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Remove the urinary catheter. Caring for a urine bag at home: how to flush the catheter How to remove a catheter from the bladder

This procedure is necessary for rinsing the bladder, drug administration. This process has certain features. The patient is first prepared for the procedure, examined, and examined for contraindications.

Bladder catheterization is an effective procedure in the treatment of many pathologies. We will consider the algorithm for its implementation later in the article.

When is it necessary?

The procedure is applied in the following cases:

Clots of pus and blood in.
Inability to empty the organ due to an unstable nervous state.
Adenoma.
Adenocarcinoma.
Administration of medications after organ surgery.
Taking urine for examination.
Calculation of the quantity and quality of urine excreted.
Pinching of the excretory organ.
Prostatitis.

Contraindications

Despite the effectiveness and benefit of the method, there is a number of contraindications:

Inflammation of the prostate gland.
Inflammation of the testicles and their appendages.
Prostate abscess.
Traumatic injuries to the urethra.
Tumors of the genitourinary system.
Orchitis.
Epididymitis.
Marked narrowing of the urethra.

In addition, after the procedure the following complications may occur:

Infectious inflammatory processes.
Physical damage to the urethra by the catheter.
Perforation of the urethra.
Bleeding.

If flushing the bladder through a catheter is carried out in a hospital by a qualified and experienced specialist, there are no complications. They can happen if a person, lacking the necessary knowledge and skills, tries to carry out the procedure.

Preparing for installation

Preparation for the procedure includes next steps:

A few days before the procedure, the patient is examined by a doctor to ensure that there are no contraindications.
1-2 days before the procedure, it is better to avoid spicy, fatty foods, alcoholic and sweet carbonated drinks.
A few minutes before the procedure you need to wash yourself.
The patient then goes to the treatment room, where he is prepared even more thoroughly by a specialist.
The doctor treats the genitals with an antiseptic and tells the patient about the upcoming actions.

After this, the patient is ready for the procedure, for the insertion of a catheter.

What is included in the catheterization kit?

The procedure kit contains:

Sterile catheter. It can be either metal or silicone (Foley catheter).
Antiseptic solution for treating the genitals.
Tweezers.
Sterile petroleum jelly.
Capacity for .
Sterile wipes.
Oilcloth.
Sterile gloves.

How to install a catheter?

The process varies slightly depending on the gender and age of the person.

In women

The algorithm consists of the following steps:

The patient lies down on the couch and takes the desired position.
The nurse prepares the instruments, places a container for urine, and treats the genitals with an antiseptic.
Next, a sterile napkin is placed on the pubis, and the nurse spreads the labia.
The opening of the urethra is exposed.
Then a sterile catheter is lubricated with petroleum jelly, inserted very carefully into the urethra, and the other end of the catheter is directed into a container for urine.
Urine usually comes out of the catheter immediately afterward. This indicates correct insertion and position of the catheter.
The catheter is then carefully removed. If necessary, urine is collected for examination.

If you need to administer medicine, they do not rush to remove the catheter; the drug is administered with its help. In this case, the catheter is removed after administration of the medicine.

The external genitalia are again treated with an antiseptic. Use a napkin to remove any remaining moisture on them.
The patient can lie down for 5-10 minutes, then gets up and gets dressed. The procedure is considered completed.

Bladder catheterization soft catheter for women in the video clip:

Click to view (do not watch for the impressionable)

In men

Algorithm of actions during the procedure:

The man lies down on the couch, and the genitals are treated with an antiseptic.
The doctor prepares the instruments and places a container for urine.
The glans penis is then very carefully pulled apart to expose the urethra.
The urethra is once again treated with an antiseptic, and the catheter is lubricated with Vaseline.
Next, the catheter is very carefully inserted into the urethra.
The catheter enters the urethra.
Gradually, urine is released through the catheter.
If necessary, medications are administered.
Then the catheter is very carefully removed from the urethra, from the genital organ.
The head of the penis is once again treated with an antiseptic, and excess fluid on the genitals is removed with a napkin.
A man can lie down for 5-10 minutes, then he can get up and get dressed. The procedure is completed.

More details how inserting a catheter into a man watch in the video:

In children

The child may also need to flush the bladder through a catheter. The procedure is as follows:

The child goes into the office, lies down on the couch, and the genitals are treated with an antiseptic.
The doctor selects the necessary tools, the smallest catheter.
The catheter is treated with Vaseline, it is inserted into the urethra only 2 cm. For adults, it is inserted 4-5 cm. For children, it is enough to insert the catheter to a shallow depth.
Urine usually comes out immediately. Children should not keep the instrument in the urethra for a long time.
As soon as the urine is cleared, if necessary, the medicine is immediately administered, and then the instrument is very carefully removed.
The genitals are again treated with an antiseptic.
The child may need more time to recover: 15-20 minutes. He is allowed to lie down. Then the child can get dressed. The procedure is completed.

Increased physical activity is not recommended for the child in the first week after the procedure.

Suprapubic bladder catheterization

This procedure is much more complex and serious. The catheter is inserted into the suprapubic part and remains there on an ongoing basis.

Only the doctor can decide how long you can keep the catheter in the bladder.

Catheter is inserted during a minor operation in a clinic setting. The catheter is secured, leaving only a small hole in the abdomen for the catheter to exit. It's almost invisible. Urine will be excreted regularly through it.

The hole is regularly treated with an antiseptic and covered with gauze. During recovery, specialists very carefully remove the catheter in the clinic.

Suprapubic catheterization of the bladder is used only as a last resort if the patient himself is unable to void.

This procedure is usually prescribed after bladder injuries or surgeries. The catheter helps with the recovery process.

Read our article on how to do an ultrasound of the bladder.

