catheterization

this is for sem4 Renal system - catheterization.

first, i would like to state that it is not very likely that catheterization will come up for OSCE physical Examination (In IMU.) reasons being;

• it is a relatively long procedure, it is very difficult to complete it within 5 mins
• it needs a sterile equipment (sterile gloves need to be unraveled properly)
• it needs manipulation to remove the catheter after the student inserts the catheter - which means the examiner has to remove the catheter. highly unlikely for them to move so efficiently. (haha j/k. just troublesome)
• i am not sure if they have more than 2 models for catheterization in IMU.

HOWEVER, they may very well ask this in a stand-alone OSCE question. in which case not only they will ask about the procedure, they may ask about;

• indication
• contraindications
• complication
• anatomy / physiology behind it
• materials needed

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procedure

1. GIEP - explain very clearly how the catheterization will be performed, and what s/he might expect to feel during the procedure. inform patient it would feel like s/he must urinate, and that it may be slightly uncomfortable. Also explain that cooperation is needed to be still during procedure. Also, talk about chaperone  
2. inspect area for any bleeding (reason will be stated later in this post) or injuries
3. obtain appropriate catheterization kit / supplies
4. follow aseptic techniqes and standard precautions by washing hands and putting on sterile gloves
5. open kit in sterile manner
6. prepare patient by draping him in sterile drapes found in kit, and expose the genital area - maintain patient's privacy and comfort 
7. open the catheter and place on the sterile drape using aseptic technique.
8. once operator is gloved, an assistant is required to squirt some lubricant into the syringe. 
9. if there is a pre-filled sterile syringe with water-soluble lube in the kit, step 8 can be omitted
10. open package of povidone-iodine and pour onto cotton swabs
11. inform the patient you are going to hold the genital area and clean it with the povidone-iodine. assure him/her that it won't stain permanently. 
12. once genitalia is clean, if male, hold penis at 90-degree angle to the abdomen and instill the lubricant into the urethra. 
13. grasp catheter with your dominant hand about 3/4 of the way toward tip - inform patient that you are going to insert now, and insert the catheter. 
14. once in, check if the urine is flowing. 
15. inflate the foley catheter using the prefilled syringe and inflate balloon. 
16. pull out the cathether until it sits in the proper position.
17. attach drainage bag if not already in place
18. tape catheter onto abdomen.

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materials 

sterile working area

sterile gloves

sterile lubricant

Foley catheter

sterile gauze

antiseptic cleansing solution - typically povidine-iodine

sterile forceps

syringe filled with sterile water for catheter balloon

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indication

• when a sterile urine sample is needed
• monitor urinary output in patients who are incapacitated
• bypass obstructive processes in urethra, prostate, or bladder neck 
• act as traction device for purpose of controlling bleeding after prostate surgery

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contraindications

• appearance of blood at the urethral meatus in patient who has sustained pelvic trauma. 
• allergy to materials used in procedure (latex, rubber, tape, lubricants)

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potential complications

• urethral dilation due to placement of long-term indwelling catheter - leaking
• urinary structural trauma
• UTI
• inflammation of urinary tract secondary to procedure

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