Cranium
Cranium
email : bobby_fkua@yahoo.com
Indikasi
A. Diagnostic
• Mengukur residual urine post miksi karena tidak adanya usg untuk
pemeriksaan
• Pengambilan sample urine untuk pemeriksaan mikroskopis dan
kultur urine pada penderita yang tidak dapat miksi spontan
• Pengukuran produksi utine pada penderita dengan penyakit kritis
B. Investigational
• Mengisi buli-buli untuk persiapan pemeriksaan usg abdomen
• Pemeriksaan urodinamik
• Pemeriksaan sistogram
C. Therapeutic
• Untuk persiapan persalinan yang menggunakan enestesi epidural
• Retensio urine (contoh : karena adanya obstruksi bladder outlet
seperti batu atau BPH)
• Inkontinensia urine yang sangat mengganggu
• Persiapan untuk operasi besar (seperti operasi abdomen dan pelvis)
• Pemberian kemoterapi intra buli-buli (seperti pemberian mitomycin
C dan bacillus
• Calmette-Guérin [BCG])
• Pasien yang tidak memungkinkan atau menolak dilakukannya terapi
medis atau pembedahan terhadap kelainan di buli
• Sebagai spalk urethra sekaligus untuk drainage urine ( contoh : post
operasi urethroplasy pada penderita hypospadia)
• Penderita dengan gangguan fungsi pengosongan buli-buli (
contohnya ada trauma medulla spinalis, diabetes mellitus dengan
neuropathy buli-buli)
Metode Pemasangan Kateter
1. Condom catheters.
2. Clean intermittent self-catheterization (CISC): Menggunakan kateter
yang dilubrikasi dengan gel dan dimasukkan sendiri oleh penderita
seperti pemasangan kateter pada umumnya
3. Intra-urethral catheterization
4. Suprapubic catheterization: Kateter dimasukkan melalui dinding
abdomen bawah ke dalam buli-buli
Classification of Urinary Catheters
A. Ukuran
• Ukuran kateter urethra bervariasi . Pemilihan ukuran
disesuaikan dengan penderita dan indikasi pemakaian.
Ukuran kateter diukur berdasarkan :
• Charrière (Ch) units: catheter’s diameter in millimeters (1 Ch =
0.33 mm diameter
• French (Fr) units: catheter’s circumference in millimeters (12 Fr =
12-mm circumference)
• Panjang kateter urethra :
• Anak-anak: 30 cm
• Perempuan: 26 cm (20–26 cm)
• Standard: 43 cm (41–54 cm)
B. Material
1. Latex (rubber)
• Soft and fl exible
• All rubber uncoated: short-term use up to 4 weeks
• Does not have a smooth surface, causing high surface friction
2. Polytetrafl uoroethylene (PTFE)-coated
• Inert
• Provides a smooth outer surface
• Can remain in situ for up to 4 weeks
3. Silicone elastomer-coated
• Less prone to encrustation
• Compatible with the urethral mucosa
• Can remain in situ for up to 12 weeks
4. Hydrogel-coated
• Absorb fluid, thus form a hydrophilic slippery “cushion” between
urethra and catheter surface reducing trauma
• Resists encrustation and bacterial colonisation
• Can remain in situ for up to 12 weeks
• Silver-alloy coated: can reduce infections in the short-term
5. Silicone
• 100% latex free: used in those with latex allergy
• Thin-walled
• Have wider drainage lumens
• Compatible with the urethral mucosa
• Lack flexibility
• High surface friction
• Can remain in situ for up to 12 weeks
• Can be hydrogel coated
6. Plastic or polyvinylchloride (PVC)
• Relatively cheap
• Develop cracks and quickly encrust
• Short-term use (e.g., CISC)
• Rigid at temperatures lower than body temperature and therefore
can cause discomfort
• Thin-walled with the widest lumens
C. Tip and Holes
1. Straight: no bends at the tip
• Ordinary straight: holes on the side
• Couvelaire (whistle-tip): straight with openings lateral and
distal to the balloon, providing a large drainage area to drain
debris and blood clots
• Council tip: have a small hole at the tip, which allows them to
be passed over a wir
2. Coude: Bent/curved tip (approximately 45°) to allow passage through
prostate
a. Delinotte (Mercier): a bent straight-tip
b. Dufour: a bent couvelaire
D. Lumens
1. One lumen
• Nelaton catheters : a simple straight tube with (a) hole(s) at the end. These are
mainly used for CISC. These catheters do not normally have an inflatable
balloon.