How to restore the bladder after a catheter?

After the procedure comes recovery period. The procedure itself may cause discomfort and even pain.

The recovery process includes resting the patient in the first two weeks. It is shown to lie down a lot, because physical fatigue can lead to complications. You should also not lift weights for the first month.

The patient should try to empty the bladder himself, even if it is not easy at first. Liquid may come out in small quantities at first. We must try to relax him as much as possible, not be nervous or worry.

Gradually, the functions of the bladder and urinary tract are normalized. Usually, patients recover in the first days; by 3-4 days any pain and discomfort disappear, urine is excreted correctly, and the amount is within .

In severe cases, the patient may need diapers. Liquid may come out very unexpectedly. This is completely normal during the recovery period.

Gradually, the functions of the bladder are normalized, and the person learns to control the process of urination.

The first week you need at least 2-3 times a day treat the urethra with antiseptics to prevent inflammation.

Bladder catheterization is a serious procedure that helps in treating the bladder and examining its condition. A correctly performed procedure will help the patient recover.

How and how to flush a catheter in the bladder if it is clogged, learn from the video:

To combat urological diseases, a urinary catheter is used - a system of rubber tubes that is inserted into the bladder through the urethra to control the amount of urine released or diagnose its composition. It is also intended to carry out the act of urination if a person has urinary dysfunction.

General information

Diseases such as cancer of the genitourinary system, prostate adenoma, urinary retention and kidney diseases lead to problems with urine output. One of the methods of their treatment is the introduction of a catheter into the urethra. This is done to drain the bladder and make urination easier. The conductor can be latex or rubber (soft) or plastic or metal (hard). It looks like a straight or curved tube with holes at both ends. At the same time, soft ones have an oblique cut, and hard ones have a handle, beak and rod.

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Types and sizes

Types of catheters are distinguished depending on the function they will perform.

Classification is made depending on the material from which the devices are made and the time they remain in the body. The number of channels and organs into which the device is inserted are taken into account. In this case, the length of the tube depends on the physiological characteristics of the body. Women's catheters are usually shorter. The optimal length for women is 12-15 cm, for men - about 30 cm.

Based on the material of manufacture, they are distinguished:

elastic (rubber);
soft (latex or silicone);
hard (plastic or metal).

Depending on the length of stay in the ureter:

permanent (introduced for a long term);
disposable.

Taking into account the organ of administration, they distinguish:

urethral;
ureteral;
instruments for the renal pelvis;
stents for the bladder.

By location there are:

internal (entirely located inside the body);
external (one end goes out).

Depending on the number of channels, there are options:

single-channel;
dual-channel;
three-channel stent.

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Most common types

The Nelaton catheter is the best disposable catheter.

For catheterization of the bladder, different types of catheters are used. Their choice depends on the function they will perform. The quality of the device is also important, since in some cases it leads to irritation or allergic reactions. Including the above factors, the most common are:

Urethral Foley catheter. It is considered an indwelling urinary catheter. Has a blind end and two holes. At the end there is a rubber reservoir, to which a thin channel is connected. Used to flush the bladder, remove blood clots or urine.
Nelaton catheterization device. Straight, elastic, with rounded ends. Has a smaller diameter than Foley. Not used as a permanent one. Inserted into the urinary canal for drainage.

Thiemann stent. It has one channel for drainage and 2 holes near the tip. Used for prostate diseases.
Pizzeria device. A rubber conductor with 2-3 holes and a cup-shaped tip. Installed as a permanent one for drainage of the kidneys when their main function fails.
Melekote is identical to the Pizzera pattern.
A Poisson stent is a smooth rubber thread with three holes and a spiral ending. It is administered using a metal probe, which must then be removed. Rarely used for the treatment of the genitourinary system.

Each of the examples of catheterization devices has advantages and disadvantages in use. If the insertion of a catheter is intended for a short period of time, the best disposable catheter is Nelaton. The Foley stand is more suitable not only for removing urine, but also for administering medications. If the patient is unable to urinate, the Pizzera option is most suitable.

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How do they put it?

To place a catheter in the urethra, you must follow some rules. First, the catheter placement must be sterile. To do this, in order to avoid sepsis, the instrument and genitals are treated with antiseptic disinfectants. Secondly, patients who have undergone the procedure claim that it hurts. To relieve such sensations, use Lidochlor gel or other approved painkillers.

Inserting a urine catheter is much more difficult for men than for women. The problem is that men have narrowing in the urethra and it is longer than women's.

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The procedure in men is performed correctly if fluid appears in the catheter.

The technique of inserting a catheter into men is complex. During the procedure, the patient should lie on his back with his knees bent and relax. The doctor treats the genitals and the apparatus with an antiseptic and begins to slowly insert the instrument. In this case, the penis should be in a position perpendicular to the body. A signal that the manipulation is happening correctly is the appearance of liquid in the catheter.

The bladder catheter in men is 20-30 cm long with a narrow diameter. This is due to the physiological characteristics of the body. Therefore, you need to use the appropriate instance. At the end of the procedure, the insertion site of the adapter is disinfected with an antiseptic, and the urinal is attached to the inner side of the thigh. If the patient is lying down - go to the bed.

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Catheterization in women

Inserting a urethral catheter for women is simple. In this case, the patient lies on her back, legs spread, knees bent. The labia and instruments are treated with disinfectants. The urethral catheter is inserted 4-6 cm into the urinary canal, lowering the second edge into a special reservoir. It is attached to the thigh with a tight bandage. During manipulation, blood may appear, but this is not dangerous. If the doctor did everything correctly, the bleeding is insignificant and does not recur.

