Urologic Procedures



Urologic Procedures










Urinary tract infections (UTIs) are the most common nosocomial infections. A common cause of these infections is poor infection control practices by health care workers during placement of catheters in the urinary bladder or during care for patients who have indwelling catheters in place. Radiographers frequently work with patients who have urinary catheters in place. Although no longer a common practice, radiographers may be responsible for inserting a catheter into the patient’s urinary bladder before radiographic imaging procedures take place.

Catheterization of the urinary bladder refers to the insertion of a plastic, silicone, or rubber tube through the urethral meatus into the urinary bladder. Catheters are inserted into the urinary bladder for a number of reasons: to keep the bladder empty while the surrounding tissues heal after surgical procedures; to drain, irrigate, or instill medication into the bladder; to assist the incontinent patient to control urinary flow; to begin bladder retraining; or to diagnose disease, malformation, or injury of the bladder.

Cystography, retrograde pyelography, and placement of ureteral stents all involve radiographic imaging. These procedures are performed frequently in the special procedures area of the radiographic imaging department or in the cystoscopy laboratory. As part of the health care team, radiographers actively participate in these diagnostic examinations and treatments because fluoroscopy and radiographic images are required while they are in progress.


PREPARATION FOR CATHETERIZATION

The urinary bladder is sterile; therefore, urinary catheterization requires sterile technique. Because the urinary bladder is easily infected, any object or solution that is inserted into it must be free of bacteria and their spores. Infection or injury may result when the technique used in the performance of the catheterization of the urinary bladder is poor or when caring for a patient.

Catheterization is not performed without a specific order from the physician in charge of the patient. It is less stressful for some patients if male technologists catheterize male patients and female technologists catheterize female patients. Although there will probably be a radiology nurse available in the imaging department to perform catheterization, or the patient may come from the floor with a catheter already in place, it is important for the technologist to understand the procedure in the event it becomes necessary to perform it.

When a physician requests catheterization of a patient, it must be established which type of catheter is to be used. Depending on the reason for the radiographic procedure, a straight catheter or an indwelling catheter (usually a Foley) is chosen. A straight catheter is used to obtain a specimen or to empty the bladder and is then removed. An indwelling catheter is inserted and left in place to allow for continuous drainage of urine. Most hospitals provide prepared sterile trays for catheterization with the desired type and size of catheter and the necessary equipment included. A tray set is chosen according to the type of catheter to be inserted. The equipment needed to perform catheterization is listed as follows:

1. Straight or indwelling catheter

2. Antiseptic solution (swabs or solution with cotton balls)

3. Water-soluble lubricant

4. Sterile gloves

5. Sterile drape

6. Sterile forceps if using cotton balls for cleansing meatus

7. Closed drainage system set (indwelling catheter)

8. Receptacle for draining urine (straight catheter)

9. Specimen bottle

The antiseptic solution most frequently used for cleansing the penis or the female perineum before catheterization is a povidone-iodine solution. For cleansing purposes, the patient must be assessed for allergic response to iodine before this solution is used. A drape sheet and an extra means of casting light on the perineal area are also needed. Do not attempt to catheterize a female patient unless adequate lighting is provided. Catheter size and tips vary and are graded according to lumen size, usually on the French scale. The size of the catheter is listed on the prepared catheterization set.

A straight catheter is a single-lumen tube (Fig. 11-1). Indwelling catheters have a double lumen with an inflatable balloon at one end. One lumen is attached to a urinary bag to allow for continuous urinary drainage; the other lumen is a passageway controlled by a valve that serves as a portal for instilling sterile water into the balloon. The balloon holds the catheter in place after it is inserted into the bladder (Fig. 11-2). A third type of catheter, known as the Alcock catheter, may occasionally be seen. This type of catheter has three lumens in which the third lumen provides a passage for irrigation solution and is used for patients in need of continuous bladder irrigation.







FIGURE 11-1 The top catheter depicts a straight catheter.






FIGURE 11-2 A Foley catheter with the balloon inflated.


May 8, 2019 | Posted by in GENERAL RADIOLOGY | Comments Off on Urologic Procedures
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