Examinations & Procedures - Part 2

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You are working as an SHO in the department of Accident and Emergency, your next patient is 58 year old Mr Mark Newman who is in severe abdominal pain and unable to pass urine. Please see him, collect relevant history, perform the necessary procedure and talk to him about further management.

Male Catheterization

Male catheterization may be indicated for a variety of reasons, including:

1. Urinary retention: If a patient is unable to urinate, catheterization may be necessary to drain the bladder.

2. Urinary incontinence: In some cases, catheterization may be used to manage urinary incontinence or leakage.

3. Bladder outlet obstruction: If a patient has a blockage in their urinary tract, such as a prostate enlargement, catheterization may be necessary to relieve the obstruction.

4. Urinary tract infections: Catheterization may be indicated in patients with recurrent urinary tract infections to obtain a sterile urine sample for culture and sensitivity testing.

5. Monitoring urine output: In certain situations, such as during surgery or critical illness, catheterization may be used to monitor urine output and kidney function.

6. Diagnostic procedures: Catheterization may be used in certain diagnostic procedures, such as urodynamic testing, to measure bladder function and urine flow.

The decision to perform male catheterization should be made on a case-by-case basis, taking into account the patient's individual circumstances, medical history, and the potential risks and benefits of the procedure. The healthcare provider should carefully evaluate the need for catheterization and discuss the procedure and its potential risks and benefits with the patient.

Here are the detailed steps involved in male catheterization:

1. Explain the procedure to the patient: Before beginning the procedure, explain to the patient the reason for the catheterization, what to expect during the procedure, and any potential risks involved.

2. Gather the equipment: Gather all the equipment required for the procedure, which includes a sterile catheter, sterile gloves, lubricant, antiseptic solution, sterile drapes, and a urinary catheter bag.

3. Position the patient: Position the patient on a flat surface, usually on their back with their legs slightly apart, or in the lithotomy position with the legs bent up towards the chest and the soles of the feet together.

4. Prepare the equipment: Open all sterile packages and prepare the catheter for insertion. Put on sterile gloves and prepare the lubricant.

5. Clean the penis: Clean the penis and the surrounding area with antiseptic solution using a circular motion, starting from the urethral meatus and working outwards.

6. Anesthetize the urethra: Anesthetize the urethra with a topical anesthetic if required (not always required, usually the lubricating gel has anaesthtic agent which works both ways for anaesthetising as well as lubricating the urethra)

7. Lubricate the catheter: Apply a generous amount of sterile lubricant to the tip of the catheter.

8. Insert the catheter: Hold the penis with one hand and insert the catheter gently into the urethra with the other hand. Advance the catheter slowly and steadily until urine starts to flow into the catheter bag.

9. Secure the catheter: Once the catheter is in place, secure it with adhesive tape or a catheter strap to prevent it from being accidentally pulled out.

10. Monitor the patient: Monitor the patient for any signs of discomfort, pain, or bleeding during the procedure.

Post-catheterization management involves the following steps:

1. Observe the urine output: Observe the urine output and monitor the color, clarity, and quantity of urine. Notify the physician immediately if there is no urine output or if there are any signs of bleeding.

2. Keep the catheter clean: Keep the catheter and the surrounding area clean and dry to prevent infection. Clean the catheter and the genital area with soap and water daily and after each bowel movement.

3. Check for signs of infection: Watch for signs of infection, such as fever, chills, foul-smelling urine, or redness and swelling around the catheter insertion site.

4. Change the catheter: Change the catheter if it becomes blocked, if there is leakage around the catheter, or if it becomes dislodged or accidentally removed.

5. Remove the catheter: Remove the catheter as soon as it is no longer needed to minimize the risk of infection. Follow the physician's instructions for removing the catheter.

6. Provide aftercare instructions: Provide the patient with aftercare instructions, including how to care for the catheter and how to monitor for any signs of infection or complications.

Red flags

After catheterization, patients should be aware of the following red flags, which could indicate a potential complication:

1. Pain or discomfort in the bladder or urethra
2. Bloody urine or blood clots in the urine
3. Fever or chills
4. Inability to urinate or decreased urine output
5. Persistent abdominal pain or discomfort
6. Leakage of urine around the catheter site
7. Changes in the color or odor of urine
8. Redness, swelling, or discharge at the catheter insertion site
9. Signs of an allergic reaction, such as hives or difficulty breathing.

If a patient experiences any of these red flags, they should contact their healthcare provider immediately or seek medical attention. The healthcare provider may advise the patient to come to the emergency room or schedule a follow-up appointment for further evaluation and management.

In general, patients should be instructed to monitor their symptoms closely after catheterization and to report any unusual symptoms or changes in their condition to their healthcare provider. It's important to seek prompt medical attention if any red flags occur to prevent serious complications.