How Do I Perform Self-Catheterization After Bladder Surgery?

Catheterization is the insertion of a urinary catheter into the bladder through the urethra to extract urine. The purpose is to relieve urinary retention, take uncontaminated urine samples for examination, determine residual urine, measure cold and heat sensation, volume, and pressure of the bladder, and inject contrast agents or drugs to help diagnosis or treatment. The surgeon stands on the right side of the patient, wears sterile gloves, disinfects the perineum and urethral opening with sterile water or benzalkonium bromide, sterilizes the front end of the catheter with sterile lubricating oil, and holds the penis in his left hand (for female patients, the surgeon Separate the labia minora with the thumb and index finger of the left hand to expose the urethral orifice), insert the urinary tube into the bladder until the urine out of the urinary catheter. ^[1]

Catheterization

Catheterization is the insertion of a urinary catheter into the bladder through the urethra to extract urine. The purpose is to relieve urinary retention, take uncontaminated urine samples for examination, determine residual urine, measure cold and heat sensation, volume, and pressure of the bladder, and inject contrast agents or drugs to help diagnosis or treatment. The surgeon stands on the right side of the patient, wears sterile gloves, disinfects the perineum and urethral opening with sterile water or benzalkonium bromide, sterilizes the front end of the catheter with sterile lubricating oil, and holds the penis in his left hand (for female patients, the surgeon Separate the labia minora with the thumb and index finger of the left hand to expose the urethral orifice), insert the urinary tube into the bladder until the urine out of the urinary catheter. ^[1]

Purpose of Catheterization:

1. Derive uncontaminated urine samples directly from the bladder for bacterial culture, measure bladder volume, pressure, and check residual urine volume, identify urinary closure and urinary retention to help diagnosis.

2. Release urine for urinary retention patients to reduce pain.

3. Catheterize the patient's urine before organ operation in the pelvic cavity to empty the bladder and avoid accidental injury during the operation.

4. When coma, urinary incontinence or perineal damage, keep the urinary catheter to keep the local dry and clean. After surgery for some urinary diseases , indwelling urinary catheterization is often required to promote the recovery of bladder function and healing of the incision.

5. Rescue patients who are in shock or dying, and record urine volume and specific gravity correctly to observe renal function.

1: Urinary retention caused by various lower urinary tract obstructions.

2: Rescue critically ill patients.

3: Diagnosis and treatment of bladder disease.

4: Perform urethra or cystography.

5: Take uncontaminated urine samples for bacterial culture.

6: Routine catheterization before obstetric surgery.

7: intravesical drug infusion or bladder irrigation.

8: Explore whether the urethra is narrow and understand the cause of oliguria or anuria.

1: Sterile urinary catheterization bag: 1 treatment bowl, 2 urinary tubes, 1 small medicine cup, 2 vascular forceps, 1 paraffin oil cotton ball, 1 specimen bottle, 1 hole towel, and gauze 1 20ml syringe (with 20ml saline)

2: Primary vulvar disinfection items: one sterile treatment bowl (more than 10 cotton balls containing disinfectant solution, 1 vascular forceps), 1 cleaning glove.

3: Others: Sterile holding forceps, sterile gloves, disinfection solution (iodine volts), medium single, potty.

1. Bring something to the bed and explain the purpose of catheterization to the patient to get cooperation.

2. Those who can take care of themselves tell the patient to clean the vulva, and those who can't get up, the nurse assists in washing.

3. The operator stands on the right side of the patient. The patient takes a supine position, bends the hips and knees, stretches the legs slightly, removes the contralateral legs, covers them on the proximal legs, and covers the contralateral thighs with a cover to expose the perineum.