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Suprapubic catheter

A suprapubic catheter (or cystostomy) is inserted for long-term drainage. It is placed through an incision in the pubic abdomen under local or general anesthesia. In this case, there is a bag on the stomach to collect excreted urine. It is necessary to install a catheter of this type:

women after gynecological surgery;
if the patient has urethral cancer;
disabled people who are unable to walk with a urethral device;
if a person needs not only to catheterize the ureter, but also to maintain sexual activity.

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Urethral or suprapubic catheter

A urethral catheter can damage the neck and walls of the bladder.

Both cystostomy and urethral catheters have advantages and disadvantages. When installing the urethral version, the neck and walls of the bladder can be damaged. Suprapubic is less traumatic for humans. Cystostomy is easier to handle, and the likelihood of inflammatory infections is less. Moreover, an incision in the abdomen heals faster and causes less discomfort than a tube in the genitals. Among other things, if the device becomes clogged, urine flows down it, infecting the genitals. And if such a problem occurs in a suprapubic sample, urine is excreted in any case.

The suprapubic catheter has advantages in diameter. It is much wider than in the urethra. But cystostomy also has a number of negative aspects. Firstly, it is blocked more often, since it can only be installed for a long time. Secondly, the side effects of its presence in the body are: urinary retention, spasm or stones. Thirdly, it is difficult for patients who are overweight to place a suprapubic catheter.

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Care of an indwelling catheter

The procedure for removing or replacing a stent is performed only by a doctor.

If the catheter is in the bladder for a long time, it requires special care. The main thing is to keep the injection site clean. This requires washing your genitals with soap after each bowel movement. It is important to clean the urine bag daily with soap and water. If the device becomes clogged, it must be removed immediately. In this case, removal and replacement are carried out only by a doctor in an operating room.

Each stent care procedure must be carried out under sterile conditions and with disinfected equipment. The catheter tube needs to be changed every 7 days and periodically moved in the ureter. It is important not to forget to rinse the bladder by introducing antiseptics and disinfectants. A mandatory condition for installing a urinal is that it is always located below the level of the genital organs.

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Treatment of the urinal

It is not difficult to care for the urine bag. First it should be disconnected from the system, then washed. The last manipulation is carried out by soaking the reservoir in a solution consisting of water and vinegar (2 to 3). The urinal is then dried and reattached. If the patient is not instructed in the procedure, removal of the bag is performed only by a health care professional.

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Is the catheter leaking?

If a patient walks with a catheter for a long time, it may leak. In this case, the cylinder does not fill properly. And in case of such trouble, it is appropriate to remove the catheter and disinfect its location. Leakage occurs for the following reasons:

incorrectly selected device;
small tank volume;
blockage;
the onset of infectious processes of the genitourinary system;
spasms.

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Replacing a urinary catheter

If bleeding occurs after the procedure, you should immediately consult a doctor.

Replacement means the same as inserting a catheter. If the patient wears a catheter for a long time and knows the rules for its use, replacement is allowed to be done at home. To prevent negative consequences, it is recommended to disinfect your hands and tools. It is important that the components of the device are stored in the refrigerator and in closed packaging. Before starting the procedure, clear the old catheter of liquid using a large syringe.

The patient must certainly be in a relaxed state, but with maximum concentration on the process. If during the procedure you feel that the tube is going through hard, you should not continue. In this case, it is important to remove the device and contact a specialist. The reason for seeking help may be prolonged bleeding after the procedure, discomfort in the urethral area, lack of urine in a special bag, or bloating.

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Removing a device

You can remove the catheter using several techniques. The tube from the reservoir is cut off. After this, the liquid flows out, and the adapter can be carefully pulled out. The main tube is disconnected from the reservoir. Then a large syringe is installed in it, with which the urine is sucked out. At the same time, it is important to monitor how much fluid has left the system, so as not to leave even a small amount in the body. After cleaning, carefully remove the device.

After this, the external organs of the genitourinary system must be disinfected. The patient should not move much after removing the device. It is imperative to monitor the sensations in the first minutes after removal. If there is no urge to urinate, there is blood in the urine or the stomach is swollen, it is important to contact a urologist to find out the reasons.

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What is bladder catheterization?

The main goal of catheterization is to restore the normal outflow of urine from the lumen of the bladder, which normalizes all urodynamic processes and prevents a number of dangerous complications for the patient’s life.

The catheter is inserted into the external opening of the urethra, after which it gradually moves along the urethra and reaches the lumen of the bladder. The appearance of urine in the catheter is evidence that the procedure was performed correctly and successfully.

When performing bladder catheterization, it is important to observe a number of the following basic conditions:

insertion of a catheter into the urinary canal (urethra) should be done carefully, without the use of rudeness or violence;
the procedure begins with the use of elastic devices (Timann or Mercier type catheter);
in order to minimize possible damage to the walls of the urethra, it is necessary to use a large-diameter catheter;
a metal catheter is inserted into the patient only if the doctor performing the manipulation is fluent in this skill;
if any pain occurs during catheterization, it must be stopped and the patient must be immediately hospitalized in a hospital;
if the patient has acute urinary retention, but inserting a catheter into the bladder is impossible (there are contraindications), then percutaneous cystostomy is used.

Types of catheters and their classification

Previously, only metal (rigid) catheters were used for catheterization, which led to frequent complications (trauma to the mucous membranes, ruptures, etc.). Currently, silicone (soft) and rubber (elastic) devices of different diameters have become widespread.

The following types of devices are used:

Nelaton catheter (used for catheterization for a short period of time, for the purpose of one-time drainage);
Foley catheter (inserted for a long period of time, has several passages through which medications are simultaneously administered and urine is removed);
Tieman stent (a device used by urologists for prostate diseases, it adapts well to the bends of the urethra).

