Features of the procedure
Catheterization is needed when squeezing the lumen of the ureter with an adenoma and other tumor formations. Scars after injuries and inflammatory processes disrupt urination. In such cases, a Foley catheter is placed, which must be cared for at home.
The device, consisting of flexible tubes and a balloon, has 2-3 outlets designed for the following purposes:
- bladder lavage;
- drug administration;
- hemostasis.
The urinal is attached directly to the outer edges. Catheterized patients after strokes and in coma also need to flush the catheter and bladder.
At home, flushing of the urinary catheter or bladder in post-stroke patients should be carried out by a nurse. With a catheter in place, the procedure is performed by relatives to prevent the accumulation of urine sediment and the development of a bacterial infection. The procedure is carried out with clean hands and sterile instruments.
The algorithm looks like this:
- The tubes are disconnected from the urinal.
- The tip of the syringe is inserted into the tube, the liquid in the amount of 50-100 ml is injected with pauses after every 2-3 ml without strong pressure.
- After washing, the syringe is removed, the liquid flows into the prepared container.
Often, flushing of the bladder catheter is combined with medicinal irrigation of the bladder cavity. Instruments are sterilized and stored in a disinfectant solution: 3% chloramine or 2% chlorhexidine.
The nurse or doctor asks the patient to tighten the muscles as if urinating, which makes flushing easier. After the procedure, you need to lie down for 30-45 minutes.
Normally, after operations and with proper catheterization, the bladder empties itself at home, which is the prevention of an infectious process. Sometimes herbal preparations, cranberry juice for natural cleansing are prescribed. There is no need for targeted washing of the organ.
It is necessary to wash with the help of medicines with an interval of two days, less often - once a day. Most often, no more than 12-14 procedures are required.
It is important to block the bladder for 2 hours twice a day to train the sphincters
Purpose of the procedure and solutions
Bladder flushing is performed for various indications:
- determination of the capacity of the body;
- removal of small stones;
- cleansing the cavity from pus and dead cells;
- removal of blood before examination;
- effects on the mucous membranes of drugs.
Modern methods of treating bladder cancer are minimally invasive, since they imply easy access to the tumor focus.
Injected fluids are selected depending on the goals of the procedure:
- A solution of boric acid with a 2% concentration for antiseptic purposes, removing pus. With an inflammatory process and a disturbed outflow of urine, it is more expedient to cure the cause than to rinse the bladder. Boric acid can be prescribed for the prevention of infectious stones in order to acidify the environment.
- The solution of furatsilin is not recognized as effective, since it is a nutrient medium for microorganisms, including Pseudomonas aeruginosa. With prolonged use, the mucous membranes in the bladder become more susceptible to infection.
- Chlorhexidine is used for urethritis and before diagnostic procedures. When heated, the solution loses its antiseptic qualities. Prohibited use during pregnancy. When washing the bladder, as well as cystoscopy, a 0.02% sterile aqueous solution is poured. The drug is not diluted with hard water. If irritation, burning and itching occur, a different solution must be used. Chlorhexidine is not prescribed for tissue trauma and rashes around the urethra.
Previously, instead of the listed funds, a solution of potassium permanganate was used in a ratio of 1 to 10,000. Silver nitrate, penicillin, protargol or collargol are used for therapeutic effects on the mucous membrane.
When caring for bedridden patients, the nurse explains to relatives how to flush the catheter. In addition to chlorhexidine, Dioxidin, diluted in a ratio of 1:40, Miramistin is used.
https://youtube.com/watch?v=ZtuHcvAlM5M
Signs of a clogged heating system
The fact that flushing of the heating system in a private house is required can be guessed from the following signs of clogged pipes and radiators:
- If during normal operation of the boiler and correct adjustment of the system in the rooms it became noticeably colder. Most likely, this is due to the deterioration of the heat transfer of the radiators due to their contamination inside.
- The heating of pipes and batteries after starting the system is very slow.
- Another characteristic sign of clogging of devices with deposits is uneven heating of the battery.
- Sometimes the pipeline itself is hot, while the batteries remain cold.
- Fistulas in pipelines or their rupture can also indirectly indicate various deposits. This is due to the fact that the plaque contains chemicals that corrode and thin the walls of the pipes. As a result, they become susceptible to corrosion and water hammer.
The presence of at least one sign indicates the need to clean the heating circuit from deposits. In this case, you need to decide in advance how and with what to flush the heating system in a private house. Most often, horizontal sections of the pipeline are contaminated, which will not be difficult to wash on your own.