4. Place the small rubber sheet and the treatment pad under the patient's hip, place the curved plate near the perineum, place the dressing bowl and the curved plate between the patients' legs, and wrap the left thumb with a sterile gauze "8" shape, Forefinger, right hand holding a hemostatic forceps to clean the vulva (penis and labia majora) with a 0.1% Xinjieer cotton swab, and then use the left thumb and index finger to separate the labia majora, scrub the labia minora and urethral opening, from the outside to the inside, from top to bottom The cotton ball should be used only once. When scrubbing the urethral orifice, gently rotate the scrub at the urethral orifice and scrub down for a total of two times. The second time, wipe the cotton ball down to the anus. Place the dirty cotton ball in the curved disc and remove it. The left finger yarn is arranged in the dressing bowl, the dressing bowl is removed, and the curved plate is placed at the end of the bed.

5. Remove the sterile urinary catheter and place it between the patients' legs. Open the urinary catheter and pour 0.1% of Xinjieer into a small cup filled with dry cotton balls. Wear sterile gloves, lay a hole towel, and make the hole towel and the urethral catheter. The cloth forms a sterile area.

6. Take a curved disc and place it on the left side of the patient s eyelet. Lubricate the front end of the catheter with a paraffin oil cotton ball and place it in the curved side of the eyelet. Separate and fix the labia minora with your left hand, and use a hemostat with your right hand. Cinch new Jieer cotton swabs from top to bottom, disinfect the urethral orifice from the inside to the outside (gentlely rotating and disinfecting the urethral orifice after scrubbing downwards, a total of two times) and the labia minora, each cotton ball is limited to one use. After scrubbing

1. The patient was lying on his back with his legs bent and abducted, with a tarpaulin under the buttocks or a midsole. The patient first washed the vulva with soap solution; the male patient opened the foreskin and washed it.

2. Disinfect the urethral orifice and vulva with 2% red mercury or 0.1% siemenil or 0.1% chlorhexidine solution from the inside to the outside. Later, the vulva was covered with a sterile hole towel, while the man covered the penis with a sterile towel to expose the urethral opening.

3 The surgeon wears sterile gloves and stands on the right side of the patient. The penis is held by the left thumb and forefinger. The female separates the labia minora to expose the urethra. The outer end of the tube was closed with a hemostat, and its opening was placed in a sterile curved plate. About 20-22cm for men and 4-6cm for women. Release the hemostatic forceps and urine will flow out.

4 For those who need to be cultured in bacteria, save the middle section of urine in a sterile test tube for inspection.

5. After the catheter was closed, the catheter was slowly pulled out to prevent urine from flowing out of the tube from contaminated clothing. When indwelling catheterization is needed, fix the urinary tube with adhesive tape to prevent it from coming out. Clamp the outer end with hemostatic forceps and wrap the mouth with sterile gauze to prevent urine from escaping and contaminating. Bacteria plastic bag hanging on the side of the bed.

1. Strict aseptic operation to prevent urinary tract infection.

2. Insert the urinary tube gently so as not to damage the urethral mucosa. If there is a blocking feeling during insertion (do not insert it very much), you can change the direction (also 2-3cm back, inject paraffin oil into the ureter to lubricate the urethra). Insert 5-7 (male) / 2-3 (female) cm when there is urine outflow, do not be too deep or shallow, especially avoid repeatedly pumping the urinary tube. (Although a guide wire can be inserted very quickly and powerfully, it is most likely to damage the urethral mucosa, so it can be removed before; the paraffin oil must be repeatedly applied to the catheter twice)

3 Choose the thickness of the catheter, suitable for children or suspected

The oldest record of TCM urinary catheterization in Jin Dynasty

Li Shizhen's "Compendium of Materia Medica", the 18th volume of the "King melon" article quoted Jin Gehong "behind the elbow" and said: "Urine is not passable, the root of the gourd pounds the juice, the less is hydrolyzed, and the tube is blown into the lower part" If it is blown into the anus, it will not work, and it will be blown back and forth. "This is the earliest Chinese medical literature on urinary catheterization, although the" lower blow "in the text does not say that it is blown into the anterior yin. However, according to the later "Blowing Back and forth", it can be determined that its "lower part" is actually the anterior yin (urethral orifice), and the tube is a urinary catheter. This method uses a catheter to blow viscous liquid into the urethra. With the expansion of the liquid, the liquid is poured back into the bladder, thereby forming a liquid channel between the bladder and the urethra, leading to urine, thereby achieving the purpose of catheterization. This method of urinary catheterization is called mouth-blowing-liquid infusion. Although the literature does not explain what the "tube" as a urinary catheter is, or how deep the urethra should be inserted, and there are many difficulties in the operation of this method, and the success rate is limited, but it is sufficient to prove that Doctors have indeed applied urinary catheterization in clinical practice.

