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Overview Urethral catheterization permits direct drainage of the urinary bladder and is of-ten performed in pediatric practice. This video demonstrates a diagnostic urethral catheterization in a male infant, using a catheter without a balloon. Indications A common diagnostic indication for urethral catheterization is the need to col-lect a sterile...
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... vary in construction material, design, and size. The choice of catheter depends on the size of the urethra and, generally, on the age of the child ( Table 1). The two basic types of catheter are the straight catheter and the balloon (or Foley) catheter (Fig. 1). Straight catheters are soft, single-lumen catheters that are usually made of polyvinyl chloride. They are used for the collection of uncon- taminated urine for diagnostic purposes or for intermittent catheterization in patients who have neurogenic bladder. Balloon catheters consist of a double- or triple-lumen tube with an expandable balloon at the distal end that secures the catheter in the bladder. Often made of latex or silicone, balloon catheters are gen- erally used when the catheter must remain in the bladder, such as when there is a need for close monitoring of urine output, for prevention or relief of an obstruc- tion, or for continuous irrigation of the bladder. Balloon catheters are also used when complete vesical filling is necessary, as for imaging of the urinary tract. Although some clinicians substitute appropriately sized feeding tubes for ure- thral catheterization in infants, feeding tubes should not be used. If the length of insertion is excessive, intravesical knotting of the feeding tube may occur, imped- ing catheter removal. 3 Before you begin the procedure, explain the anatomy involved, the nature of the procedure, and the benefits, risks, and complications to parents or caregivers or to patients if they are old enough to understand. Ask about the child’s medical history to determine whether the child is allergic to latex or iodine and whether there have been previous attempts at catheterization. After placing the patient in the supine, frog-leg position, ask an assistant to hold the legs firmly, which permits adequate stabilization of the pelvis and complete visualization of the external genitalia (Fig. 2). Using gauze, wash the external geni- talia with soap and water, rinse with clean water, and dry the skin. Wash and dis- infect your hands. Place the sterile urethral catheterization kit on a tray and open the inner paper wrapping to form a sterile field. Pour the chlorhexidine (or iodine) disinfectant solution over the sterile swabs. Place a sterile, 10-ml syringe prefilled with lubricant gel onto the sterile field and open a sterile catheter. Disinfect your hands and put on sterile gloves. Lubricate the distal end of the catheter with ster- ile gel. The anatomy of the male infant or child is similar to that of the male adult, except for the obvious differences in size and lack of secondary sexual characteristics. The urethral meatus is fairly easy to locate when the glans is visible; it may be more difficult to locate in uncircumcised newborns or young boys with a tight foreskin. A physiologic phimosis is frequently present during childhood, and the foreskin should never be forced to retract. The male urethra has an S-shaped curve behind the symphysis pubis. After the urethra passes the external sphinc- ter, it enters the bladder. Prepare the entire genital area by cleansing three times, going from the center to the periphery, using an antiseptic agent. While holding the penis in a vertical position with your nondominant hand and gently retracting the foreskin, if present, use your dominant hand to wash the urethral meatus three times in circular mo- tion, using antiseptic-soaked cotton swabs. In many clinics and hospitals, lubricant gel is placed on the catheter before the procedure is performed. Some pediatric centers also insert some lubricant into the urethra, using a syringe without a needle. If you choose to instill some of the sterile lubricant gel into the urethra, use 1 to 2 ml for neonates and infants and up to 5 ml for adolescents. Instillation of the viscous gel helps to dilate the meatus, which permits better visualization. Allow 2 minutes before proceeding with the catheter- ization if lidocaine gel was used for analgesia. Slowly insert the tip of the catheter into the urethral meatus with your domi- nant hand, using your fingers or forceps to advance it into the bladder (Fig. 3). You may encounter resistance near the base of the penis because of the anatomical curving of the urethra. Gently pull the penis rostrally to overcome the obstacle. You may feel resistance again because of the contraction of the external bladder sphincter. You can overcome this resistance by maintaining traction on the penis while applying gentle but continuous pressure with the catheter. After the catheter has entered the bladder, urine should drain through it into the container. When urine flow has ceased, remove the catheter and send the urine for culture and urinalysis. If the foreskin is present, gently pull it back over the glans to pre- vent the development of a paraphimosis. Urethral catheterization can be difficult in uncircumcised boys; if it is essential to obtain the urine sample and the urethral meatus cannot be catheterized, you may need to perform suprapubic aspiration. Consider this procedure only if the bladder is palpable or if the presence of urine has been confirmed by ultraso- nography. If the urine return is minimal, massage the suprapubic region with gentle pres- sure to increase urine flow. If there is no urine return, which can happen with coil- ing of the catheter in the posterior urethra, the catheter should be removed and properly discarded. Consider whether the procedure should be attempted again with a catheter that is a different size or has a different degree of stiffness. If the cath- eterization was performed to verify that a child is anuric, be sure to consider how much hydration should be given before reattempting the procedure. Although rare, complications of urethral catheterization may occur. Immediate complications may include gross or microscopic hematuria or the creation of false passages or a frank fistula with urethral perforation. Urethral strictures may be a long-term complication. A paraphimosis may be caused by failure to replace the foreskin after catheterization. In addition, iatrogenic infection may occur if asep- tic conditions are not adequate. ...
