临床技能学之留置导尿

留置导尿技术UrinaryCatheterization将无菌导尿管经尿道插入膀胱的方法。ByinsertingaFoleycatheter,youaregainingaccesstothebladderanditscontents.Thusenablingyoutodrainbladdercontents,decompressthebladder,obtainaspecimen,andintroduceapassageintotheGUtract.Thiswillallowyoutotreaturinaryretention,andbladderoutletobstruction.经尿道导尿术耻骨弓上导尿术Introduction导尿术ScenarioAA40yearoldmalepresentingasatraumawithbloodattheurethralmeatusandanon-palpableprostate.ScenarioBA75yearoldmalewithanenlargedprostatepresentingwithsepticshocksecondarytopneumonia,requiringurinarycatheterizationformonitoringofresuscitation.Whetherornotyou

wouldplaceacatheterinthepatientbasedonthosedifficulties？If

yes,tofurtherelaborateoncathetersizesandtypes？If

no,

whatstepstheyyou

taketoaddressthesuspectedpathology？主要内容一、目的二、禁忌症三、尿管的种类四、尿道解剖特点五、准备六、操作程序七、注意事项八、并发症解除尿潴留协助诊断

细菌培养监测尿量尿流动力学测量：膀胱容量、压力及残余尿鉴别尿闭与尿潴留进行尿道或膀胱造影等

协助治疗如胱内化疗Indications一、目的ContraindicationsFoleycathetersarecontraindicatedinthepresenceofurethraltrauma.二、禁忌症尿道周围有严重感染急性前列腺炎急性附睾炎急性尿道炎全身出血性疾病CathetersaresizedinunitscalledFrenchOneFrenchequals1/3of1mmCathetersvaryfrom12(small)FRto48(large)

FR(3-16mm)insize三、导尿管的种类Urethralcathetertypes直头Straighttip弯头Coudetip三腔3-waycatheterirrigationMaleUrethral

Anatomy四、男性尿道解剖特点男性尿道长约18～20cm三个狭窄：尿道外口，尿道内口、膜部两个弯曲：耻骨下弯和耻骨前弯耻骨下弯固定无变化耻骨前弯则随阴茎位置不同而变化如将阴茎向上提起，耻骨前弯即可消失。女性尿道长约4～5cm尿道短、直、粗,富于扩张性尿道外口位于阴蒂下方,与阴道口、肛门相邻比男性更容易发生尿道的感染Relevant

anatomy四、女性尿道解剖特点术者准备洗手戴口罩、帽子病人准备核对、评估解释操作的目的和过程。物品准备一次性导尿包，条件允许备数个碘伏棉球。必要时备：围屏、毛毯Preparation五、准备导尿的目的病人的病情病人的合作程度膀胱充盈度局部皮肤EquipmentSterileglovesSteriledrapesCleansingsolutionCottonswabsForcepsSterilewater(usually10cc)Foleycatheter(usually16-18French)Syringe(usually10cc)Lubricant(xylocainejelly)Collectionbagandtubing用物Procedure备物

Gatherequipment.查对、评估、解释Explainproceduretothepatient体位（仰卧屈膝位）

Assistpatientintosupinepositionwithlegsspreadandfeettogether

操作者站在病人右侧，脱去对侧裤腿，盖在近侧腿部，对侧用被遮盖，两腿外展、足部相抵，暴露外阴。六、操作程序清洁会阴（第一次消毒）：将小橡胶单和治疗巾垫于病人臀下，放治疗盘于会阴部。

消毒顺序：从外向里，由上向下。持血管钳夹消毒棉球（1%新洁尔灭）进行初步消毒男病人：依次为阴阜、大腿内侧1/3、阴茎、阴囊。提起阴茎将包皮向后推，暴露尿道口，自尿道口向外旋转擦拭尿道口、龟头及冠状沟（3次）。女病人：阴阜→对侧大阴唇→近侧大阴唇→对侧大小阴唇沟→近侧大小阴唇沟→（分开）对侧小阴唇→近侧小阴唇→尿道口→肛门。每只棉球只用一次。污棉球、手套置弯盘内移至床尾。Procedure六、操作程序在病人两腿之间按无菌技术操作打开导尿包

