URINARY CATHETERIZATION

Kurnia Penta Seputra

Department of Urology
Saiful Anwar General Hosptals

Urinary Catheterization

Urethral catheterization
Suprapubic catheterization
Ureteral catheterization
Renal catheterization (nephrostomy)

Urethral catheterization

Suprapubic catheterization
(cystostomy)

Ureteral (double J) catheter

Renal catheterization
(nephrostomy)

Urethral catheterization

INTRODUCTION

Urinary catheterization is defined as an

intervention to enable emptying of the bladder
by insertion of a catheter.

Guidelines for the Prevention of Catheter associated Urinary

Tract Infection. 2011

Types of catheter

Tieman tip catheter

Pezzer-Casper-Malecot
self retaining catheter

Foley catheter
(2-way and 3-way)

Campbell & Walsh urology 10 th edition

Catheter size

Inner diameter
(in Fr or Ch)

1 French (Cheriere) = 0.33 mm

INDICATION
The most common indications for the use of
a bladder catheter can be broadly divided into
two main categories:
1. to obtain drainage or to allow the
instillation of diagnostic or
2. therapeutic agents.

Campbell & Walsh urology 10 th edition

Indication

Diagnosis
Sample for urine
culture for female
Measurement for
post voiding
residual urine
Instillation of
contrast agent for
cystography
Urodynamic study

Therapy
Therapy
Relieve infravesical
Relieve infravesical
obstruction
obstruction
Urethral stenting
Urethral stenting
Intermittent
Intermittent
catheterization
catheterization

Complication
Injury of the urethra during introducing
catheter or because of wrong fixation
Urinary tract infection
Bladder stone
Malignant degeneration
Hematuria

Catheter-Associated Urinary
Tract Infection (CAUTI)

Epidemiology Complications of
Urethral Catheterization
UTIs account for 40% of all nosocomial infections. The major risk factor
is the use of urethral catheters, which are responsible for up to (80%) of
UTIs in the hospital setting (campbell-walsh).

The presence of a urinary catheter and the length of time it

remains in situ are contributory factors to
the development of a catheter-associated urinary tract infection
(CAUTI). (guideline CAUTI 2011)

An average of 25% of hospitalised patients are catheterised at

some stage during their admission.

Epidemiology
Catheter associated nosocomial UTI 5% per day

Bacteria ascend intraluminally into the bladder within

24 to 72 hours

> 1 month of catheterization Nearly all will be

bacteriuric

Long-term (>28 days) and short-term (<28 days) catheterization

80% of patients with nosocomial UTI have an indwelling urinary
catheter

Defnition
The presence of bacteria in urine (bacteriuria)
signifes either colonisation (asymptomatic
bacteriuria) or infection.

Pathogenesis

Urethral catheterisation interferes normal

defence mechanism

organisms that cause CAUTI enter the bladder

by migrating along the internal
(intraluminal) and external (extraluminal)
catheter surface

Intraluminal migration of microorganisms occurs

following contamination of the catheter lumen from
failure of the closed drainage system or from
contaminated urine in the drainage bag

Extraluminal migration of microorganisms

from the perineum can
occur at insertion or later by capillary action
via the outer surface of the catheter

CAUTI

Risk Factor

Risk factor

PREVENTING CAUTI
Avoiding indwelling catheterization
Or terminated as soon as possible

Intermittent catheterization
Incidence of bacteriuria: 1~3% per insertion

External condom catheters, only for men

12 % bacteriuria per month

PREVENTING CAUTI

Aseptic catheter insertion + Closed drainage system

Silver alloy (not silver oxide) coated catheter

For highest risk for developing serious consequences form UTI

Systemic antibiotic therapy is useful to patients catheterized

for 3~14 days (<3 days: not at high enough risk

Avoidance of unnecessary catheterization,

atraumatic technique at insertion, CIC and the use
of a closed collection circuit have
been shown to decrease the incidence of CAUTI.

REFERENCES
Guide to the Elimination of Catheter-ssociated
Urinary Tract Infections (CAUTIs)
Guidelines for the Prevention of Catheterassociated Urinary Tract Infection
Campbell-Walsh Urology 10th edition
Dasar-dasar urologi

THANK YOU