During the Northern and Southern Dynasties, Chen Yanzhi cited this type of urinary catheterization again. According to Japanese Dan Bo Kanglai's "Heart of Heart" Volume 12 and Dan Bo Yuan Jian's "Guangzhou Miscellaneous Diseases" "Guan" quoted: Unreasonable Guangefang: Take raw soil melon roots, mash the juice to reduce the hydrolysis in the tube, and blow the inner and lower parts to pass. "It can be seen that this method has been used by doctors.

Appearance of new urethral catheterization in the Tang Dynasty

Due to the limitations of oral blow-liquid back-filled urinary catheterization, its clinical application has been limited to a certain extent. However, with the continuous deepening and development of traditional Chinese medical practice, two new urinary catheterization methods appeared in the Tang Dynasty. TCM urinary catheterization has been enriched.

First of all, Sun Sijiu described the onion tube bleed-type urethral catheterization. According to "Preparation for Qianjin Qianfang": "Where the urine is not in the cell, it is a lonely cell, the fluid is not accessible, and the onion leaves are used to remove the pointed head and to be contained in the penis hole It is three inches deep, blown with a mouth, swells, and the fluid is healed. "This text details the indications for urinary catheterization, the depth of the urinary catheter and the depth of the urinary catheter and the specific operation method. In the early stage, It is undoubtedly the finest description in the literature. The principle of this method lies in the conduction of the onion tube and the expansion of the urethra through the tension of the gas, forcing the gas into the upper arm to cause "swelling", and then opening the upper arm sphincter, and using the urine retention The pressure of the bladder itself excreted urine. The advantages of this method are simpler operation, easier to master, less damage to the urethra, and less chance of postoperative infection. It is an ideal method for urinary catheterization.

Later, Wang Xi's "The Secret of Waitai" Volume 27 quoted the onion tube-medicine-mouth-blooded urinary catheterization method recorded in Zhang Wenzhong's "Emergency Emergency": "The emergency leader urinates unreasonably: take the printed seven salt The prayer sieve is used as the end, and the green onion leaf tip is used to hold the salt, and the small leaf in the inner hole of the hole is opened. Blowing the salt to the hole is very effective. This method is different from the previous method in the onion tube The addition of salt, as the operator's subjective thought may be the diuretic effect of salt, but objectively speaking, its principle of action is still the use of gas expansion, which is no different from the previous method. Because the operator's subjective hope is Drugs, so during the operation, the focus is on blowing the drug into the urethra, and the point of blowing gas into the arms is ignored, so its success rate is low.

For a long time, most people think that Sun Simiao is the first medical practitioner in China and even the world to use urinary catheterization. But research shows that Ge Hong and Chen Yanzhi had already used urethral catheterization before Sun's, so in the history of Chinese medicine, Sun Siyi was not the first medical doctor to apply this technique. Recently, some people believe that "Xiaopinfang" recorded "the world's earliest flushing, urinary catheterization and enema laxative operation." The statement is also inaccurate. Specifically, the three types of urinary catheterization that appeared from Jin to Tang did not inherit and develop from each other. Ge Hong, Sun Siyi, and Zhang Wenzhong all independently found and applied urinary catheterization. Therefore, in the sense of medical history, each of the three has its own initiative, but in terms of time, Ge Hong was earlier. Therefore, the period from Jin to Tang was the pioneering period of TCM urinary catheterization. The urinary catheterization in this period was marked by mouth-blowing, and the catheter was mainly onion tubes.