Blockage diagnostics
How to determine whether flushing of the sewerage, water supply or heating pipeline is necessary? Look out for these signals:
- metallic taste of water;
- the presence of rust flakes;
- violation of the color of the supplied water;
- bad smell from the system;
- decrease in heat transfer of batteries;
- reduction in water pressure;
- drain problems.
Regular flushing of pipes is the best way to extend the life of communications in the house.
The failure of elements is not the worst thing that can happen due to improper care of communications. After all, before they break, the family can consume polluted water for a long time, which can adversely affect the well-being of the inhabitants of the house. Rusty and dirty water is detrimental to both the digestive system and the skin. If the heating system is clogged, in winter you will have to freeze, and, possibly, suffer from a breakthrough in communications.
Timely flushing of heating, sewage and water supply pipelines can save the house from accidents, the wallet from additional expenses, and the family from illness.
Pipes can become clogged to such an extent when they look quite tolerable from the outside.
Pipeline testing.
At the end
installation, and periodically after repair
pipelines pass hydraulic
trial
for strength and density,
then washed and purged, and
additionally tested for
tightness with air or inert
gas.
For what, the pipeline
at both ends they will be drowned out by welded
plugs with taps for release
air, all installed fittings
fully open, in place regulating
valves and measuring devices
install mounting coils, fittings
for instrumentation to muffle. Allowed test
with heat and anti-corrosion insulation.
Pipeline
filled with water at a temperature of 5-40
degrees, but not to cause the appearance
sweating. If the temperature is below 0, then
measures are taken against freezing.
piston pump
create the necessary pressing pressure
1.25-1.5 from the worker, but not less than 2 at.
Pressure oil
pipelines must be subjected to
hydraulic test during trial
pressure that is one and a half times
working.
When filling
water to completely displace all the air.
Pressure increase
smoothly. Pressure rise rate
must be specified in the design
documentation. Use for lifting
pressure compressed air or gas, not
allowed.
Disable
pipeline from the pump.
Withstand 10 min
(strength test) and check:
lack of drips, bulging and gusts.
The pressure must
controlled by two manometers,
with an accuracy class of at least 1.5, with a diameter
not less than 160 mm and a scale of 4/3 of the measured one.
One is installed near the unit,
another at a distant point.
Then they reduce
pressure up to working and conduct
careful inspection of welds (test
for density). During the inspection,
tapping with a hammer weighing no more
1.5 kg. In pneumatic test
tapping is not allowed.
At the end
inspection, the pressure is again increased to
test and withstand another 5
minutes, after which it is reduced again to
worker and again carefully inspect
pipeline.
Duration
density test determined
inspection and leak test time
detachable connections.
Then open
air vents and empty the pipeline
through the drains.
results
satisfactory if not happened
breaks, visible deformations, falls
pressure gauge, not detected
leaks and sweating. Welded caulking
seams are prohibited.
With unsatisfactory
results, defects are eliminated, and
tests are repeated. results
documented or entered in
pipeline passport.
Substitution allowed
hydraulic test for
pneumatic in cases:
-
if the supports are not
calculated on the weight of water; -
at T below 0 and
freezing hazards; -
if application
liquids are not allowed.
Provided
acoustic test control
emission and positive temperature
air.
Pneumatic
strength and density test
produced by air or inert
gas. Raise pressure slowly
speed 5% of Retc
per minute, but not more than 2 atm per minute with
periodic inspection of the pipeline
at pressures up to 2 atm twice, more
2 - 3. pressure increase during examination
stop.
Leaks
identified by sound and soapy
emulsion.
For the time of testing
mark the 10 m security zone with flags
for underground laying and 25 - for
overhead, both ways and expose
after 200 m posts. During the ascent
pressure stay of people in security
zone is prohibited.
Compressors and
manometers should be located outside the security room
zones.
After graduation
hydraulic test pipeline
emptied and purged with air
until the water is completely removed. Then
additional pneumatic
tightness tests
air or inert gas under the working
pressure within 24 hours new and not
less than 4 hours to be repaired.
Determined
rate of pressure drop after holding
to equalize the temperature. Temperature
controlled by thermometers at different
ends of the pipeline.
pressure drop
should be at least 0.2% per hour.
32
1 Cleaning technology
flushing
or purge is carried out by one of
the following ways:
-With
skipping cleaning or separating
devices;
-without
skip cleaning or separating
devices.
flushing
and purge with the passage of treatment or
separating devices should
perform on pipelines with a diameter
219 mm and more.
flushing
and purge without skipping treatment or
separating devices allowed
produce:
-on the
pipelines with a diameter of less than 219 mm;
-on the
pipelines of any diameter
the presence of steeply curved inserts with a radius
less than five pipeline diameters or
with a length of the cleaned area less than
one kilometer.
cleaning
cavities of underwater pipeline crossings
with a diameter of 219 mm and whiter, laid
with the help of underwater technical means,
produce:
- flushing
with the passage of the separator piston in the process
filling with water for the first
stage of hydraulic testing;
- purge
with skipping or pulling
cleaning device before carrying out
the first stage of the pneumatic test.
flushing
Flushing
subject pipelines to any
appointments, the test of which is provided
in a hydraulic project.
