This document provides an overview of urethral catheterization procedures. It defines different types of catheters and discusses catheter anatomy and indications for use. The document outlines the necessary staff and supplies for catheterization and provides a step-by-step description of the catheterization technique for both males and females. Potential complications are reviewed as well as post-procedure care and things to watch out for after catheterization.
Objectives :
-List the indications and contraindications for urinary catheterization.
- Indicate the appropriate catheter type/size.
- Discuss the risks associated with catheterizations.
-Describe the equipment for female/male/pediatric urinary catheterization.
- Discuss a safe method of performing urinary catheterizations .
Objectives :
-List the indications and contraindications for urinary catheterization.
- Indicate the appropriate catheter type/size.
- Discuss the risks associated with catheterizations.
-Describe the equipment for female/male/pediatric urinary catheterization.
- Discuss a safe method of performing urinary catheterizations .
COLONOSCOPY- A PICTORIAL OVERVIEW
• Dear viewers,
• Greetings from “Surgical Educator”
• This week I have uploaded a video on Colonoscopy- the Lower GI Endoscopy.
• In this episode, I showed only the colonoscopic features of common pathologies in colon and rectum.
• I restricted my talk to the essential minimum that an undergraduate medical student must know about the Colonoscopy.
• I discussed about the diagnostic and therapeutic procedures you can do with the Colonoscopy.
• I hope it would be interesting and very useful to all my viewers.
• You can access this video in the following links:
• surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
• Thank you for watching the video.
COLONOSCOPY- A PICTORIAL OVERVIEW
• Dear viewers,
• Greetings from “Surgical Educator”
• This week I have uploaded a video on Colonoscopy- the Lower GI Endoscopy.
• In this episode, I showed only the colonoscopic features of common pathologies in colon and rectum.
• I restricted my talk to the essential minimum that an undergraduate medical student must know about the Colonoscopy.
• I discussed about the diagnostic and therapeutic procedures you can do with the Colonoscopy.
• I hope it would be interesting and very useful to all my viewers.
• You can access this video in the following links:
• surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
• Thank you for watching the video.
Catheterization Procedure by Anushri Srivastav.pptxAnushriSrivastav
Catheterization of the bladder involves introducing a latex or plastic tube through the urethra and into the bladder. The catheter provides a continuous flow of urine in patients unable to control micturition or those with obstructions. It also provides a means of assessing urine output in hemodynamically unstable patients. Because bladder catheterization carries the risk of UTI, blockage, and trauma to the urethra, it is preferable to rely on other measures for either specimen collection or management of incontinence.
Types of Catheterization.
Intermittent and indwelling retention catheterizations are the two forms of catheter insertion
INTERMITTENT CATHETERIZATION
introduce a straight single-use catheter long enough to drain the bladder (5 to 10 minutes
When the bladder is empty, you immediately withdraw the catheter.
COMPLICATION- increases risk of trauma and infection.
INDICATION- It is common for people with spinal cord injury or other neurological problems such as multiple sclerosis to perform self– intermittent catheterization up to every 4 hours daily for months or years.
UTI rate is lower than for patients with long-term indwelling catheters.
INDWELLING CATHETERIZATION-
remains in place for a longer period, until a patient is able to void voluntarily or continuous accurate urine measurements are no longer needed
The straight single-use catheter has a single lumen with a small opening about 1.3 cm ( 1 2 inch) from the tip.
. Urine drains from the tip, through the lumen, and to a receptacle.
An indwelling Foley catheter has a small inflatable balloon that encircles the catheter just above the tip. When inflated the balloon rests against the bladder outlet to anchor the catheter in place.
The indwelling retention catheter often has two or three lumens within the body of the catheter . One lumen drains urine through the catheter to a collecting tube. A second lumen carries sterile water to and from the balloon when it is inflated or deflated. A third (optional) lumen is sometimes used to instill fluids or medications into the bladder. It is easy to determine the number of lumens by the number of drainage and injection ports at the end of the catheter
A second type of intermittent catheter has a curved tip
A Coudé catheter is used on male patients who may have enlarged prostates that partly obstruct the urethra. It is less traumatic during insertion because it is stiffer and easier to control than the straight-tip catheter
Plastic catheters are suitable only for intermittent use because of their inflexibility
Latex catheters are recommended for use up to 3 weeks. Be aware of allergies.