• Malécot or DePezzer catheters : These have a triangular-/mushroom-looking tip
designed for suprapubic catheterization or to drain urine from the renal pelvis.
They are without a balloon, and therefore will stay in position because the tip will
fold out once the stick inside the lumen of the catheter is retracted.
2. Two lumens
• Foley catheters: Two-way catheters with a tube and a balloon at the end to keep
them from falling out of the bladder.
3. Three lumens
• Hemostatic catheters: Three-way catheters are generally thicker than the previous
two catheters with an extra small separate channel. This allows fluid/irrigant to
pass to the tip of the catheter and into the bladder to flush it and wash away
blood and small clots through the primary arm that drains into a collection
device. The inflation arm has a small plastic valve that allows for the introduction
or removal of sterile water through a very small channel to inflate or deflate the
retaining balloon.
4. Four lumens
• Three of the four lumens act as drainage conduit, inflation and deflation valve, or
continuous irrigation port while the fourth lumen provides irrigation or aspiration
of the operative site (e.g., following a transurethral resection of the prostate).
Types of large-diameter catheters. A, Conical tip urethral catheter, one eye. B, Robinson
urethral catheter. C, Whistle-tip urethral catheter. D, Coudé hollow olive-tip catheter. E,
Malecot self-retaining, four-wing urethral catheter. F, Malecot self-retaining, two-wing
catheter. G, Pezzer selfretaining drain, open-end head, used for cystotomy drainage. H,
Foley-type balloon catheter, one limb of distal end for balloon inflation (i), one for
drainage (ii). I, Foley-type, three-way balloon catheter, one limb of distal end for balloon
inflation (i), one for drainage (ii), and one to infuse irrigating solution to prevent clot
retention within the bladder (iii).
E. Number and Volume of Balloons
• The maximum volume the balloon can accommodate
is normally printed on the side of one of the arms.
This can range from 5–40 mL.
• Most catheters have one balloon; however, there are
some catheters that have two balloons (Figure 3.7).
They are normally used after prostatectomy, and the
second balloon sits in the prostatic capsule/fossa to
help with tamponade of bleeding vessels.
The bladder balloon is generally inflated first and the
catheter pulled to the bladder neck and then the
prostatic balloon is inflated.
PROSEDUR PEMASANGAN KATETER
Alat-alat yang dibutuhkan :
A. Alat B. Obat
a. Tromol steril berisi a. Aquadest
b. Gass steril b. Bethadine
c. Deppers steril
d. Handscoen c. Alkohol 70 %
e. Cucing
f. Neirbecken
g. Pinset anatomis
h. Doek
i. Kateter steril sesuai ukuran yang dibutuhkan
j. Tempat spesimen urine jika diperlukan
k. Urobag
l. Perlak dan pengalasnya
m. Disposable spuit
n. Selimut
O. Plester
p. Xylocain gel
Persiapan
• Informed consent tentang indikasi, cara pemasangan dan
komplikasi yang bisa terjadi
• Jelaskan tentang kemungkinan adanya rasa tidak nyaman selama
pemasangan dan selama pemakaian kateter
• Berikan antibiotika profilaksis secara intravena sekitar 30 menit-1
jam sebelum kateterisasi dengan menggunakan golongan ampicillin
atau cephalosporin generasi II atau antibiotika yang sesuai dengan
pola kuma di rumah sakit
• Operator cuci tangan sampai bersih, meliputi
– Melepaskan semua benda yang ada di tangan
– Menggunakan sabun
– Lama mencuci tangan 30 menit
– Membilas dengan air bersih
– Mengeringkan dengan handuk / lap kering
Dilakukan selama dan sesudah melakukan tindakan kateterisasi
urine
• Siapkan alat dan bahan yang diperlukan di atas meja
Prinsip- prinsip pemasangan kateter
– Gentle / lembut
– Asepsis &antiseptic
– Lubrikasi yang adekuat
– Gunakan ukuran kateter yang lebih kecil / sesuai