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留置导尿技术Urinary Catheterization 导尿术Introduction将无菌导尿管经尿道插入膀胱的方法。By inserting a Foley catheter, you are gaining access to the bladder and its contents. Thus enabling you to drain bladder contents, decompress the bladder, obtain a specimen, and introduce a passage into the GU tract. This will allow you to treat urinary retention, and bladder outlet obstruction.经尿道导尿术耻骨弓上导尿术Scenario AA 40 year old male presenting as a trauma with blood at the urethralmeatus and a non-palpable prostate. Scenario BA 75 year old male with an enlarged prostate presenting with septic shock secondary to pneumonia, requiring urinary catheterization for monitoring of resuscitation. Whether or not you would place a catheter in the patient based on those difficulties?If yes, to further elaborate on catheter sizes and types?If no, what steps they you take to address the suspected pathology?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、并发症一、目的Indications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二、禁忌症ContraindicationsFoley catheters are contraindicated in the presence of urethral trauma. 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三、导尿管的种类Urethral catheter types直头 Straight tip弯头 Coude tip三腔 3-way catheter irrigationCatheters are sized in units called FrenchOne French equals 1/3 of 1 mmCatheters vary from 12 (small) FR to 48 (large) FR (3-16mm) in size四、男性尿道解剖特点Male Urethral Anatomy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。四、女性尿道解剖特点Relevant anatomy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五、准备Preparation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用物EquipmentSterile glovesSterile drapesCleansing solutionCotton swabs ForcepsSterile water (usually 10 cc)Foley catheter (usually 16-18 French)Syringe (usually 10 cc)Lubricant (xylocaine jelly)Collection bag and tubing六、操作程序Procedure备物 Gather equipment.查对、评估、解释 Explain procedure to the patient体位(仰卧屈膝位) Assist patient into supine position with legs spread and feet together 操作者站在病人右侧,脱去对侧裤腿,盖在近侧腿部, 对侧用
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