Pure silicon or Teflon catheters are best suited for long-term use (2 to 3 months) because of less encrustation at the urethral meatus
Balloon sizes range from 3 mL (pediatric) to large postoperative volumes (75 mL). In adults the 5-mL and 30-mL sizes are the most common: The 5-mL size allows for optimal drainage, whereas the 30-mL size is used after pros
Urinary catheterisation is a procedure used to drain the bladder and collect urine, through a flexible tube called a catheter. Urinary catheters are usually inserted by doctors or nurses in hospital or the community.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
2. OVERVIEW
WHAT – DEFINITION,TYPES
WHERE – ANATOMY
WHY, WHEN – INDICATIONS AND CONTRAINDICATIONS
WHO – STAFFS
HOW –
PREREQUISITES
TECHNIQUES
POST REQUISITES
COMPLICATIONS
15. TECHNIQUE
Step 5 Set up
Sterile field
Lay down
Equipment
Take SWFI
adequate
amount
Take
Betadine
Take Jelly in
sterile
method
Step 6 Don Sterile
Gown
Don Sterile
Gloves
Step 7 Test
Equipment
Inflate
Foley
balloon
Step 8 Painting
(3 swabs)
From
umbilicus
To mid
thighs
Retract
foreskin
Step 9 Draping EYETOWEL
16. TECHNIQUE
Step 10 Lubricate
urethra
Use a full tube of
2% lignocaine
jelly in males
Or at least 10 ml in a
syringe without a
needle
1ml per
cm of
Urethra
Step 11 WAIT
Use Penile
Clamp
Or, Grab the penis
anterio-posteriorly
Prevent
spillage
For at
least 2-5
minutes
17. TECHNIQUE
Step 12 Lubricate
Foley
Step 13 Hold the
penis at 90°
Straighten and
stretch the penis
slightly
Step 14 Introduce the
catheter
Gentle
pressure
Step 15 Advance
Until theY-
shaped ports
reach meatus
Resistance
may be felt at
Sphincter
18. TECHNIQUE
Step 16
Wait for
urine to
drain
May be
delayed by
jelly
Aspirate with
syringe with
minimal force
Step 17
Once flow
of urine is
observed
Inflate
balloon
WITH SWFI
Should be
pain free
Step 18 Connect Urine
collection bag
Step 19 Retract
catheter
Until
resistance
19. Step 20 Fix
catheter
To medial or
anterior surface
of thigh
No tension
on the
catheter
Omega
Technique
Step 21 ROLLBACK FORESKIN
Step 22 Measure the urine
drained immediately
Step 23 Documentation
TECHNIQUE
20. KEY DIFFERENCES IN FEMALES
Urinary opening is different from Genital opening and comparatively smaller
Position the patient in Frog leg
Length of the urethra is significantly smaller, therefore, instillation of jelly into the
urethra is not essential
Insertion of the entire length of the catheter is also not required,
~10-15cm of length is sufficient
21. TECHNIQUE
Tips for Good Catheterization
ALWAYS PROVIDE PROPER PRIVACYTO PATIENT
Watch the patient’s face during each step
Communicate with the patient and explain what you are doing
DO NOT USE EXCESSIVE FORCE, EVER
29. POST CATHETERIZATION CARE
Clean the catheter with Normal Saline from EUM up to the Ports of the
catheter
Clean Genitalia with Normal Saline
Retract the Foreskin and remove all smegma,Then roll back the foreskin
again
Wash penis and scrotum as well
In females, wash the entire introitus including labial folds
Keep the drainage system closed
30. POST CATHETERIZATION CARE
Adequate hydration should be done to keep the urine dilute
2-3L of oral water intake in normal adults unless contraindicated
Patients can be allowed to shower with a catheter in place
Always keep the Urobag below the level of the bladder to prevent reflux
Keep the Urobag off the floor
Catheter should not come below the patient’s body or legs
31. RED FLAGS
Accidental removal of the catheter with an inflated balloon
DO NOT REPLACE CATHETER
Fever >101°F or 38.3 ° C
No urine draining in the bag
Foul smelling urine
Bright red-coloured urine or large volume of clots
Persistent Supra-pubic pain
Good afternoon everyone
and welcome to today’s talk on a topic that is so simple that it is performed on a daily basis in all wards but equally complex, that if something goes wrong, it can even lead to a permanent disability in a patient
Today, we will be talking about what- that is the definition and types of catheterization,
Where, the brief anatomy of relevant organs
Why and when, that is the indications and contraindication of the procedure
Who can perform the procedure and finally how and how not to perform the procedure.
First things first,
Urethral catheterization and foley catheterization are used synonymously, but are they the same??
Actually, they are not
Urethral catheterization is the insertion of any catheter through the urethra for draining urine, washing the bladder or to instill medications in the bladder.
Whereas Foley catheterization in insertion of specific type of catheter, that is the Foley catheter in some part of the body. Apart from Urethra, it can be used for cervical ripening during induction of labour, washing extradural hemorrahges in burrhole surgeries and also to stop epistaxis.
Though not recommended, it can also be used as a Tourniquet.
Urethral catheterization can be intermittent type, where the catheter is removed after the completion of the procedure. Commonly call in and out procedure. It can performed with Robinson’s catheter also known as the red rubber catheter
The Nelaton’s catheter and the tiemann catheter.
The second type is the indwelling type, where the catheter is left in situ after the procedure is completed for some time maximum of 2 weeks to 3 months, depending upon the type of material the catheter is made up of. It is most commonly done by using a Foley catheter
The foley catheter is a self-retaining multi-lumen catheter, made from Natural latex rubber, polyurethane, Silver alloys and Silicone.
It may be double-lumen and up to four lumens.
In a double lumen catheter, one of the lumens is used for draining the bladder and the other one is used for inflating the balloon.
The extra lumen in the triple lumen catheter is for connecting the irrigating fluid for washing the bladder.
