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1
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- William Deaton, D.O.
- Metro Health Hospital
- Grand Rapids, MI
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- Non-Deflating Catheter Removal
- Suprapubic Catheterization and Aspiration
- Urethrogram
- Priapism
- Phimosis
- Paraphimosis
- Testicular Torsion
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- Indicated for a catheter that will not deflate due to either valve
blockage, external clamping or kinking of tube, or crystallization of
fluid within balloon.
- Cut the balloon proximal to the filling port. If this does not result in a
release of water from the cath, pass a wire from a central line into=
the
inflation channel to puncture the balloon. If this does not work, pass=
the
central line into the channel and pop the balloon.
- Last ditch, leave the central line in the channel and introduce eith=
er
ether, acetone, or mineral oil into the balloon to reduce
crystallization. If ba=
lloon
ruptures, make sure the entire balloon is intact to prevent a bladder
foreign body.
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4
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- Indicated when a clean catch urine specimen is indicated and a cathe=
ter
is contraindicated, to relieve obstruction, or trauma patients with
major urethral injury.
- Contraindicated with a small or non-palpable bladder or previous low=
er
abdominal surgery.
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5
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6
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- Percuss abdomen to determine the level of the bladder.
- Prep the skin in a sterile fashion.
- Inject 1% Lidocaine in the midline, two finger breadths superior to =
the
symphysis pubis.
- Use a 20-gauge spinal needle to anesthetize the abdominal wall. Insert this needle directly
posteriorly while aspirating.
If urine is obtained, withdraw needle. If air is obtained, stop
immediately.
- Make a 1cm horizontal incision in midline of anesthetized area. Using a trocar, insert a
suprapubic catheter into the same region as the spinal needle until
urine is aspirated..
- Advance the catheter 3cm and remove the trocar.
- Connect drainage system and secure the tube to the skin.
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7
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- Indicated in trauma patients with blood at the meatus or severe pelv=
ic
fractures.
- Insert a 50mL Tomey syringe into the meatus and instill 10mL of a 10%
contrast solution.
- Take X-ray of pelvis to look for leakage of dye.
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8
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- Persistent erection originating from high arterial flow or
veno-occlusive disorders.
May also be due to medication reaction.
- First try ice packs and running up and down stairs to create a
“steal” effect??
- Terbutaline 5mg orally followed by 5mm orally 15 minutes later.
- Intercavernous injection of alpha agonist (phenylephrine) if this is
post injection of erection inducing drugs.
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9
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- Aspiration of corpus cavernosum may be required.
- First perform a penile nerve block with 1% plain lidocaine.
- Attach a 18ga needle on a large syringe and introduce into the corpus
cavernosum through the shaft of the penis at 10 and 2 o’clock
positions. If necessar=
y do
this on both sides.
- May need instillation of phenylephrine (10mg in 500mL) to replace
aspirated blood.
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10
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- Inability to retract a previously retractable foreskin, usually caus=
ed
by a infectious process.
- Treat infection and refer to a urologist for circumcision.
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11
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- Foreskin has been retracted and then remains proximal to the glans p=
enis
causing swelling and pain.
- Glans penis and foreskin can become ischemic due to lack of blood
supply.
- Some causes are failure to retract foreskin after catheter placement,
adhesions, piercings, and infectious process.
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13
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- Reduction is necessary AFTER penile nerve block has been done.
- Place index finger and middle finger behind the paraphymotic ring and
exert pressure on the glans penis with the thumb.
- If this is not successful, use a 20ga needle to make 15-20 small hol=
es
in the edematous skin and gently try to express the edema fluid.
- If still unsuccessful, emergent urological referral is needed.
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14
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15
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16
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- Testicle rotates medially and cuts off blood flow to itself.
- Usually presents in childhood or early adolescence.
- May have recent history of self-limiting episodes of lower abdominal
pain or testicular pain. May
have recent trauma.
- On physical, the cremasteric reflex may be absent, and the testicle =
may
be high riding and swollen.
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18
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- Prior to manual detorsion, urgent urological consult should be made.=
- First, treat with IV pain control and possible sedation or spermatic
cord injection.
- Rotate the testis laterally and superiorly. Do not attempt this multiple
times. If successful, =
the
testis will drop into normal position.
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20
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