URINARY CATHETERS AND DRAINAGE DEVICES
Catheters and procedures discussed in this section are usually used to collect diagnostic urine samples as well as to ensure adequate urinary drainage in sick children. Some catheters are also used for other purposes as well.
Simple rubber catheter is ~20-30 cm long rubber tube with a blunt tip and a slit-like opening (eye) just proximal and lateral to the tip (Fig. 32.29).
Sterilization: Disposable catheters are preferred, though may be re-used after boiling.
Uses: Simple rubber catheter is a multi-purpose tube, used as:
Fig. 32.29: Simple rubber catheter and flatus tube.
• Non-retaining urinary catheter to: (i) relieve acute urinary retention, (ii) differentiate between anuria and urinary retention, (iii) collection of urinary samples for cultures, and (iv) diagnose urethral strictures;
• Flatus tube to: (i) diagnose anal atresia (patency check) in newborns, (ii) relieve flatus, (iii) deliver bowel enema or bowel washes;
• Limb tourniquet for: (i) venipuncture (ii) minimize distal bleeding in emergency;
• Nasal catheter for: (i) nasal/oropharyngeal or endotracheal suction, (ii) nasal oxygen delivery, (iii) diagnosis of nasal atresia at birth (patency check).
Flatus tube is a simple rubber catheter with three differences: (a) longer length of ~50-70 cm, (b) thicker diameter of ~1 cm, and (c) bulbous tip with two side eyes to facilitate expulsion of gases (Fig. 32.29). It may be re-used after cleaning with soap and water and sterilization by boiling.
Procedure: Flatus tube is inserted per rectally in left lateral position after proper lubrication for ~15-20 cm, while outer end is immersed under water to detect passage of gas bubbles.
Uses: Flatus tube is commonly used for: (a) gaseous deflation of bowels in paralytic ileus or toxic megacolon, (b) diagnosis of low bowel obstruction (absolute constipation), and (c) reduction of volvulus.
Foley's catheter is a self-retaining urinary catheter, available in pre-sterilized disposable pack with different sizes (No. 8-30), according to its diameter and length. It is a long latex rubber tube with following parts: (a) doublelumen body, (b) blind inner tip with side-slit (eye), (c) distensible balloon just proximal to the tip, and (d) outer end with two openings, one each for main catheter and balloon (Fig. 32.30).
Procedure: The catheter with collapsed balloon is inserted via urethra after adequate lubrication, till free flow of urine begins. Subsequently, the balloon is distended with 30-40 ml of sterile water (and not the
Fig. 32.30: Foley’s catheter.
air that may introduce infection) to allow self-retention. While removing, balloon must be first deflated first to avoid urethral injury.
Uses: Foley's catheter is primarily used as Self-retaining urinary catheter in children with: (a) chronic bladder dysfunction or urinary retention, (b) urethral tear, to allow healing (conservative treatment with railroad method), (c) post-genitourinary surgery for repeated bladder washes. Rarely, it is also be used for gastrojejunostomy feeding or as hemostatic temponade in emergency treatment of bleeding esophageal varices. Complications of Foley's catheter include: (a) ascending urinary tract infection, (b) local urethral trauma during insertion or removal, leading to hematuria or late strictures, and (c) impacted balloon.
Malecot's catheter is a self-retaining catheter, available in different sizes (No. 8-44), according to its diameter. It is a long India-rubber tube with three main parts:
(a) blind tip with slit-opening on the side, i.e.
eye, (b) a flower-like structure just proximal to the tip that allows self-retention, and (c) tubular single-lumen body (Fig. 32.31). Before insertion, the flower has to be collapsed by stretching the catheter over an introducer. It may be re-used after sterilization by autoclaving.
Fig. 32.31: Malecot’s catheter.
Fig. 32.32: Condom catheter.
Uses: Malecot's catheter is mainly used as self-retaining catheter for:
• Intercostal chest drainage in empyema/pneumothroax,
• Suprapubic cystostomy for urinary retention when urethral catheterization is not possible,
• Post-operative drainage of deep-seated abscesses, e.g. perinephric abscess/hematoma,
• For condom catheterization (see below).
Malecot's catheter is no longer used as self-retaining urinary catheter.
Condom catheter comes in a disposable readymade pack or may be prepared by making a small nick at the tip of a condom and inserting a Malecot's catheter through this nick in such a way that the catheter flower rests on this nick (Fig. 32.32). The other end of catheter is connected with a urine collection bag via PVC tubing.
Uses: Condom catheter is used as a non-invasive urine collecting device in: (a) cases with urinary incontinence to prevent soiling, (b) young infants or unconscious children to monitor urinary output. Being non-invasive, the risk of urinary tract infection is minimal with condom catheterization.
32.4