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Citations
... The urethral catheter used in children may be the straight, nonretaining, or balloon self-retaining type, and the sizes range from 4.0 F to 14.0 from the newborn to 12 years of age. [54,55] Urethral catheters may be inserted and retained as an indwelling catheter or intermittently by the patient (intermittent self-catheterization) or the caregiver, depending on the indication for the procedure. Intermittent self-catheterization is the passage of a catheter to drain the bladder and the immediate of the catheter after the procedure. ...
... [15,22,23,52,53,59] Appropriate informed consent must be obtained from the parents or legal guardians for the younger children and from the patient in those who can understand the implications. [54] The presence of the parents or legal guardian during the catheterization procedure is essential as it relieves the child's anxiety, thus providing a more conducive atmosphere. [60] The appropriate catheter size must be selected based on the age and weight of the patient, as has been documented in the literature. ...
... [60] The external genitalia is cleansed with soap and povidone-iodine solution, after which there is the installation of 10 ml of 2% lidocaine jelly through the external meatus of boys while in the perimeatal area of the girls. [54,60,63] The use of local anaeshetic jelly has been found to reduce patient discomfort during the procedure. [64] In the uncircumcised male, the prepuce is retracted to expose the external meatus however if it is still difficult then the catheter can be inserted gently through the opening on the foreskin. ...
Background: The urethral catheter is an essential medical device that is used in everyday medical practice worldwide. The urethral catheter has evolved over the years with several modifications and improvements to overcome the shortcomings of previous productions. With several indications, it remains one of the most commonly used devices traversing almost all specialties in the field of medicine; however, the process of urethral catheterization is occasionally challenging and may result in injury to the urethra. The attendant complications following its passage far outweigh its cost and the required skills to necessitate appropriate insertion. Knowledge of the type of urethral catheter, training with regard to its insertion, care while in situ, and competency of the attendant caregivers are required for safe catheterization.
Aim: This review aims to disseminate knowledge on urethral catheter types, insertion procedures, and its attendant complications so that doctors and other health-care professionals may safely perform this necessary procedure.
Materials and Methods: A review of internatinal literature was conducted using PubMed database and goggle search using key words such as urethral catheter materials and types.
Result: 105 articles were identified and found suitable for the study.
... The method for doing so varies widely and traditional selection processes rely on the child's age, body weight, or both. [18][19][20][21] Exact formulas have even been derived to provide an ideal and custom approach to proper catheter sizing in children. One relies on a patient's age to estimate body weight (in kg) up to 10-years: 22 Weight may not always be the most accurate, however, as there can be great variance of expected weight for a given age. ...
... Care should be taken to avoid forceful catheter placement as the tissue of a male infant is much less resilient compared to an adult male. 18 Again, the most important factor when it comes to Foley placement in male versus female patients, is technique. In females, exposure is important and may require additional personnel to ensure contamination is minimized. ...
Determining the need for bladder decompression and urinary diversion in the perioperative pediatric surgical patient can cause a clinical conundrum for the surgical team. Add in the several different types of urinary diversion devices possible, and the various materials associated therein and the process can suddenly seem unnecessarily daunting given the lack of concise recommendations and broad consensus. The decision to divert urine, though seemingly trivial, is associated with inherent risks. Managing and mitigating certain risks are best approached through proper education, selection, and technique. We provide a broad overview of pediatric catheter selection, indications, and pitfalls to streamline the process so that energy and attention can best be focused on the planned intervention at hand.
... Urine sample obtained via aseptic bladder catheterization and CSF via lumbar puncture (LP) should be considered in a respiratory-and hemodynamically-stable infant. [48][49][50] A positive bacterial culture after 24 to 36 h confirm the type of bacterial pathogen, and allows antimicrobial susceptibility testing. [42] Biological markers, such as procalcitonin (PCT), C-reactive protein (CRP), white blood cell, and absolute neutrophil count (ANC), are not specific of bacterial infection. ...