Opencatheterizationkitandcatheter术者戴好无菌手套、铺洞巾，将弯盘移至洞巾旁。

Preparesterilefield,applysterilegloves检查气囊完好性

Checkballoonforpatency润滑导管前端

Generouslycoatthedistalportion

(2-5cm)ofthecatheterwithlubricantProcedure六、操作程序第二次消毒

男病人：左手用无菌纱布裹住阴茎，将包皮向后推，暴露尿道口。右手持镊夹取无菌棉球消毒尿道口、龟头、冠状沟（螺旋3次）、加强消毒尿道口女病人：用左手拇、食指分开并固定小阴唇，右手用镊子夹棉球分别消毒尿道口、两侧小阴唇、加强消毒尿道口尿道口须消毒2次。每只棉球只用一次，污棉球置床尾弯盘内。消毒顺序：由里向外，由上向下Applysteriledrape.

Iffemale,separatelabiausingnon-dominanthand.

Ifmale,holdthepeniswiththenon-dominanthand.

Usingdominanthandtohandleforceps,cleanseperi-urethralmucosawithcleansingsolution.Cleanseanteriortoposterior,innertoouter,oneswipeperswab,discardswabawayfromsterilefield.

右手从尾部抓住尿管，让尿管轻轻盘绕在手心。Pickupcatheterwithgloved(andstillsterile)dominanthand.Holdendofcatheterlooselycoiledinpalmofdominanthand.插管。见尿液流出再插入1-2英寸(1inch=2.54cm)。

Identifytheurinarymeatusandgentlyinsertuntil1to2inchesbeyondwhereurineisnoted男病人：左手用无菌纱布固定阴茎，右手持导尿管前端，将阴茎向上提起，使之与腹壁成60°角，对准尿道口轻轻插入约20-22cm。Inthemale,liftthepenistoapositionperpendiculartopatient‘sbodyandapplylightupwardtraction(withnon-dominanthand).女病人：左手固定小阴唇，右手持导尿管前端，对准尿道口轻轻插入约4-6cm。Procedure六、操作程序将尿液引流入弯盘内或按需采集尿标本根据导尿管的气囊容积向气囊内注入等量灭菌注射用水（约10-20ml）

Inflateballoon,usingcorrectamountofsterileliquid(usually10ccbutcheckactualballoonsize)轻拉导尿管有阻力感，即证实导尿管已固定于膀胱内。

Gentlypullcatheteruntilinflationballoonissnugagainstbladderneck接尿袋

Connectcathetertodrainagesystem无张力固定

Securecathetertoabdomenorthigh,withouttensionontubingProcedure六、操作程序引流袋低于膀胱

Placedrainagebagbelowlevelofbladder评价尿管功能及尿液的量、颜色、气味等

Evaluatecatheterfunctionandamount,color,odor,andqualityofurine脱手套、正确处理医疗废物、洗手

Removegloves,disposeofequipmentappropriately,washhands记录

Documentsizeofcatheterinserted,amountofwaterinballoon,patient'sresponsetoprocedure,andassessmentofurineProcedure六、操作程序ComplicationsThemaincomplicationsaretissuetraumaandinfection.After48hoursofcatheterization,mostcathetersarecolonizedwithbacteria.Catheterscanalsocauserenalinflammation,nephrocystolithiasis,andpyelonephritisifleftinforprolongedperiods.尿路感染和尿道损伤保持引流通畅，避免导尿管受压、扭曲、堵塞防止逆行感染，集尿袋不得超过耻骨联合（膀胱高度）保持尿道口清洁七、并发症Thealternativestourethralcatheterizationincludesuprapubiccatheteri