A urinary catheter is a temporary, flexible tube designed to drain urine from the bladder when a patient is unable to empty it naturally. While often a concern for those preparing for surgery, the decision to use a catheter is clinical and depends on the specific nature of the operation and the patient’s health status. Catheterization is common in the perioperative setting, but it is not a routine requirement for every procedure. Its use is carefully considered by the surgical team based on clear medical indications.
Factors Determining Catheter Use During Surgery
One of the most common reasons a urinary catheter is placed is the anticipated duration of the surgery. For procedures expected to last three hours or longer, an indwelling catheter is typically used to ensure continuous bladder drainage throughout the operation. This prevents bladder distension and potential injury. An empty bladder is also necessary during specific types of surgery, particularly those involving the pelvic area, the abdomen, or the genitourinary tract. Keeping the bladder decompressed provides the surgeon with a clearer field of view and reduces the risk of accidental trauma to the organ during the procedure.
Precise monitoring of the patient’s fluid status is another determinant for catheter placement. During complex or prolonged surgeries, patients often receive large volumes of intravenous fluids or medications that affect kidney function. The catheter allows the medical team to accurately measure urine output minute-by-minute, which is an indicator of kidney perfusion and overall hydration status.
A catheter may also be required if the patient will be significantly immobile immediately following the operation. This is particularly relevant after major orthopedic surgeries, such as those involving the pelvis or hip, where movement to use a bedpan or commode is restricted. The catheter provides a continuous, sterile drainage system that avoids the need for movement and maintains patient comfort during the initial recovery period.
Common Types of Surgical Catheters
The most frequently used type in a surgical setting is the indwelling catheter, often called a Foley catheter, which is designed to remain in the bladder for an extended period. This device features two internal channels: one allows urine to drain into a collection bag, while the second is used to inflate a small balloon at the catheter tip. Once inflated with sterile water, this balloon anchors the catheter firmly inside the bladder, preventing it from slipping out.
A different device, known as an intermittent or straight catheter, may be used when continuous drainage is not needed. This is a single-use, one-way tube that is inserted only to empty the bladder completely just before or during the procedure and is removed immediately afterward. Intermittent catheterization serves the purpose of clearing the bladder without leaving a foreign body in place post-surgery.
For some procedures, a suprapubic catheter may be employed as an alternative to the more common urethral route. This catheter is surgically inserted directly into the bladder through a small incision in the lower abdominal wall, completely bypassing the urethra. This approach may be chosen when urethral access is difficult or when a longer-term catheter is anticipated, offering easier management and reduced risk of urethral irritation.
The Patient Experience: Insertion and Removal
For most patients undergoing general anesthesia, the catheter insertion occurs after they are asleep and before the surgery begins. This timing ensures that the patient does not experience discomfort associated with the placement of the tube through the urethra. The procedure is performed by nurses or surgical staff using sterile technique to minimize the risk of introducing bacteria.
The catheter is typically removed once the patient meets certain criteria, often within 24 hours of the operation. Patients are generally awake for the removal, which involves deflating the small retention balloon before gently withdrawing the tube. While the process is quick, it can sometimes cause a brief, uncomfortable sensation, such as a temporary burning or stinging feeling.
After the catheter is removed, it is common to experience temporary urinary irritation. This may include urinating more frequently than normal or a slight burning sensation when passing urine for the first few attempts. Some patients may also notice temporary difficulty with starting or stopping the flow of urine as the bladder regains its normal function.
Understanding and Minimizing Catheter Risks
The primary medical concern associated with the use of indwelling urinary catheters is a Catheter-Associated Urinary Tract Infection, commonly referred to as a CAUTI. The presence of the tube provides a pathway for bacteria to enter the bladder from the surrounding environment, and the risk of infection increases significantly the longer the catheter remains in place. Non-infectious complications such as pain, bladder spasms, or bloody urine are also common.
Minimizing the risk of complications starts with limiting the duration of use, as the catheter should be removed as soon as it is medically safe. While the catheter is in place, prevention relies on maintaining a sterile, closed drainage system. This involves ensuring the collection bag is always positioned below the level of the bladder to prevent urine from flowing back into the body, and that the tubing is free of kinks or obstructions.
Proper hygiene is also important, requiring meticulous hand washing before and after handling any part of the catheter system. Patients and caregivers should be vigilant for signs of a potential infection, which include:
- Fever.
- Chills.
- Pain in the lower abdomen.
- A sudden change in the urine’s appearance, such as it becoming cloudy or having a foul smell.
Reporting these symptoms quickly allows for prompt medical intervention.