Veterinary Medicine - October 2008 - (Page 559)

Placing an indwelling catheter and a connection to a closed urine collection system* An indwelling catheter may be placed immediately after obstruction relief if a strong urine stream is not present on expression, the patient is systemically ill, excessive hematuria is present, or the obstruction relief was dif cult. Or you may place an indwelling catheter up to several hours later if the patient reobstructs or has dif culty urinating because of an atonic bladder. To place an indwelling catheter, sedation or anesthesia is generally required in cats and in some dogs. Surgically scrub the penis and prepuce or vulva, and wear sterile gloves for this procedure. Use a 5-F (5- to 8-F in female dogs) red rubber (polyvinyl) or Foley (silicone or latex) catheter; these catheters are less likely to cause injury to the urethral and bladder mucosae because they are more pliable than polypropylene catheters. However, if necessary, a 3.5-F red rubber or Foley catheter may be used. In male cats, an open-ended 3.5-F, 4- to 6-in polytetra uoroethylene catheter with a silicone hub (e.g. Slippery Sam urethral catheter—Smiths Medical) can be placed. Although 3.5-F catheters can sometimes be placed more easily, they are also more easily obstructed than are larger-diameter catheters. Placing a more pliable catheter may require using a wire guide to facilitate passage. Often a generous amount of sterile lubricant applied to the catheter is needed to aid passage, especially for the Foley catheter’s balloon portion. If a Foley catheter is used, distend the balloon attached to the distal end of the catheter as instructed by the manufacturer once the end of the catheter has been inserted into the bladder lumen. If a red rubber or Foley catheter is used, suture a ange of tape attached to the catheter as it emerges from the prepuce or the vulva to the adjacent skin to help keep the catheter in place (Figure A). To minimize bacterial contamination after inserting an indwelling catheter into the bladder lumen, attach the catheter to a sterile, closed urine collection system, whether a commercially available product (e.g. Jorgensen Laboratories, Loveland, Co.; Bard Medical Division, Covington, Ga.) or one constructed from a recently emptied intravenous uid bag connected to a sterile administration A. An indwelling 5-F Foley catheter attached to a closed urine collection system. Note the tape ﬂange sutured to the body of the cat near the prepuce and the tape securing the collection system to the tail. set. A recent study indicated that properly stored, used intravenous bags are not likely to be a source of bacterial contamination when used in such a constructed system.1 Reduce tension on the indwelling catheter by attaching the collection system to the patient’s tail or body with elastic wrap and sutures. Mechanical restraint such as an Elizabethan collar is sometimes needed to keep a patient from pulling out or chewing on the urinary catheter. Pain management should be incorporated into the patient care plan. Nonsteroidal anti-in ammatory drugs may be used if renal function is adequate, and opioids may be used for pain relief. Remove indwelling catheters as soon as possible, generally within one to three days after placement. Indwelling catheters do predispose patients to urinary tract infection. However, do not give antibiotics unless evidence of urinary tract or systemic infection exists.. *Source: Bowles MH. Unblocking the urethra of the male cat. In: Ettinger SJ, Feldman EC, eds. Textbook of veterinary internal medicine. 6th ed. St. Louis, Mo: Elsevier Saunders, 2005;385-386. REFERENCE 1. Barrett M, Campbell VL. Aerobic bacterial culture of used intravenous uid bags intended for use as urine collection reservoirs. J Am Anim Hosp Assoc 2008;44(1):2-4. tering an antiemetic, or decreasing the dose slightly. Side effects do not occur as commonly with tiopronin administration but can include behavioral changes, myopathy, proteinuria, thrombocytopenia, immune-mediated anemia, skin lesions, lethargy, elevated liver enzyme activities, or a sulfur odor to the urine.24 Dissolution will be successful in about two-thirds of the dogs treated and requires about one to three months. Monitoring dissolution progress by imaging may require ultrasonography or double-contrast cystography. No proven cystine urolith dissolution protocol is available for cats. Consider surgical removal, lithotripsy, or voiding urohydropropulsion for eliminating cystine uroliths in cats or in dogs in which medical dissolution is not acceptable or successful. Prevention. The high recurrence rate of cystine uroliths and the inherited VETERINARY MEDICINE October 2008 559

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Veterinary Medicine - October 2008 Contents Leading Off Clinical Exposures Idea Exchange Stalking Stones Vaginitis in Dogs CE Form Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - October 2008

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