Name of the Procedure:

Intermittent urinary catheterization with coude (curved) tip catheter (HCPCS code A4352).

Summary

Intermittent urinary catheterization with a coude tip involves inserting a flexible tube with a curved tip into the bladder to drain urine. The procedure is usually done several times a day to ensure proper bladder drainage in individuals who cannot urinate normally.

Purpose

The procedure addresses urinary retention and neurogenic bladder, aiming to:

• Relieve urinary retention.
• Prevent bladder overdistension and potential kidney damage.
• Reduce the risk of urinary tract infections.

Indications

• Chronic urinary retention.
• Neurogenic bladder due to spinal cord injury or neurological diseases.
• Prostatic hypertrophy causing obstructive uropathy.
• Post-surgical urinary retention.

Patients who are appropriate candidates for this procedure include those who:

• Have difficulty emptying their bladders naturally.
• Have been diagnosed with urinary retention or neurogenic bladder.
• Require intermittent catheterization as part of their management plan for urinary incontinence.

Preparation

• Maintain a clean catheterization environment.
• Gather necessary supplies: catheter, lubricant, antiseptic wipes, and a drainage container.
• Wash hands thoroughly.
• The patient might need to perform a pre-procedure bladder scan to assess urine volume.

Procedure Description

1. Hand Hygiene: The patient or caregiver washes hands thoroughly with soap and water.
2. Preparation: Clean the urethral opening with antiseptic wipes.
3. Lubrication: Apply water-soluble lubricant to the catheter tip.
4. Insertion: Gently insert the coude tip catheter into the urethra until urine begins to flow.
5. Drainage: Allow urine to drain completely into the designated container.
6. Removal: Slowly remove the catheter once the bladder is empty.
7. Disposal: Dispose of the used catheter following proper healthcare waste protocols.

Tools, equipment, or technology:

• Coude tip catheter (with or without specialized coatings such as Teflon, silicone, etc.)

Duration

The entire catheterization process generally takes around 5 to 10 minutes.

Setting

The procedure can be performed in various settings, including:

• Home
• Outpatient clinic
• Long-term care facilities

Personnel

• Trained patients or caregivers
• Nurses or healthcare professionals (for teaching and monitoring)

Risks and Complications

Common risks:

• Mild discomfort during insertion
• Minor urethral irritation

Rare risks:

• Urinary tract infections (UTIs)
• Urethral trauma or bleeding
• Bladder spasms

Benefits

Expected benefits include:

• Immediate relief from urinary retention
• Reduced risk of bladder and kidney damage
• Better management of urinary incontinence and overall quality of life

Recovery

Post-procedure care:

• Monitor for any signs of UTI, such as fever, chills, or burning sensation during urination.
• Maintain the catheterization schedule as directed by the healthcare provider.
• Regular follow-up appointments for monitoring and possible adjustments.

Expected recovery time:

• Patients can usually resume their normal activities immediately after the procedure.
• Regular monitoring and adherence to catheterization schedules ensure optimal recovery.

Alternatives

Other treatment options might include:

• Indwelling urinary catheters (Foley catheters)
• Suprapubic catheters
• Medications to manage bladder function
• Surgical interventions, such as bladder augmentation

Pros and cons of alternatives:

• Indwelling catheters reduce the frequency of catheterization but carry a higher risk of infections.
• Suprapubic catheters also reduce infection risks but require surgical insertion.
• Medications might not be effective for all conditions.
• Surgical options are more invasive with longer recovery times.

Patient Experience

During the procedure, patients may feel:

• A mild discomfort or a sensation of pressure as the catheter is inserted.
• Some relief as the bladder empties.

Pain management and comfort measures:

• Use of water-soluble lubricant to ease catheter insertion.
• Proper hygiene to prevent infections.
• Slow and careful catheterization to minimize discomfort.

Patients are often educated and supported by healthcare professionals to perform this procedure safely at home, promoting independence and comfort.