Improvement of Early Catheterization in Yuan Dynasty

Although early urethral catheterization has its advantages, its own shortcomings are also obvious. First, the onion tube was too soft and brittle, which caused some difficulties in the operation process. Second, the ancient doctors were mostly male, and the mouth-blowing type was not suitable for female patients. This has made useful improvements for future generations. Ruming Yanggong's "Summary of Medical Formulas" for urinary closure "use a terrier dog to study, put a little borneol musk, and the sacral tube is blown into the stem." Even if the sacral tube is used instead of the onion tube, the application of drugs is also more complicated. However, Luo Tianyi, a doctor of the Yuan Dynasty who contributed the most to the improvement of catheterization, wrote in the book "Sanbaomen" in Health Book 17: "There is a prostitute, the disease turns to dysentery, the urination is unreasonable, and the abdominal distension is like a drum. For several months dying, a medical pig's pancreas was inflated, put on a sacral tube, put it in the urine, and blown into the air, that is, the urine was healed. "This record not only replaced the onion tube with a sacral tube, but also used a pig. Bladder blowing instead of direct air blowing from the population is also suitable for female patients, and the operation process is more sophisticated. The pig's bladder, sacral canal, and patient's bladder constitute a closed system. After the gas is twisted into the patient's bladder, in addition to using the patient's bladder In addition to the pressure of the catheter, the urethral catheter also has a negative pressure suction effect, so the method is more advanced, and the success rate is greatly improved. Characterized by the emergence of a new type of urinary catheterization marked by sacral canal and indirect air blowing, the development period of TCM urinary catheterization in the Yuan Dynasty.

The widespread application and theoretical recognition of urethral catheterization in the Ming Dynasty

With the continuous deepening of medical practice, urinary catheterization has gradually been accepted by the majority of doctors for its simplicity and effectiveness. By the Ming Dynasty, this technique had been widely used. This was first manifested in the large amount of medical literature at that time. . For example, Li Shizhen's Compendium of Materia Medica, Wang Kentang's "Guidelines for the Rule of Cure", Zhu Xi's "Puji Fang", Sun Yikui's "Red Water Xuanzhu", Zhang Jingyue's "Book of Jingyue", etc. Various methods of urinary catheterization are recorded in different ways, of which the Compendium of Materia Medica is more prominent, and it quotes almost all the descriptions of urinary catheterization in ancient literature. For example, under Volume 3, "Dripping and External Treatment": "The onion tube is inserted into three inches and blown through" is obviously the Sun Sifu method; "Fried salt is blown into the hole" is obviously the Zhang Wenzhong method; "Into the hole" is obviously the Yanggong method; the "pigsing and blowing method" is obviously the Luo Tianyi method. Secondly, the widespread use of urinary catheterization in the Ming Dynasty is also manifested in the conscious application of clinical practice by Li Shizhen and others. Li Shiyun: "The onion tube blows salt into the jade stem. The rule was successful. "

Although Luo Tianyi described advanced urinary catheterization, his literature described only a medical case, which was discovered by accident. Therefore, the promotion of this method needs to be theoretically affirmed. To be included in the category of TCM therapy may be the opportunity to make a lot of choices and comparisons by using urinary catheterization. Therefore, in the Ming Dynasty, the improved urinary catheterization was theoretically recognized, such as "Red Water Black Pearl" Volume 15 "Urine can not open the door, miscellaneous prescriptions", "use pig urine cells, a tip at the bottom, use The tube passes, placed in the hang, the bottom of the tube is tied with a thin rod, the tube of the tube is blocked with a thin rod, the urine is sealed with wax on the oral cavity, blown with gas for seven minutes, tied, and then the root of the tube is twisted by hand. Put the yellow wax, plug the tube and put it on the urinary head, let go of the root tube of the sacral canal, and let the air pass in. Natural urination, the magic effect. At the same time, the "Zheng Zhi Zhi Yuan" also has exactly the same discussion. This description It is no longer a medical record, but a more abstract theoretical description. At this point, the new type of urinary catheterization has been recognized by the theoretical community and has become one of the conventional methods for treating urinary retention. Therefore, the Ming Dynasty was a mature period in the history of the development of urinary catheterization. Its main performance lies in the widespread use of new urinary catheterization and theoretical recognition. ^[2]