Technique of the procedure

In order to carry out the catheterization procedure, in accordance with all the rules of asepsis and antisepsis, it is necessary to carry it out in a specialized hospital, using modern antiseptics, sterile devices, medical disposable gloves, etc.

Bladder catheterization in a woman

The manipulation algorithm is as follows:

The woman is placed on her back, asked to bend her knees and spread them apart.
The female genital organs are thoroughly cleaned using antiseptic solutions, after which the vaginal opening is covered with sterile napkins.
With the right hand, a well-lubricated catheter for urine is inserted until it appears (approximately 4-5 cm).
If urine suddenly stops flowing, this may indicate that the device has hit the wall of the bladder, so you need to pull the catheter back a little.
After the manipulation is completed and the urine has completely drained, it is necessary to carefully remove the catheter and treat the lumen of the urethra again with an antiseptic solution.
The patient is required to remain in a horizontal position for an hour.

During pregnancy, situations arise when a woman requires catheterization, for example, when a calculus moves and blocks the lumen of the urinary tract, which leads to acute urinary retention, as well as before an upcoming cesarean section.

Bladder catheterization in a man

In men, catheterization is complicated by the anatomical structure of the urethra, namely its small diameter, significant length, tortuosity and the presence of physiological narrowings.

The procedure algorithm is as follows:

The man is placed on his back (there is no need to bend his legs at the knees).
The penis and groin area are covered with sterile napkins around the entire perimeter.
With his left hand, the doctor pulls back the foreskin, exposing the lumen of the urethra, and at the same time extends the penis perpendicular to the surface of the patient’s torso. The head of the penis and other male genital organs are carefully treated with antiseptic solutions.
A pre-lubricated catheter is inserted with the right hand, all movements should be smooth and uniform, and the doctor should apply only a slight force in places of anatomical narrowing (the patient is asked to relax as much as possible).
Periodic palpation of the catheter tip is recommended, especially if there are obstacles in its path, until urine flows through it (evidence that it has reached the lumen of the bladder).
When the procedure is completed, the catheter is removed, and the lumen of the urethra is re-treated with an antiseptic solution. The patient is required to remain in a horizontal position for an hour.

Bladder catheterization in a child

In general, the technique of catheterization in children does not differ significantly from the procedure performed in adults. It is carried out with the aim of restoring normal urine flow and eliminating all signs of acute urine retention.

Inserting a catheter into a child requires special care and precision, since there is a high risk of damage to the mucous membranes, up to complete rupture of the wall of the urethra or bladder. That is why a smaller diameter device is used for catheterization of children, and if such a possibility exists, the procedure is carried out under ultrasound or x-ray control.

Indications and contraindications for performing the procedure

Main indications for bladder catheterization:

development of acute urinary retention in various pathological conditions;
chronic retention of urine in the lumen of the bladder;
the patient's state of shock, in which there is no possibility of spontaneous passage of urine;
the need to determine the exact volume of daily urine in patients in the intensive care unit or intensive care unit;
determining the volume of urine that remains in the patient after urination;
administration of contrast agents (required for cystourethrographic examination);
washing the lumen of the bladder with solutions of antiseptics or antibiotics;
to remove blood clots from the bladder;
carrying out a number of diagnostic procedures (for example, taking a urine test for further culture on nutrient media, when passing it naturally is impossible or difficult).

The following pathological processes may be contraindications for catheterization in men and women:

inflammatory process in the tissues of the prostate gland (acute prostatitis or exacerbation of its chronic form);
inflammatory process in the testicles or their appendages;
abscesses of the prostate or other space-occupying formations in it, leading to a sharp narrowing of the lumen of the urethra, when insertion of a catheter is impossible;
infection of the urethra (acute urethritis or exacerbation of a chronic process, when the edematous component is pronounced);
traumatic injury to the urethra or its sharp deformation due to strictures (insertion of a catheter can lead to rupture of the urethral wall);
pronounced spasm of the external sphincter of the bladder (for example, against the background of impaired innervation due to damage to the lumbar spine);
contracture of the cervical part of the bladder.

Complications after manipulation

As a rule, if catheterization is performed by an experienced specialist, and the patient does not have any pathological processes that impede the advancement of the catheter through the urethra, then complications are quite rare.

The most common adverse outcomes from the procedure are:

damage to the walls of the urethra or bladder, which leads to blood in the urine (hematuria);
accidental rupture of the wall of the urethra or perforation of the bladder (this occurs when the catheter is roughly inserted);
infection of the urethra or bladder (cystitis or urethritis develops);
a sharp decrease in blood pressure numbers (hypotension due to manipulation).

Replacing or removing the catheter

If bladder catheterization is performed for a long period of time, it often becomes necessary to replace the device. This occurs in the following situations:

initially incorrectly selected catheter size, as a result of which gradual “leakage” of urine is observed;
blockage of the device lumen;
the appearance of severe spasms in the patient or other unpleasant sensations requiring temporary removal of the catheter.

Removal of the device, as well as its insertion, should only be done by a specialist with a medical education in order to prevent any complications. The doctor disconnects the urine reservoir from the main tube. Using a large syringe attached to the outer opening of the tube, the residual volume of urine is removed, then the catheter is completely removed. All movements must be smooth and careful, and any “jerks” must be avoided.

Conclusion

Bladder catheterization is a manipulation that requires the intervention of only a specialist with a medical education.

Each patient who has a catheter requires constant monitoring. If any unpleasant symptoms appear, a diagnosis of this condition is necessary, and the issue of its removal can only be decided by a doctor.

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How is a Pezzer catheter used?

