How does a catheter work?
A catheter is a thin tube, which gets inserted into the bladder. The bladder catheter serves thereby diagnostical and therapeutic purposes. Whether it is transurethral or suprapubic: Whether it has a stiff or a flexible tube, it drains urine. The distinguishing characteristics are the duration of use, materials, length, shapes and sizes, also called as Charrière-sizes.
Catheter – Medical application for continence care
For therapeutic purposes the catheter is inserted into the hollow organs of the body and gives patients at home, on the way or during the night a safe feeling: regardless of whether it is used in nursing-homes, in hospitals, for paraplegics or for homecare.
The bladder catheter is no longer indispensable within the continence supply. It serves the purpose to drain the bladder, whenever the natural urination no longer is possible.
Whether external- or intermittent self-catheterisation - During the catheterisation a tube is inserted into the bladder, regardless if it is through the urethra (transurethral) or through the abdomen (suprapubic). Appropriate catheter-sets serve the purpose to place, replace or caretaking of catheters for both men and women. Bladder catheters distinguish between catheter types, permanent catheters and disposable catheters as well as catheter tips.
Catheter – Transurethral bladder catheter
The transurethral bladder catheter gets into the bladder via the urethra. In this area they either can be used for long-term drainage or single use. Transurethral catheters intended for long-term drainage have different application periods, depending on different material properties, and is used for urinary incontinence, as irrigation catheters or for micturition disturbances.
Transurethral single use catheters are used for intermittent self-catheterisation (ISC) or intermittent external catheterisation. This catheter is especially used for neurogenic micturition disturbances, for urine extraction or diagnosis.
Catheter – Suprapubic bladder catheter
This catheter is not inserted naturally through the urethra. Instead this catheter reaches the bladder by puncturing the abdominal wall and thereby inserted invasive above the pubic bone. The catheter is most likely fixated by using a balloon and in very seldom cases it is fixated by sewing the catheter on the skin. This catheter is used for micturition disturbances, infections, urinary retention or when a transurethral catheterisation is not possible.
What types of catheters exists?
The catheter tips not only differ between size and placement of the openings, the so-called eyes, but it rather also differentiates by the shape and curvature.
Bladder catheters with straight tip
- Central open
A bladder catheter with a Nelaton-tip have a straight, closed hollow tip, which have a rounded end. Beneath the catheter tip the urine can either be drained through the two oppositely placed eyes or up to four lateral staggered eyes. It can be used suprapubic as well as transurethral.
When talking about an olive-tip, it refers to a straight catheter tip, which is characterised by its conical tapered shape. The tapered shape is equipped with a spherical thickening at the end.
Catheter according to Couvelaire: A Couvelaire-tip – also known as Whistle-tip – have an open, spoon-like shape with two eyes, which are aligned laterally. Due to its bigger sized opening, this catheter tip is especially suitable for irrigation catheters, in order to flush clots away.
A catheter with a central opening and lateral aligned eyes, the drainage takes directly place at the tip. The tip is significantly shorter than other long-term catheters and thereby reduces irritations in the bladder wall. Catheters equipped with a central open tip are only used suprapubic and can be inserted into the bladder by using a guidewire.
Bladder catheters with a curved tip
A bladder catheter equipped with a Mercier-tip is similar to a Nelaton-catheter, only that the tip is bent by 30°. Hence it is also described as beak shaped. Moreover, the cylindrical, curved catheter tip is equipped with two lateral staggered eyes. Advantages of this variant: Thanks to its curved shape, this variant is popular among men, because the insertion is easier, due to curvature of the male urethra. This catheter-type finds further applications for special treatments and for the examination of the bladder.
The Tiemann-catheter are also most likely used by male patients, as the special shape is well suited for passing the rear end of the male bladder. This variant is conical tapered, slim and slightly bent by 30° (Similar to the Olive-tip). Moreover, the hollow tip at the end is minimally enlarged. As an exception, this variant is usually only equipped with one drainage eye.
A bladder catheter with a Dufour-tip is similar to a Tiemann-catheter, with the difference that it is equipped with two lateral staggered eyes rather than one. Besides that, the tip is open and bent by 30°. The atraumatic Dufour-tip is well suited for an optimal and problem-free passage of the prostatic fossa.
Who can place a catheter?
Catheterisation – Suprapubic catheter
Regardless whether transurethral or suprapubic – a written prescription of a doctor is mandatory.
During a suprapubic bladder puncture, or rather during a suprapubic fistula, the first placement should always be undertaken by a doctor and is non-delegable. The conditions during the catheterisation shall be sterile. The first placement usually takes place in clinics or outpatient departments.
The replacement of a suprapubic bladder catheter shall be undertaken by a doctor or medical professionals.
Catheterisation – Transurethral catheter
The catheterisation of a transurethral bladder catheter can be placed by examined nurses, if there is a medical prescription for it. Here there are no differences between the first placement and replacement of a transurethral bladder catheter.
Regardless of male or female: examined nurses have been taught the catheterisation during their education. In reality though, it happens quite often that the catheterisation of males, in nursing homes or outpatient departments, is not undertaken by the nurses. The majority of care centres rejects this procedure, due to possible complications. In such cases, an independent urologist takes over the process or the patients are directed to clinics.
Hygiene plays an important role during this process. A germ-free condition, sterile gloves and the usage of disinfectant is absolutely necessary. Only by strictly following the instructions, the risk of transmitting germs and ascending infections can be reduced.
Whether a transurethral or suprapubic bladder catheter: In case of a surgery, the doctors or nurses places the catheter directly during the surgery.
Self-catheterisation – Intermittent Self-Catheterisation (ISC)
This method refers to a procedure, where a nurse is not needed for catheterising the patient. Sterile packed ISC-catheters are essential for the mobile usage of treating micturition disturbances. The products for self-catheterisation are available as ready for use or not ready for use variants with different coatings. Ready to use ISC-catheters are slippery and can be used without any preparation time. The ISC-catheters which are not ready to use has to be coated with the enclosed sterile water pouch, in order to activate the gliding property.
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