Name of the Procedure:

Insertion Tray without Drainage Bag with Indwelling Catheter, Foley Type, Three-Way, for Continuous Irrigation (HCPCS Code: A4313)

Summary

This procedure involves the insertion of a specialized type of Foley catheter, known as a three-way catheter, which allows for continuous irrigation of the bladder. This type of catheter is used without an accompanying drainage bag and is inserted using a sterile insertion tray.

Purpose

The procedure is performed to manage and treat urinary retention, bladder obstructions, or to allow for continuous irrigation of the bladder to prevent or manage blood clots, debris, or infection within the urinary tract. The primary goal is to ensure the bladder remains clear and functional.

Indications

• Obstructive uropathy
• Bladder or prostate surgery
• Severe hematuria with clot formation
• UTI prevention and management in specific cases
• Patients requiring continuous bladder irrigation

Preparation

• The patient may need to fast for a few hours before the procedure if sedation is used.
• Inform the healthcare provider of all medications and allergies.
• Baseline diagnostic tests like urinalysis and blood tests might be conducted.
• Local cleaning of the insertion area.

Procedure Description

1. The patient is positioned comfortably, usually lying on their back.
2. The genital area is cleaned with antiseptic solution.
3. A sterile insertion tray is prepared and opened.
4. The Foley catheter is lubricated and gently inserted into the urethra until it reaches the bladder.
5. The catheter’s balloon is inflated to keep it in place.
6. The third lumen of the catheter is attached to an irrigation solution to provide continuous irrigation.

Duration

The insertion procedure typically takes about 15-30 minutes.

Setting

This procedure can be performed in a hospital, outpatient clinic, or a surgical center.

Personnel

• Registered Nurse (RN) or Licensed Practical Nurse (LPN)
• Urologist or a trained healthcare provider
• Anesthesiologist (if sedation is used)

Risks and Complications

• Infection (urinary tract infection, sepsis)
• Bleeding
• Discomfort or pain
• Accidental removal or displacement of the catheter
• Bladder spasms
• Allergic reaction to materials used

Benefits

• Immediate relief from urinary retention
• Reduced risk of bladder damage
• Prevention of clot formation in the bladder
• Improved urinary function
• Enhanced patient comfort

Recovery

• Regular monitoring of urine output and signs of infection.
• Drink plenty of fluids to help flush out the catheter and bladder.
• Follow-up appointments as recommended.
• Avoid strenuous physical activity until cleared by physicians.

Alternatives

• Use of two-way catheters.
• Intermittent catheterization.
• Medications to manage bladder conditions.
• Surgical intervention for underlying conditions.

Each alternative comes with its own set of pros and cons, depending on the patient's specific condition and overall health.

Patient Experience

During the procedure, patients might feel some pressure or discomfort. Mild discomfort can last for a few days post-procedure. Pain can usually be managed with prescribed medications and proper positioning. It's vital to maintain hygiene around the catheter site and report any unusual symptoms to the healthcare provider immediately.