Catheters can have different lengths and are made from different materials: metal, plastic, rubber. It is important that the instruments are sterilely clean and do not cause inflammation in the cavities of the organs into which they are inserted. Most often, catheters are used in urology to ensure the outflow of urine from the bladder. For this purpose, a Pezzer catheter is used. This instrument is often used before childbirth to empty a woman's bladder. A full bladder can interfere with the normal passage of the baby through the birth canal.

The Pezzer catheter is made of rubber and has an extension and 2 holes at the end. The tool is introduced as follows. The area around the urethra is treated with a disinfectant solution. A probe is inserted into the channel so that the catheter is stretched at its end. The instrument is then inserted into the urethra, after which the probe is removed and the catheter straightens on its own.

It is necessary to insert the Pezzer catheter to a depth of 6 cm so that its end is located at a sufficient distance from the urethra and bladder walls. If the instrument is inserted too deeply, its end will touch the top of the bladder, resulting in no outflow of urine. If the catheter is not inserted deep enough, it can cause bladder hyperreflexia. The Pezzer catheter is removed by pressing on the walls of the urethra.

How to place a subclavian catheter

A subclavian catheter is placed when peripheral veins are inaccessible for infusion therapy, if intensive and multi-day therapy is necessary, during long-term operations with large blood loss. It is also used when parenteral nutrition is necessary, in case of need for control and diagnostic studies.

In preparation for catheterization of the subclavian vein, the patient is placed on an operating table with the head end lowered by 15 degrees. This is necessary to prevent air embolism. The surgical field is treated 2 times with a 2% iodine solution, a sterile diaper is applied and treated again with 70% alcohol.

The patient is given local anesthesia. Then a puncture of the skin is performed with a needle and syringe for catheterization, and a vacuum is created by pulling the piston. When entering the subclavian vein, blood appears in the syringe. Next, the needle is inserted another 2-3 mm. Then the syringe is removed, and the entrance to the needle is closed with a finger.

A guidewire is inserted through the needle, the needle is removed, and a catheter is inserted through the guidewire to a depth of 6-8 cm. After removing the guidewire, the doctor controls the location of the catheter in the vein by the flow of blood into the syringe. The catheter is then flushed and the infusion system is connected or closed with a sterile rubber plug.

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Insertion of a catheter (hollow rubber, plastic or metal tube) into the urethra and bladder for therapeutic or diagnostic purposes.

The procedure is contraindicated in acute inflammatory processes in the urethra and bladder, as it contributes to the spread of infection.

For catheterization you need to prepare the following:
- sterile catheter and tweezers in a sterile tray. A rubber tube about 15 cm long is placed on the outer end of the metal catheter. Before use, the elastic catheter should be kept in hot, sterile distilled water - it will become softer;
- 0.02% solution of furatsilin or 0.1% solution of rivanol for treating the external opening of the urethra before catheterization;
- sterile glycerin, petroleum jelly or syntomycin emulsion;
- cotton balls, non-sterile tweezers, tray.

Preparing for catheterization includes treating the nurse’s hands with warm water and soap and brushes, alcohol, iodine and the patient’s external genitalia. The patient (or patient) lies on his back, legs bent at the knees and spread apart. A tray for collecting urine (urinal bag) is placed between the legs.

Before insertion catheter the woman is washed and, if necessary, douched, treated with a cotton ball with a solution of sublimate (1:1000), oxycyanic mercury (1:1000), and furatsilin.

Bladder catheterization in women.

The bladder in women, as a rule, does not cause problems.

Using the fingers of the left hand, carefully spread the labia, and 2 openings become visible: the upper one is the opening of the urethra, the lower one is the entrance to the vagina. The catheter, lubricated with sterile glycerin or petroleum jelly, is inserted very smoothly, without effort, with the right hand. The appearance of urine is a sign that the catheter is in the bladder. If it is impossible to insert a catheter, you should tell your doctor.

The catheter is removed a little before all the urine comes out so that its last portion washes the urethra. The urethra in women is short (4-6 cm), so catheterization in them is not very difficult. In men, the urethra has a length of 22-25 cm and forms two physiological narrowings that prevent catheterization.

Bladder catheterization in men.

Maintaining catheter for a man is done as follows. The sister takes the penis by the head with her left hand and wipes it, the opening of the urethra and the foreskin with cotton wool moistened with a solution of boric acid. Then the opening of the urethra is opened and a catheter (previously coated with sterile Vaseline) is inserted into the urethra using tweezers or using a sterile gauze pad.

Catheter inserted with the right hand very smoothly, while the penis is, as it were, pulled onto the catheter. The patient is asked to take several deep breaths, at the height of inspiration, when the muscles that close the entrance to the urethra relax, while continuing to apply gentle pressure, a catheter is inserted. Its presence in the bladder is indicated by the release of urine. If the catheter cannot be inserted, then if resistance is felt, do not apply force, as this can lead to serious injury.

Once the catheter reaches the bladder, urine appears. The catheter should be removed a little earlier than all the urine has come out, so that the remaining portion of urine flows out and flushes the urethra after removal. catheter.

Catheter removal

After a long stay catheter There is almost always inflammation of the urethra (irritation from rubber, plastic, microscratches on the mucous membrane). To prevent complications, before removing the catheter, a furatsilin solution is injected into the bladder and, without disconnecting the syringe, removed catheter.

After catheter removal It is also useful to take anti-inflammatory baths for several days with a weak solution of potassium permanganate (potassium permanganate): its crystals are diluted in boiled water in a jar, warm boiled water is poured into a basin, a solution of potassium permanganate is added (make sure that no crystals get in!) until light. pink in color and sit in the basin for a few minutes. You can also make similar baths with a decoction of chamomile, St. John's wort, and sage (method of preparing solutions: 1 tablespoon of herb per 1 glass of water, bring to a boil, but do not boil, let steep for 5 minutes). Baths are done several times a day, the more often the better.

