Insertion of temporary indwelling bladder catheter; complicated (eg, altered anatomy, fractured catheter/balloon)
CPT4 code
Name of the Procedure:
Insertion of Temporary Indwelling Bladder Catheter; Complicated
Common name(s): Foley catheter placement, complex bladder catheterization
Summary
A bladder catheter is a flexible tube inserted into the bladder to drain urine when normal urination is difficult. In cases of altered anatomy or complications such as a fractured catheter or balloon, this procedure involves additional steps and care.
Purpose
This procedure helps manage urinary retention, obstructed urine flow, or need for accurate urine output measurement. It also addresses complications arising from anatomical variations or damaged catheters.
Indications
- Severe urinary retention.
- Bladder obstruction due to swelling, stones, or tumors.
- Patients with altered anatomy (e.g., due to surgery or congenital issues).
- Managing a fractured catheter or balloon.
- Need for precise monitoring in critically ill patients.
Preparation
- Fast as instructed, usually starting a few hours before the procedure.
- Adjust medications as directed by your healthcare provider.
- Complete necessary diagnostic tests such as an ultrasound or X-rays.
Procedure Description
- Initial assessment and positioning of the patient.
- Sterile field preparation and hygiene measures.
- Local anesthesia may be applied to minimize discomfort.
- A specialized catheter is selected to account for anatomical nuances.
- Lubrication and careful insertion of the catheter through the urethra into the bladder.
- Inflation of the catheter balloon to secure it in place.
- Verification of urine flow and catheter placement.
Tools and equipment: Sterile catheter kit, lubricating jelly, local anesthetic, sterile gloves, and drapes.
Duration
Typically, the procedure takes 20-30 minutes, though it may vary based on complexity.
Setting
The procedure is commonly performed in a hospital, outpatient clinic, or surgical center.
Personnel
- Urologist or trained healthcare provider (e.g., nurse practitioner).
- Assisting nurse.
- Anesthesiologist may be involved if sedation is required.
Risks and Complications
- Infection at the insertion site.
- Bladder spasms or discomfort.
- Accidental injury to the urethra or bladder.
- Catheter blockage or dislodgement.
- Rare: Septicemia or significant bleeding.
Benefits
- Prompt relief from urinary retention or obstruction.
- Accurate urine output measurement.
- Improved comfort and management of urinary complications. Benefits are typically realized immediately.
Recovery
- Follow post-procedure instructions: hydration, catheter care, and hygiene.
- Monitoring for signs of infection or complications.
- Follow-up visit to assess catheter function and plan removal. Recovery time varies; in most cases, normal activity can resume within a day.
Alternatives
- Intermittent catheterization.
- Suprapubic catheter placement.
- Medications to relieve symptoms of retention or obstruction.
Pros and cons: Alternatives may vary in invasiveness, risk levels, and effectiveness depending on the underlying condition.
Patient Experience
Patients may feel pressure or discomfort during catheter insertion and some soreness afterwards. Pain management strategies, such as local anesthetics and oral pain relievers, are employed to ensure comfort. Post-procedure, patients are typically educated on catheter care and what sensations to expect.