Sepsis remains a significant cause of neonatal morbidity and mortality in China. A better understanding of neonatal sepsis in China as compared with other industrialized and non-industrialized countries may help optimize neonatal health care both regionally and globally. Literature cited in this review was retrieved from PubMed using the keywords "neonatal sepsis," "early-onset (EOS)" and "late-onset (LOS)" in English, with the focus set on population-based studies. This review provides an updated summary regarding the epidemiology, pathogen profile, infectious work-up, and empirical treatment of neonatal sepsis within and beyond China. The incidence of neonatal EOS and the proportion of Group B Streptococcus (GBS) within pathogens causing EOS in China seem to differ from those in developed countries, possibly due to different population characteristics and intrapartum/postnatal health care strategies. Whether to adopt GBS screening and intrapartum antibiotic prophylaxis in China remains highly debatable. The pathogen profile of LOS in China was shown to be similar to other countries. However, viruses as potential pathogens of neonatal LOS have been underappreciated. Growing antimicrobial resistance in China reflects limitations in adapting antibiotic regimen to local microbial profile and timely cessation of treatment in non-proven bacterial infections. This review stresses that the local epidemiology of neonatal sepsis should be closely monitored in each institution. A prompt and adequate infectious work-up is critically important in diagnosing neonatal sepsis. Adequate and appropriate antibiotic strategies must be overemphasized to prevent the emergence of multi-resistant bacteria in China.
... The foreskin should never be retracted past the point where it has already naturally separated. 7 If the meatus cannot be seen, the genitals can be prepared and draped in a sterile manner without retraction. The catheter can then be lubricated and gently inserted through the foreskin opening and guided into the meatus, much like an intravenous catheter is guided into a vein by feel. ...
... Diagnostic catheterization is performed in contrast-enhanced investigations (voiding cystography), for the collection of sterile urine samples for urinalysis and urine culture in case of suspected urinary tract infection, when a less invasive method of urine collection is not feasible, as well as for 24-hr urine collection for estimation of diuresis, quantitative proteinuria and metabolic evaluation in infants and small children who are unable to collect urine in a container. Therapeutic catheterization, on the other hand, is performed for decompression of acute urinary retention, regular bladder emptying (intermittent catheterization of neurogenic bladder), as well as for intravesical drug administration [1]. ...
... The procedure is relatively safe when contraindications for catheterization are taken into account (pelvic fractures, known trauma to the urethra or blood at the meatus [2]), and when it is performed by an experienced staff and using an appropriate urinary catheter size. Complications are rare, but can occur and include hematuria, creation of false passages, urethral perforation, urethral strictures, paraphimosis and iatrogenic infection [1]. ...
... Currently, the size of the urinary catheter is selected according to child's age [1,3] as well as according to child's body weight [4,5]. Sometimes these tables are not immediately available. ...
To perform proper and optimal catheterization, a urinary catheter of appropriate size has to be selected as the success of a procedure is often dependent on it. Catheterization of the urinary bladder is a common procedure in pediatric practice which is used for numerous diagnostic and therapeutic purposes. There are very few recommendations on how to choose the optimal size of a catheter on the basis of a child’s age or weight. Based on a few published relationships between a child’s age, body weight and urinary catheter size, as well as personal experience, the author has developed a formula for estimating urinary catheter size according to a child’s weight that reads as follows: Urin:Catheter Presented formula may prove useful in everyday clinical practice and especially in emergency settings.
Lubricity is a key property of hydrophilic-coated urinary catheter surfaces. In vitro tests are commonly employed for evaluation of surface properties in the development of novel catheter coating technologies; however, their value in predicting the more subjective feeling of lubricity requires validation. We herein perform a range of in vitro assessments and human organoleptic studies to characterise surface properties of developmental hydrophilic coating formulations, including water wettability, coefficient of friction, dry-out kinetics and lubricity. Significant reductions of up to 40% in the contact angles and coefficient of friction values of the novel coating formulations in comparison with the control poly(vinylpyrrolidone)-coated surfaces were demonstrated during quantitative laboratory assessments. In contrast, no significant differences in the more subjective feeling of lubricity between the novel formulations and the control-coated surfaces were observed when formulations were haptically assessed by the techniques described herein. This study, importantly, highlights the need for optimisation of in vitro and human haptic assessments to more reliably predict patient preferences.
This chapter will continue to examine the struggle of how to balance innovation of new drugs with access to lower cost generic drugs. In particular, this chapter will focus on the development of small-molecule drugs and their generic counterparts. The development of biologics and their generic counterparts will be addressed in the next chapter.
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