Urinary catheter is a system of tubes placed in the body to drain and collect urine from the bladder.

Urinary catheters are used to drain the bladder. Bladder catheterization is often the last resort due to possible complications from long-term catheter use. Complications associated with catheter use may include:

Bubble Stones
Blood infections (sepsis)
Blood in the urine (hematuria)
Skin damage
Urethral injury
Urinary tract or kidney infections

There is a wide variety of urinary catheters. Urinary catheters vary in the material they are made from (latex, silicone, Teflon) and type (Foley catheter, straight catheter, curved tip catheter). For example, a Foley catheter is a soft plastic or rubber tube that is inserted into the bladder to drain urine.

Urologists recommend using the smallest catheter size. Some people may need larger catheters to prevent urine from leaking around the catheter or if the urine is concentrated and contains blood or large amounts of sediment.

It must be remembered that large catheters can damage the urethra. Some people may develop an allergy or sensitivity to latex with long-term use of latex catheters. In these patients, Teflon or silicone catheters should be used.

Long-term (permanent) urinary catheters

A catheter, which is inserted into the bladder for a long time, is connected to a urine bag to collect urine. There are two types of urinals.

The first type of urine bag is a small bag that is attached to the leg with an elastic band. This urine bag can be worn during the day, as it can be easily hidden under trousers or a skirt. The bag is easy to empty in the toilet.

Another type of urine bag is a large bag that is used at night. This urine bag is usually hung on the bed or placed on the floor.

How to care for your urinary catheter

If the catheter becomes clogged, painful, or infected, the catheter must be replaced immediately.

To care for an indwelling catheter, you must wash the urinary area (where the catheter exits) daily with soap and water. Also thoroughly clean the genital area after each bowel movement to prevent the catheter from becoming infected. Urologists no longer recommend the use of antibacterial ointments for cleaning catheters, since their effectiveness in preventing infection has not been proven.

Increase your fluid intake to reduce the risk of complications (if you are healthy enough to drink plenty of fluids). Discuss this problem with your doctor.

The urine bag should always be positioned below the bladder to prevent urine from flowing back into the bladder. Empty the urine bag either every 8 hours or as it becomes full.

Make sure that the urine bag outlet valve remains sterile. Wash your hands before and after handling the urine bag. Do not let the outlet valve touch anything. If the outlet valve is dirty, wash it with soap and water.

How to treat a urinal?

Clean and deodorize the urine bag by filling the bag with a solution of two parts vinegar and three parts water. You can replace the vinegar-water solution with chlorine bleach. Soak the urine bag in this solution for 20 minutes. Hang the urine bag with the outlet valve open to dry it.

What to do if the catheter leaks?

Some people may experience urine leakage around the catheter. This phenomenon may be due to a small catheter, an improperly sized balloon, or bladder spasm.

If bladder spasm occurs, check that the catheter is draining urine properly. If there is no urine in the urine bag, the catheter may be blocked by blood or coarse sediment. Or, the catheter or drainage tube has become twisted and formed a loop.

If you have been taught how to flush a catheter, try to flush the catheter yourself. If you cannot flush the catheter, consult a doctor immediately. If you have not been instructed how to flush the catheter and urine does not flow into the urine bag, you should immediately contact your doctor.

Other causes of urine leakage around the catheter include:

Constipation
Urinary tract infections

Potential Complications of Using Urinary Catheters

Contact your doctor if you develop any of these complications:

Bleeding in or around the catheter
The catheter drains little or no urine despite adequate fluid intake
Fever, chills
Leakage of large amounts of urine around the catheter
Strong-smelling urine or urine that is cloudy or thick
Swelling of the urethra around the catheter

Suprapubic urinary catheters

Suprapubic urinary catheter is an indwelling catheter that is inserted directly into the bladder through the abdomen above the pubic bone. This catheter is inserted by a urologist in either a clinic or hospital setting. The catheter exit site (located on the abdomen) and the catheter should be cleaned daily with soap and water and covered with dry gauze.

Suprapubic catheters are replaced by qualified medical personnel. The suprapubic catheter can be connected to the standard urine bags described above. A suprapubic catheter is recommended:

After some gynecological operations
For patients who require long-term catheterization
For patients with trauma or urethral blockage

Complications caused by the use of a suprapubic catheter may include:

Bladder stones
Blood infections (sepsis)
Blood in the urine (hematuria)
Skin damage
Urine leakage around the catheter
Urinary tract or kidney infections.

After prolonged use of a catheter, bladder cancer may develop.

How to place a urinary catheter in a man?

Wash your hands. Use betadine or a similar antiseptic (unless specifically instructed) to clean the urethral meatus.
Wear sterile gloves. Make sure that you do not touch the outside of the gloves with your hands.
Lubricate the catheter.
Take your penis and hold it perpendicular to your body. Pull the penis slightly towards the navel.
Begin to gently insert and advance the catheter.
You will encounter resistance when you reach the external sphincter. Ask the patient to take several deep breaths to relax the muscles that close the urethral opening and continue to advance the catheter.
If urine appears, continue to advance the catheter to the level of the “Y” connector. Keep the catheter in one position while you inflate the balloon. Inflating the catheter balloon in the urethra causes severe pain and can lead to injury. Check that the catheter is in the bladder. You can try flushing the catheter with a few milliliters of sterile water. If the solution does not return easily, the catheter may not be inserted far enough into the bladder.
Secure the catheter and attach a urine bag to it.

How to place a urinary catheter in a woman?