Recently there has been the development of various types of Foley catheters such as premedicated and silver-coated catheters to decrease the incidence of CAUTI, temperature sensing catheters to measure the temperature of the body through the bladder and also catheters with a drainage bag attached to it.
These catheters come in different sizes.
And like with all tubes whose sizes are measured in French, these catheters are also colour code labelled.
The most commonly used foley catheters are labelled with green or orange, that is of 14Fr and 16Fr catheters.
The knowledge of anatomy required for proper foley catheterization is what sets the male and female sexes apart.
In both males and females, urethral catheterization involves the introduction of a catheter from the External urethral meatus through the urethra up to the bladder but.
There are some key differences
The urethra for one is around 4cm long in females whereas it is more than 6 times the length in males.
The urinary and genital tracts open separately in females but are the same in males
The urethra is essentially straight in females but the male urethra is S-shaped.
The identification of the external opening may be difficult to an untrained eye in females but can be easily identified in males.
Resistance can be felt in various location while catheterization in males but it is not so in females
Who is entitled to perform urethral catheterization.
Does he/she need to be an urologist?
Normally NO
A paramedic, A Nurse or Any doctor can perform this procedure.
When they do this at the right time in the right place, they become superheroes in the eyes of the patient
Because in the words of Wise Birbal, “there is no greater satisfaction to a human than to pass urine when it is urgent!”
There are two sets that can be seen in the picture
The first one is Dressing set
It has a kidney tray, hemostat and toothed forceps with some gauze
It has a one extra thing and a piece of essential equipment that is missing
This is now a catheter set
It has a sponge holding forceps, a kidney tray with some gauzes and an eye towel.
Complications of catheterization include
CAUTI or Catheter-associated urinary tract infection is one of the most common complications of catheterization.
It can be prevented by using sterile techniques during catheterization, and in modern times, the use of pre-medicated catheters though not available in our set-up.
Next is Iatrogenic Paraphimosis, which usually occurs due to failure or negligence of the person performing the procedure to roll back the foreskin after completion of the procedure. Simple rolling back of the foreskin will prevent this, however if paraphimosis does occur, manual reduction of the foreskin can be attempted in the ward, and if not successful, can be done under anesthesia. If that is still not successful, a dorsal slit will have to be made followed by circumcision once the swelling subsides.
Next is Iatrogenic Paraphimosis, which usually occurs due to failure or negligence of the person performing the procedure to roll back the foreskin after completion of the procedure. The simple rolling back of the foreskin will prevent this, however, if paraphimosis does occur, manual reduction of the foreskin can be attempted in the ward, and if not successful, can be done under anaesthesia. If that is still not successful, a dorsal slit will have to be made followed by circumcision once the swelling subsides.
Rarely Glans amputation or Penile amputation may be required if the distal penile tip is necrosed because of paraphimosis, usually seen in comatose patients.
Urethral injury can occur during the course of the procedure or may develop as a reaction of the insult of the catheter some months later.
False passages and urethral perforation are can occur when excessive force is exerted upon the catheter in a mechanically obstructed urethra
Urethral tears can occur if the balloon is inflated within the lumen of the urethra
Urethral strictures can form months later even with a clean procedure because of tissue reactions to micro insults that are bound to occur during catheterization.
Patients usually have hematuria or scrotal swelling may occur due to urine leakage into the surrounding area.
Treatment can be done for minor injuries by cystoscopy guided foley catheterization and prolonged catheterization. Some patients may even require urethroplasty or even lifelong urinary diversions.
Urethral strictures can be treated effectively by urethral dilatations.
Accidental removal or pulling the catheter is usually seen in mentally differently-abled patients with psychiatric disorders.
Or it can happen if the balloon is punctured, which can be due to a manufacturing defect.
If there is an accidental withdrawal of the catheter with an inflated balloon, it will result in urethral injuries, which may lead to the patient requiring urethroplasty or life-long urinary diversion.
Therefore, one of the primary ways of preventing accidental removal is testing the equipment before insertion, using adequate anaesthetic and lubricating agents to avoid irritation to the urethra and fixing the catheter properly.
Catheter blockage can be because of hematuria or Sediments.
If the catheter is blocked, the blockage can be attempted to be removed by flushing the catheter with Irrigation syringe with NS. Or the catheter can be changed altogether
Formation of sediments is only natural in patient with long term foley catheter can does not require taking any actions unless the patient is symptomatic for UTI or if the catheter is blocked.
Bladder dysfunction may occur in a patient who has undergone catheterization for a long time.
The bladder literally forgets how to do its job, hence the bladder needs to be trained to regain the function
Bladder training can be done by removing the catheter of more than 7 days by clamping the catheter for 2 hours and releasing the clamp for 10 minutes and repeating the cycle for 24 hours or more as required except at night.
Sometimes bladder training may be required even up to 7 days.
However, in rare cases, bladder dysfunction may be prolonged and not relived by training alone.
These cases can be diagnosed with Cystometrogram and can be attempted to be treated with CISC or clean intermittent self-catheterization.
And just for your information, our institution has one of the most advanced Cystometrogram in the country and is a referral centre for the procedure.