Lecture 3

Question 1

What are the characteristics of bladder expression for urine collection?

Answer 1

-animals often resist
-typically need a relaxed animal or one with a disease affecting micturition
-can result in hematuria

Question 2

What are the pros of voiding and expression as urine collection methods?

Answer 2

-easy to perform
-non-invasive
-minimal cost
-adequate for some tests

Question 3

What are the cons of voiding and expression as urine collection methods?

Answer 3

-unsterile sample; not ideal for culture
-patients do not always cooperate

Question 4

Which test result can be influenced by voided/expressed collection?

Answer 4

WBC/pyuria

Question 5

What is cystocentesis?

Answer 5

use of a needle to puncture the bladder and collect urine via aspiration

Question 6

What are the indications for cysto?

Answer 6

-prevent contamination from lower tract
-localization of hematuria, pyuria, and bacteriuria
-therapeutic cystocentesis (caution, can cause rupture)

Question 7

What are the pros of cysto as a urine collection method?

Answer 7

-sterile sample
-minimally invasive
-usually well-tolerated
-inexpensive

Question 8

What are the cons of cysto as a urine collection method?

Answer 8

-requires training and practice
-requires cooperative patient +/- sedation
-possible damage to bladder/rupture

Question 9

What are the keys to cysto technique?

Answer 9

-stabilize syringe with thumb and index finger
-avoid repositioning hands
-aspirate with middle and ring fingers
-stabilize bladder with non-dominant hand

Question 10

What are the two methods for positioning a needle for a cysto?

Answer 10

-direct needle towards the trigone at a 45 degree angle
-direct the needle perpendicular to table at a 90 degree angle

Question 11

What must be considered when using a 90 degree angle approach for a cysto?

Answer 11

possibility of hitting the aorta, vena cava, or colon

Question 12

What are the possible patient positions for a cysto?

Answer 12

-standing
-lateral
-dorsal

Question 13

What are the keys to a cysto in a male dog?

Answer 13

-palpate bladder; do not proceed if bladder is empty
-insert needle cranial to prepuce on midline
-go adjacent to prepuce for small bladders

Question 14

What are the keys to positioning for a cysto in female dogs?

Answer 14

-draw an X between the inguinal and caudal abdominal mammary glands and aim at the cross
-use alcohol and insert needle where pool accumulates

Question 15

What are the contraindications for cystocentesis?

Answer 15

-insufficient volume of urine
-patient resistance
-thrombocytopenia or coagulopathy
-urothelial carcinoma

Question 16

What are potential complications of cysto?

Answer 16

-hematuria
-damage to bladder wall and/or adjacent structures
-sudden collapse/vagal event

Question 17

Which test result could be influenced by cysto?

Answer 17

RBC/hematuria

Question 18

What are the two types of catheterization?

Answer 18

-indwelling urinary catheter
-intermittent catheritization

Question 19

What are the possible goals of catheterization?

Answer 19

-diagnostic
-therapeutic

Question 20

What are potential complications of catheterization?

Answer 20

-urethral trauma
-kinking/twisting
-obstruction
-early removal by patient
-catheter-associated infection

Question 21

What are the indications for diagnostic catheterization?

Answer 21

-collect sterile urine sample
-measure urine output
-measure post-micturition residual volume
-instill contrast material for radiographic studies
-catheter aspiration of urethral, prostatic, or bladder lesions

Question 22

What are the indications for therapeutic catheterization?

Answer 22

-relieve urinary obstruction
-relieve urinary retention
-facilitate surgery

Question 23

What are the steps surrounding catheter placement that can help prevent catheter-associated UTI?

Answer 23

-aseptic technique during placement
-good hand hygiene
-replace damaged or dirty catheters
-avoid prophylactic antimicrobial treatment
-remove catheters once no longer indicated
-exchange catheters prior to antibiotic treatment
-maintain tubing below bladder and above drainage bag
-maintain closed drainage system

Question 24

What supplies are needed when placing a catheter?

Answer 24

-sterile gloves
-lube +/- sterile lidocaine jelly
-syringes
-sterile prep
-urinary catheter
-something to put urine in
-indwelling collection system
-sedation plan
-possible speculum

Question 25

How does sizing of catheters work?

Answer 25

-listed in Frenches -French/3 = diameter size in mm

Question 26

What are the characteristics of a foley catheter?

Answer 26

-balloon at the end -flared end for attachment to collection -separate cuff for blowing up balloon

Question 27

What is the use of a stylet?

Answer 27

facilitate passage of a soft catheter

Question 28

Which catheters are commonly used by species?

Answer 28

-foley: dogs -slippery sams: cats -tomcat: cats

Question 29

Which sedation protocol is best for catheter placement?

Answer 29

injectable +/- gas anesthesia; may not need if severely ill

Question 30

What are the characteristics of catheterization in male dogs?

Answer 30

-use a red rubber or foley -3.5 to 5 French for small dogs -5 to 8 French for medium and large dogs -measure length; do not over-insert -extrude penis and clean -lubricate entire catheter; should feed smoothly

Question 31

What is the best positioning for catheterizing a female dog?

Answer 31

ventral recumbency near end of table

Question 32

What are the landmarks for female dog catheterization?

Answer 32

-want to be before the pubic ridge -want to feel and go just below the urethral papilla

Question 33

What are the characteristics of catheterization in female dogs?

Answer 33

-difficult in small and/or spayed dogs -urethral orifice narrowed in spayed dogs; may not feel papilla -use soft catheter -typically 8 French -can use a stylet

Question 34

What are the two instruments available for assistance with female dog catheterization?

Answer 34

-speculum -otoscope

Question 35

What are the characteristics of different catheters in cats?

Answer 35

Red Rubber: -flexible -less reactive -longer term Slippery Sam: -easy to place and suture -medium term Tom Cat: -open and closed-ended options -stiff, easy to place -reactive over time -short term

Question 36

What are the steps to catheterizing a male cat?

Answer 36

-place in lateral or dorsal -pull penis away from body and towards spine to straighten flexure -extrude penis

Question 37

What are the catheter options for blocked male cats?

Answer 37

-initial catheterization with Tom Cat or Slippery Sam; then replace with Red Rubber -Red Rubber from the start (can be more difficult)

Question 38

What are tips for placing a feline urinary catheter?

Answer 38

-lubricate entire catheter -ensure adequate sedation; can use lidocaine gel -massage tip of penis if debris present -pull penis parallel and dorsally to straighten

Question 39

What are the characteristics of female cat catheterization?

Answer 39

-use small vaginoscope or otoscope -easy to do -urethral orifice usually in about 1 cm -clean vulva and perivulvar area -use 5 to 8 French red rubber or tom cat

Question 40

What are the characteristics of cystotomy catheters?

Answer 40

-surgically placed -allows for bladder emptying in neoplasia and proliferative urethritis cases -opens to ventral abdomen -main complication is resistant infection

Question 41

What is a pyelocentesis?

Answer 41

sampling of urine from the renal pelvis; typically for pyelonephritis cases