Gather all the equipment: catheter, moisturizing gel, sterile gloves, clean wipes, syringe with water to inflate the balloon, urine bag.
Wash your hands. Use betadine or another antiseptic to clean the urethral meatus. In women, it is necessary to treat the labia and urethral opening with gentle movements from top to bottom. Avoid the anal area.
Wear sterile gloves. Make sure that you do not touch the outer surface of the gloves with your hands.
Lubricate the catheter.
Separate the labia and locate the urethral opening, which is located below the clitoris and above the vagina.
Slowly insert the catheter into the opening of the urethra.
Advance the catheter gently.
If urine appears, advance the catheter another 2 inches. Keep the catheter in one position while you inflate the balloon. Check that the catheter is in the bladder. If the patient feels pain when inflating the balloon, it is necessary to stop. Deflate the balloon and advance the catheter an additional 2 inches and attempt to inflate the catheter balloon again.
Secure the catheter and attach a urine bag.

How to remove a urinary catheter?

Indwelling catheters can be removed in two ways. The first method is to attach a small syringe to the opening of the catheter. Remove all liquid. Slowly pull out the catheter.

Caution: Never remove your indwelling catheter unless your doctor has instructed you to do so. Remove the catheter only after your doctor's permission.

Some urologists instruct their patients to cut the catheter balloon inflation tube above the main tube. After all the water has drained, slowly pull out the catheter. Be careful, the catheter cannot be cut anywhere else.

If you cannot remove the urinary catheter with little effort, inform your doctor immediately.

Tell your doctor if you do not pass urine within 8 hours after the catheter is removed, or if your stomach is swollen and painful.

Short-term (intermittent) catheters

Some patients require periodic bladder catheterization. These people should be taught how to insert a catheter themselves to drain the bladder when necessary. They do not need to wear a urine bag all the time.

People who may use intermittent catheterization include:

Any patient who is unable to properly empty the bladder
Men with large prostates
People with damage to the nervous system (neurological diseases)
Women after certain gynecological operations

The process is similar to the procedures described above. However, the balloon does not need to be inflated and the catheter is removed immediately after the urine flow has stopped.

The article is for informational purposes only. For any health problems, do not self-diagnose and consult a doctor!

V.A. Shaderkina - urologist, oncologist, scientific editor

Catheterization is the procedure of inserting a catheter (for men and women) into the bladder through the urethral canal. Catheterization is used quite often and is used for diagnostic and therapeutic purposes.

Rules for catheter installation

The catheter can be installed for a short period of time, for example, short-term installation of a catheter is necessary during surgery, and for a long time if the patient has difficulty urinating. The latter can be caused by certain diseases.

A man can be affected by various pathological processes resulting from infectious infection, trauma, or neoplastic syndrome. Impaired urination can provoke the development of such unpleasant consequences as kidney failure and infertility. In this article we will consider in detail the algorithm for bladder catheterization in men.

Indications for the procedure

The catheter can be inserted for diagnostic purposes:

To obtain urine samples from the bladder cavity. The samples are subsequently used for laboratory research, for example, to determine the microflora of the bladder.
In order to determine the volume of urine that is excreted and observe its organoleptic characteristics.
To determine the level of patency of the urinary tract.

During treatment

In addition, catheterization can be performed to treat:

When restoring the urethra after surgery.
In the presence of bladder decompression.
In the presence of acute retention of urine, which can occur against the background of urethritis, pathological changes affecting the prostate gland.
For the purpose of treating the walls of the bladder with medicinal solutions.
For chronic obstruction, which can be caused by hydronephrosis.
For the purpose of removing urine if the patient is unable to urinate. For example, if the patient is in a comatose state.

The algorithm for catheterization of the bladder in men is quite complex, but it should not cause fears for patients’ health, since this procedure is carried out by experienced specialists.

Contraindications for catheterization

Although there are many indications, catheterization may not always be possible. There are some contraindications:

Presence of blood in the scrotum.
Presence of bruises in the perineal area.
Presence in the blood.
Injured bladder condition.
Injured condition of the urethra.
Prostatitis in acute form.
Anuria.
Some diseases of the genitourinary system, for example, gonorrhea.
Spasm of the urethral sphincter.
Acute inflammatory processes occurring in the bladder or urethra.
Penile fracture.

Features of catheterization in men

Due to the anatomical features of the male urethra, the catheterization procedure should only be performed by experienced specialists. Difficulties during catheterization arise due to the fact that the male urethra has a relatively large length, about 25 centimeters. In addition, there are two physiological narrowings in the urethra that prevent the free insertion of the catheter. And also it is very narrow.

The greatest caution must be observed if the procedure is performed using a metal catheter. If excessive force is applied during manipulation, the walls of the urinary system can be damaged, which may result in the occurrence of false passages.

The algorithm for bladder catheterization in men must be strictly followed.

Instruments used during catheterization

To carry out the catheterization procedure you will need the following tools:

Algorithm for bladder catheterization in men

If the procedure is performed using a soft catheter, the specialist must perform the following steps:

The medical worker must first prepare their hands, wash them thoroughly, and treat them with a disinfectant solution.
The patient is placed on his back, his legs are slightly spread, and his knees should be bent. You need to install a tray between your legs and place a diaper under your pelvic area.
The healthcare worker should wear sterile gloves and wrap a sterile napkin around the penis below the glans. This will open the external opening of the urethra.
Next, you need to treat the head with a cotton swab, previously soaked in furatsilin. Treatment should be carried out in the direction from the urethra to the edge of the head.
By squeezing the head of the penis, it is necessary to open the external urethral opening. After the hole has opened, a few drops of sterile glycerin are poured into it.

The catheter is grasped using tweezers, and its rounded hole is moistened with petroleum jelly or glycerin. After this, the catheter is inserted into the open opening of the urethra. Using sterile tweezers, insert the first five centimeters of the catheter while holding the head.

