiseptic agent, attaching a special syringe to the catheter. Often, the tube of the installed device with a urinal is permanently fixed during long-term wear and recommendations for care are given.

Carrying out catheterization of the bladder with a metal catheter is carried out similarly, apart from some tricks of the passage of physiologically difficult areas.

Nelaton female catheters

Features of bladder drainage

The female urethra has a short and wide structure, thereby greatly facilitating the installation of the catheter. The stages of bladder catheterization in women include:

high-quality preparation for the procedure with sterile processing of instruments and surfaces of the genital organs;
the introduction of an elastic catheter is made with tweezers into the external opening of the urethra to a depth of 5–6 cm;
the appearance of urine in the device will indicate the achievement of the goal.

After carrying out this procedure, in order to avoid infection, all necessary hygiene rules must be observed. When the catheter is worn for a long time, its outer end is connected to the urinal, which is securely fixed on the thigh.

But it is not always effective to conduct catheterization of the bladder with a soft catheter in women. In some rare cases, metal drainage is used.

Special attention is required for the catheterization of the child. Assign such a procedure when absolutely necessary due to the difficulty of its implementation and high risk complications. Sizes of catheters for a child are selected according to age. Only soft elastic drainage devices are used.

The immune system in children is underdeveloped, so the risk is very high infectious inflammation. Compliance with sterility when performing this invasion of the bladder is one of the main conditions for its success.

Complications during catheterization

The risk of complications during catheterization of the bladder, with its inept performance, is quite high. The procedure is always performed without general anesthesia in order to timely notice the occurrence pain at the patient. You can list the frequent negative consequences that appeared during the installation of a drainage device. These include:

damage or perforation of the urethra;
infection urinary organs in women and men (cystitis, urethritis, paraphimosis, pyelonephritis, etc.);
infection circulatory system through damage to the urethra;
various bleeding, fistulas, etc.

When using a catheter of a larger diameter than prescribed, the female may suffer from dilation of the urethra.

With the constant wearing of the drainage device, it is necessary to strictly follow all the recommendations of the attending physician regarding its operation. Bladder catheterization in women and men must be accompanied by careful hygiene of the perineum and catheter, otherwise serious complications may occur. If you find urine leaks, the appearance of blood in the urinal, with discomfort in the genitourinary organs, you should immediately contact a specialist.

The catheter is removed according to the doctor's instructions. Typically, this kind of manipulation is carried out in medical institution, sometimes can be performed at home. Properly performed catheterization of the human urinary system will help in the treatment of many infectious and noncommunicable diseases and significantly improve their quality of life.