Pass
cleaning or separating device
through the pipeline is carried out under
pressure of the liquid pumped for
hydraulic test.
ahead
cleaning or separating device
for wetting and washing away contaminants
pour water in a volume of 10-15% of the volume
cavities of the cleaned pipeline.
principled
washing scheme
with a pass cleaning or separating
device is shown in fig.
1.
Fig.1.
principled
washing scheme
pipelines:
a
- preparation of the site for carrying out
flushing; b
- water supply in front of the separator piston;
in - the passage of the piston-separator in the flow
water; G
-preparation of the site for testing; one
- area to be cleaned; 2
and 7-
bypass pipes with taps; 3
— piston-separator; 4
-collector; 5
- filling units; 6
- inlet pipe; eight-
linear fittings; 9
- drain pipe.
Pass
cleaning or separating device
in the fluid flow provides removal
from the pipeline not only pollution,
but also air, which eliminates the need
installation of air vents (except
cranes provided by the project for
operation), improves reliability
leak detection with pressure gauges.
flushing
is considered complete when the cleaning
or the separator device will come out
from the pipeline is not destroyed.
At
flushing without skipping the cleaning or
separation device quality
cleaning is provided by high-speed
fluid flow.
principled
flushing scheme without skipping treatment
and separating devices is given
in fig.
2.
Speed
flow of liquid during flushing without skipping
cleaning and separating devices
must be at least 5 km/h.
Length
sections of pipelines with a diameter of more than
219 mm, flushed without skipping cleaning
or separating devices,
installed taking into account the hydraulic
pressure loss in the pipeline and
available pump head
equipment.
flushing
without skipping cleaning or separating
device is considered complete when
a stream comes out of the drain pipe
uncontaminated liquid.
Fig.2.
principled
flushing scheme without skipping treatment
or separating devices:
a
- preparation of the site for carrying out
flushing; b
- water supply; v
-preparation of the site for testing; one
- area to be cleaned; 2
- inlet pipe; 3
- tap; 4
- filling units; 5-
linear fittings; 6
- drain pipe.
Flushing through a catheter
The catheter is connected to a tube on Esmarch's mug, into which liquid is poured. Before the procedure, the entrance to the urethra and genitals are treated with a disinfectant.
The liquid is heated to 37-40 degrees Celsius, the mug is raised two meters above the couch or chair. The end of the catheter is lubricated with sterile vaseline.
The algorithm differs when inserting a catheter in women and men in that it takes into account the difference in the length of the urethra
The nurse focuses on her own feelings with careful advancement, without using sudden movements. The exit of urine through the catheter determines the correctness of its location
Sometimes it is necessary to press on the suprapubic area to empty the bladder from urine.
When conducting proper catheterization, only disinfected instruments are used, aseptic and antiseptic conditions are observed.
There are two types of catheterization:
- a catheter tube is used during flushing to administer the solution;
- a Foley urinary catheter is needed to facilitate the process of urination;
- a cystostomy is a catheter inserted through the abdominal wall for urine outflow, washing.
Catheterization is performed in violation of normal urination with an enlarged prostate, kidney failure, the formation of stones. In inflammatory processes, hematuria and heaviness in the pelvic area, a catheter is more often inserted through the urethra.
It is impossible to flush the bladder in the following cases:
- urethral injury;
- acute inflammation of the urethra;
- damage to the sphincter of the bladder;
- sexually transmitted diseases.
The amount of fluid injected is 200-400 ml, depending on the capacity of the organ. To exit the liquid, the tube is removed from the Esmarch mug, the procedure is repeated until a clear transparent liquid exits. If a cystoscope is not inserted after washing, then the organ is half filled with saline before the catheter is removed.
Possible complications due to the introduction of drainage
- Urethritis is a chronic or acute inflammation of the urethra that occurs due to irritation and infection due to the prolonged presence of the tube.
- Cystitis is an inflammation of the bladder. It develops due to infection inside the cavity. Cystitis causes frequent and painful urination. The disease often occurs as a post-traumatic effect of wearing a drain.
- Adenomitis is an inflammatory process of the prostate gland. The symptomatology of the disease is the same as with traditional adenoma, which nullifies all the positive effects of surgical intervention.
