Prevention and Management of Complications Related to Catheterization

1. Collapse (Shock)

(I) Causes

Rapid drainage of large volumes of urine causes a sudden decrease in intra-abdominal pressure, leading to massive pooling of blood in abdominal vessels, resulting in decreased blood pressure and collapse.

(II) Clinical Manifestations

The patient suddenly experiences nausea, dizziness, pallor, shallow breathing, profuse cold sweating, muscle relaxation, general weakness, and often suddenly collapses to the ground. Some patients may also experience impaired consciousness.

(III) Prevention and Management

1. For patients with severe bladder distension who are extremely weak, the first urine drainage should not exceed 1000ml.
2. If collapse is detected, the patient should immediately be placed in a supine position or Trendelenburg position (head low, feet elevated).
3. Provide warm water or sugar water for drinking, and apply acupressure to points such as Renzhong (philtrum), Neiguan, and Hegu. Alternatively, acupuncture at Hegu, Zusanli, and other points can help with emergency resuscitation.
4. If the above measures are ineffective, establish intravenous access promptly and immediately notify the physician for emergency treatment

1. Temporary Sexual Dysfunction

(I) Causes

The patient may have an underlying disease that causes sexual dysfunction.

All other complications of catheterization can become causes of sexual dysfunction in male patients.

The psychological impact of the catheterization procedure itself on male sexual function.

(II) Clinical Manifestations

Male sexual dysfunction such as erectile dysfunction, premature ejaculation, anejaculation, retrograde ejaculation, decreased libido, and hypersexuality may all occur after catheterization, though these are rare occurrences.

(III) Prevention and Management

1. Before catheterization, repeatedly explain the procedure to the patient, ensuring they understand that catheterization itself does not cause sexual dysfunction.
2. Master catheterization techniques proficiently, operate gently, and avoid any other complications.
3. If sexual dysfunction occurs, provide psychological counseling; if ineffective, refer to an andrologist for appropriate treatment.

1. Formation of Urethral False Passage

(I) Causes

Most commonly seen in patients with spinal cord injury, where repeated intermittent catheter insertion damages the membranous urethra.

(II) Clinical Manifestations

Urethral pain and bleeding from the urethral meatus. Urethroscopy reveals false passage formation.

(III) Prevention and Management

1. When inserting the catheter, use slow and gentle manipulation, and be aware of resistance at the sphincter area. When the catheter tip reaches this location, pause briefly before continuing insertion. If necessary, 2% lidocaine may be instilled into the urethra.
2. Strictly adhere to intermittent catheterization intervals: perform catheterization once every 4-6 hours, not exceeding 6 times daily. Avoid excessive bladder distension; bladder volume should not exceed 500ml at each catheterization.
3. For patients with an established false passage, urethroscopy must be performed. Use the pressure of the irrigation fluid to locate the normal passage, then insert a guidewire into the bladder. Under guidewire guidance, advance a balloon catheter (with the tip removed) into the bladder and retain it for 2-3 weeks. Remove the catheter after the false passage has healed to prevent urethral stricture.
4. Inadvertent Insertion into the Vagina

Inadvertent insertion into the vagina is a complication unique to catheterization in female patients.

(I) Causes

Catheterization in female patients is usually uncomplicated, but catheterization failure or inadvertent vaginal insertion can occur in elderly women. In elderly women, relaxation of perineal muscles and atrophy of vaginal muscles with traction causes the urethral meatus to become embedded in the anterior vaginal wall, resulting in ectopic positioning of the external urethral orifice.

(II) Clinical Manifestations

No urine flows out after catheter insertion, while physical examination reveals bladder fullness and distension.

(III) Prevention and Management

1. If catheterization failure is due to inability to locate the external urethral orifice, careful searching for the urethral meatus should be performed. Search method: Perform routine disinfection of the external genitalia, wear gloves, place the index and middle fingers of the left hand together, gently insert them 1.5-2 cm into the vagina, flex the finger joints, then pull the anterior vaginal wall taut and evert it outward. The urethral orifice can be found in the everted mucosa; the aberrant urethral orifice is generally not deep.

2. If the catheter is inadvertently inserted into the vagina, replace the catheter and reinsert it correctly.

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2. The medical information provided here is for reference only and should not be used as a basis for clinical diagnosis or treatment.