The History of Catheters
acute urinary retention, nothing spells relief quite like a catheter.
are safe, indispensable diagnostic and treatment tools in many
employed as much to inject fluid as to drain it. In cardiology, for
they're the conduit for radiopaque dye to magnify coronary arteries and
miniature stents to unblock them. But the history of the catheter
to urology—and the process of draining a painfully distended bladder
to antiquity. Catheterization is one of civiliation's first therapeutic
using onion stalks, and the Hindus, Egyptians, Romans and Greeks
tubes of wood and precious metals. In America, Founding Father Benjamin
Franklin designed a silver coil catheter for his brother in 1752 and
used it later himself, remarking once that "only three incurable
have fallen to my share … the gout, the stone, and old age." By the
catheters had a urological niche, with innovators producing the first
Woven, soaked and dried, Louis Mercier's coude or elbow catheter
earned a 1851 patent for vulcanized or moldable hard rubber coude
be custom-shaped. While today's materials may be superior, Goodyear's
opened the door for mass production of curved models for many tasks.
had the staying power of Minneapolis urologist, Frederick E.B. Foley's
rubber balloon catheter. With its introduction in June 1935,
finally had an in-dwelling hemostatic device that could be held in
by its own configuration—not bandages or tape. Nothing matched Foley's
single, continuous design in ensuring drainage post-op or short term.
he ultimately lost in a battle with industry firm C.R. Bard for the
patent, decades later a balloon catheter is still referred to simply as
Foley, Frenchmen Malecot
and de Pezzar laid the groundwork with their "four-winged" and
models. Before them (1853), Jean Reybard inflated a bladder bag to
the "grandfather" of retained devices.
safe and acceptable, largely because of the antiseptic principles
in 1867 by Glasgow's Joseph Lister. While skeptics, including some
scoffed at swabbing surfaces prior to procedures, today urologists
on absolute disinfection to prevent microorganisms from infecting the
chronic sufferers from bladder outlet obstruction
Franklin's brother—with concealed catheters they carried on them in
canes or umbrellas.
be crucial in treating patients with permanent abnormal bladder
Post-World War II urologists faced that question on a grand scale as
with unprecedented spinal cord injuries returned home as a new catheter
population. These paralyzed patients needed more than occasional
for calculi, prostatic obstructions or urethral inflammation. They were
treated with catheter drainage of their dysfunctioning bladders.
sterile intermittent techniques because of potential bacteria. But only
when University of Michigan urologist Jack Lapides introduced clean
self-catheterization in 1971 did it come to light that germs were not
only cause of urinary tract infections (UTIs), but that persistent
urinary residuals were also culprits. Lapides also showed that
catheterization, even if not done in totally sterile conditions, was
safer than an indwelling catheter.
a multiple sclerosis sufferer, that neurogenic bladder patients didn't
require cumbersome sterilization techniques. Instead, they could
self-catheterize with a simple, clean approach based on mapping their
urethral landmarks and suffer no bacterial consequences. By learning
technique in a day, they'd have personal control for life.
measures would be
helpful as clean intermittent self-catherization. Three decades after
initial rancorous debate over the technique, millions of neurogenic
can testify to its merits.
Catheters : The
of Catheters (vs. the Catheter
A urinary catheter is
in the body to drain and collect urine from the bladder.
catheter is a soft plastic or rubber tube that is inserted into the
bladder to drain the urine. Urinary catheters are sometimes recommended
as way to manage urinary incontinence and urinary retention in both men
and women. There are several different types of catheters which may be
used for a variety of different reasons.
Urinary catheters may
used to drain
the bladder. This is often a last resort because of the possible
associated with continuous catheter usage. Complications of catheter
may include: urinary tract and/or kidney infections, blood infections
urethral injury, skin breakdown, bladder stones, and blood in the urine
(hematuria). After many years of catheter use, bladder cancer may also
Your health care
use of a catheter for short term use or long term use (indwelling). The
catheter may be left in place during this time, or you may be
on a procedure for placing a catheter just long enough to empty the
and then remove it (clean intermittent self catheterization).
Catheters come in a
(12 Fr., 14 Fr.,... 30 Fr.), materials (latex, silicone, Teflon) and
(Foley catheter, straight catheter, coude tip catheter). It is
that you use the smallest size of catheter, if possible. Commonly, a
14 Fr. or size 16 Fr. catheter is used. Some people may require larger
catheters to control leakage of urine around the catheter or if the
is thick and bloody or contains large amounts of sediment. Be aware
larger catheters are more likely to cause damage to the urethra. Some
have developed allergies or sensitivity to latex after long term latex
catheter use; these people should use the silicone or Teflon catheters.