- Chronic prostatitis - in this case, the inflammatory process goes into a permanent stage. The diagnosis is made after the inflammation has continued for more than 3 months. Catalyst of inflammation, an infection that has got inside the catheter, which has become the cause of the disease.
- Acute prostatitis - occurs due to ingestion of the urethra and urinary tract by staphylococcal and ureaplasma pathogens. The reason is insufficient hygiene while wearing the catheter.
- Orchiepidemitis - inflammation of the testicle and epididymis. It occurs as a side effect of an infectious factor entering the prostate gland. It is characterized by extensive tissue lesions, rashes like herpes are possible.
- Pyelonephritis - the lesion affects the tissues of the entire urinary system. The main blow falls on the kidneys.
Caring for an Installed Cystostomy
- The skin around the entrance is regularly washed with boiled water, a solution of potassium permanganate or furatsilina.
- The skin area is wiped dry and smeared with Lassar paste.
- Control the flow of urine. If the fluid stops flowing, the problem is that the catheter has fallen out, the tube is clogged or kinked.
- Care of the catheter is also required inside the drainage system located in the bladder. Regular flushing of the system is required. This way, you can prevent clogging of the catheter with sand and ingestion of infectious agents. For washing, they take the Janet device with a washing solution filled into it: 3% boric acid or furacilin, at a concentration of 1k 5000. The urinal is disconnected from the system, a syringe is connected and about 40 ml of the substance is injected and then disconnect the syringe from the system.Remains of urine and debris will come out of the tube. The procedure is repeated until clean water comes out of the drain.
- The system is replaced 4-8 weeks after installation. The first time manipulations are carried out in the clinic. Re-replacement is carried out independently.
How to change a catheter for prostatic hyperplasia
There are no specific dates indicating the interval after which the tube must be changed. The surgeon or urologist decides the issue of re-installation on an individual basis, according to the indications of the patient's health and vital activity.
In what cases is the tube removed for prostate adenoma?
- Unhindered entry of drugs and antibiotics. After the operation, washing with furacilin is mandatory. The solution reduces tissue irritation, accelerates wound healing and prevents the spread of infection. Entering the drug into the bladder using a catheter increases the effectiveness of drug therapy.
- Discharge of blood clots and dead fragments of the prostate. During surgery, 30% of the prostate gland is removed. Most of it is removed through the endoscope. The remaining particles exit through the urethra. Dead tissue is the cause of sepsis in the body. Flushing the bladder through a catheter speeds up rehabilitation and reduces the likelihood of complications after surgery.
- Reducing the load on injured tissue areas. A surgical operation, regardless of the type of operation (vaporization, ablation or TUR), injures healthy tissues. The body's defense mechanism is activated, aimed at restoring the normal function of internal organs. There is blood flow to the prostate gland, which leads to swelling, as in the case of a severe bruise. Often, after surgery, the urethra is compressed to such an extent that going to the toilet without a catheter becomes impossible.
Methods for installing a catheter for prostate adenoma
-
Traditional catheterization - with this solution, a Foley catheter is placed. The device has the form of a flexible tube with a special balloon at the end. After insertion through the urethral canal, the bladder is inflated to secure drainage in the bladder. A reservoir for collecting urine is attached to the other end of the Foley tube, usually fixed to the patient's leg. Through the catheter, antiseptics and antimicrobials are injected into the prostate, and the remnants of dead tissue are removed. The device is effective for short-term use.
-
The removal of the tube through the abdomen - catheterization is called - cystostomy. The main difference is that the tube is brought out to the side. To do this, a small incision is made in the abdominal cavity, where drainage is introduced. An installed cystostomy with prostate adenoma without proper care becomes the cause of infection, complete sepsis of the body or an infectious disease. For this reason, the tube is inserted into the abdominal cavity very rarely, only if conventional catheterization is not effective.
- Suprapubic drainage is an alternative to abdominal cystostomy. The tube is removed through the pubis, which is associated with less trauma for the patient.
How long is the tube for prostate adenoma
- Type of surgery:
- Minimally invasive methods: vaporization and ablation require short-term catheterization, lasting no more than a day. Manipulations to install and remove drainage are carried out during mandatory hospitalization for 2-3 days.
- After TUR, the period of wearing increases to 2-3 days.
- The patient's condition before surgery - if the residual urine was more than 200 ml, after removal of the adenoma, the catheter can be left for up to 4-5 weeks. The period of catheterization is affected by the speed of recovery of the patient.
- Postoperative recovery - you can get rid of the tube only in those cases when the patient is on the mend, urination normalizes.In an unfavorable combination of circumstances, the drainage is left until the patient has fully recovered.