A catheter that is
place for a
period of time may be attached to a drainage bag to collect the urine.
There are two types of drainage bags. One type is a leg bag, which is a
smaller drainage device that attaches by elastic bands to the leg. A
bag is usually worn during the day since it fits discreetly under pants
or skirts, and is easily emptied into the toilet. The other type of
bag is a larger drainage device (down drain) that may be used during
night. This device is usually hung on the bed or placed on the floor.
HOW TO CARE FOR
Most experts advise
(replacing) of the catheters. If the catheter is clogged (obstructed),
painful, or infected it may require immediate replacement. Routine care
of the indwelling catheter MUST include daily cleansing of the urethral
area (where the catheter exits the body) and the catheter itself with
and water. The area should also be thoroughly cleansed after all bowel
movements to prevent infection. Experts no longer recommend using
ointments around the catheter as they have not been shown to actually
You should increase
unless you have a medical condition prohibiting large amounts of fluid
intake, to reduce the risk of developing complications. You should
this issue with your health care provider.
bag must always stay lower than the bladder to prevent a back flow
of urine back up into the bladder. The drainage device should be
at least every eight hours, or when the device is full. Care must be
to keep the outlet valve from becoming infected. Wash your hands before
and after handling the drainage device. Do not allow the outlet valve
touch anything. If the outlet becomes obviously dirty, it should be
with soap and water.
HOW TO CLEAN YOUR
Some experts recommend
bag periodically. Remove the drainage bag from the catheter (attach the
catheter to a second drainage device during the cleansing). Cleanse and
de-deodorize the drainage bag by filling the bag with 2 parts vinegar
3 parts water. Chlorine bleach can be substituted for the vinegar and
mixture. Let this solution soak for 20 minutes. Hang the bag with the
valve open to drain and dry the bag.
WHAT TO DO FOR A
Some people have
urine around the catheter. This may be caused by a catheter that is too
small, improper balloon size, or bladder spasms. If bladder spasms
you should check to see that the catheter is draining properly. If
is no urine in the drainage bag, the catheter may be obstructed by
or thick sediment, or kinking of the catheter or drainage tubing. If
have been instructed on irrigation (flushing the catheter) procedure,
to irrigate the catheter and see if this helps. If you have not been
on irrigation and urine is not flowing into your collection device, you
should contact your health care provider immediately. Other causes of
leakage around the catheter include constipation or impacted stool, or
urinary tract infections.
Notify your health
provider if you
develop any of the following:
the urine has a strong
smell or becomes
thick and/or cloudy.
urethral swelling around the
bleeding into or around the
catheter draining little or no
adequate fluid intake
leakage of large amounts of
HOW TO INSERT A
1. Assemble all
sterile gloves, cleaning supplies, syringe with water to inflate the
2. Wash your hands.
cleansing product (unless instructed otherwise) to clean the urethral
3. Apply the sterile
gloves. Make sure
you do not touch the outside of the gloves with your hands.
4. Lubricate the
5. Hold the penis on
to the body. Stretch the penis away from the body.
6. Begin to gently
7. You will meet
the level of the external sphincter. Try to relax by deep breathing,
continue to advance the catheter.
8. Once the urine flow
to advance the catheter to the level of the "Y" connector. Hold the
in place while you inflate the balloon. Some men have developed
injuries due to the balloon being inflated in the urethra. Care must be
taken to ensure the catheter is in the bladder. You may try to irrigate
the catheter with a few ounces of sterile water. If the solution does
easily return, you may not have the catheter far enough in the bladder.
9. Secure the
HOW TO REMOVE A
two ways. One method is to attach a small syringe to the inflation port
on the side of the catheter. Draw out all the fluid until you are
to withdraw any more fluid. Slowly pull the catheter out until it is
Some health care
patient's to cut the inflation port tubing before it reaches the main
of the catheter. After all the water has drained out, slowly pull out
catheter until it is completely removed. Be careful not to cut the
If you cannot remove
only slight pulling, notify your health care provider immediately.
Notify your health
provider if you
are unable to urinate within 8 hours after catheter removal, or if your
abdomen becomes distended and painful.
taken directly from the medical information supplied by the US