Immersion of the catheter

It is necessary to immerse the catheter into the urethra slowly, intercepting it with tweezers. In this case, the penis must be pushed onto the catheter with your free hand. This technique will allow you to move the catheter through the urethra with greater ease. In the area at the junction of the membranous part and the spongy part, slight resistance may occur. If it occurs, then you need to pause for two to three minutes to wait for the muscle spasm to disappear, and then continue inserting the catheter.

Physiological narrowing is also present at the entrance of the urethra to the bladder. Re-insertion of the catheter may occur in this area.

After the first portion of urine appears, the opposite tip of the catheter must be lowered into the urinal.

Before stopping urination, the bladder must be rinsed. After this, observing safety precautions, the catheter is carefully removed.

After the end of urine output, a Janet syringe filled with furatsilin solution is attached to the catheter, which is poured into the bladder cavity very slowly. The volume of the injected solution should be about 150 milliliters. The catheter is then guided into a tray to remove the fluid. The rinsing procedure should be carried out until the contents of the bladder become transparent.

After the lavage is completed, the catheter is removed from the urethra using gentle rotational movements. After that, the external opening of the urethra is re-treated with a cotton ball previously moistened in a furatsilin solution. At the end of the catheterization procedure, all instruments should be placed in a disinfectant solution.

If using a soft catheter does not allow you to perform the procedure, then you will need to use a metal one. Such a procedure for inserting a urinary catheter should be carried out exclusively by a qualified doctor, because the technique is very complex and requires special care and attention.

The patient is placed on his back, and the urethral opening is treated. I turn the catheter down with its “beak” and advance it along the urethra until it reaches the bladder. To overcome the sphincter area, the penis should be directed along the midline. The catheter is inserted further, slowly moving the urethra in the direction of the instrument.

If the procedure is performed correctly, discharge into the urine container is observed, and the patient does not experience pain. Due to the fact that catheterization with a metal catheter is quite painful and traumatic, it is performed quite rarely.

Complications during catheterization

In some cases, some complications may occur, for example:

Infection of the urinary system. As a result, pyelonephritis, cystitis, and urethritis may develop.
Damage to the urethra, sometimes significant, even to the point of perforation.

Complications may arise due to errors made when inserting a catheter, especially a metal catheter, or due to insufficient preliminary examination of the patient. Most often, complications arise as a result of poor asepsis.

Everyone's favorite dogs and cats constantly delight us with their grace and beauty. However, they sometimes get very sick, for example, with severe poisoning and diarrhea.

If they are not given immediate help, they will die. And we, ordinary people, lack the skills and abilities to provide the necessary assistance.

Many diseases require serious attention that there is a need to give IVs, but it is not possible to visit a doctor.

But if you prick a dog or cat every day, then there will be no living space left on them. Therefore, an intravenous catheter becomes a great help, with the help of which you can make both a drip and an injection at any time.

Advantages of a catheter for placement in dogs and cats

A catheter is an especially good help for a veterinarian when the animal suffers from a serious illness that requires constant intravenous administration of drugs. After all, punctured veins are not only painful for the animal, but can also lead to thrombophlebitis, which is completely undesirable for him at such a moment.

In addition, placing a catheter is simply necessary when your four-legged friend needs round-the-clock care. There are diseases, for example, parvovirus enteritis, feline panleukopenia, piroplasmosis, severe poisoning and others, in which it is necessary to install IVs not only during the day, but also during the night.

Drip administration of medicinal substances is not recommended for owners to do on their own. The safest substance, ordinary saline, when administered intravenously in large quantities, can cause many problems: the volume of the liquid part of the blood increases sharply, and it becomes difficult for the heart and kidneys to cope with it. Therefore, the most basic dropper should be under the supervision of a veterinary specialist.

But in rare cases, when the owner for some reason cannot bring the animal or call a doctor at home, an IV can be placed at home. In such cases, it is simply great if the clinic has previously installed an intravenous catheter for his pet.

Disadvantages of catheter placement in dogs and cats

Catheters also have disadvantages. One of the main ones is that placing a catheter is more difficult than simply injecting a drug into a vein. This requires certain skills and not every veterinarian is able to introduce it the first time. In addition, the catheter requires very careful care.

Any intravenous administration of drugs is dangerous because bacteria and fungi can enter the blood and cause sepsis. This can happen if the injection site is not sufficiently disinfected, if the catheters are in the vein for a long time (therefore, the catheter is placed for 3-5 days, after which it is removed, if it is necessary to continue intravenous infusions, then a new catheter is placed on the other leg), if care is poor. catheter. If the first lies on the conscience of the veterinarian, the second is almost excluded (animals are rarely given intravenous catheters for a long time), then the last is the work of the owners.

It is important to ensure that the animal does not lick the catheter, the bandages do not get wet and are changed regularly, and the skin remains clean. It should be noted that animals do not like catheters. Not that it hurts, but let's face it, not everyone likes having some kind of plastic thing sticking out of your paw. They often chew the bandage and pull out the device that is interfering with them. But still, all the advantages of intravenous catheters outweigh the disadvantages.

When should an intravenous catheter be used in dogs and cats?

Emergency conditions, resuscitation, operations that require quick access to the bloodstream (for example, if you need to administer drugs urgently and at high speed).
Hospitalization of an animal with seizures.
Prescribed parenteral nutrition.
Overhydration or hydration of the body.
Transfusion of blood products (whole blood, packed red blood cells).
Repeated or continuous administration of drugs intravenously.
The need for rapid and accurate administration of the drug in an effective concentration (especially when the drug can change its properties when taken orally).

Well-chosen venous access largely ensures the success of intravenous therapy.

Criteria for choosing a vein and catheter for dogs and cats

Theoretically, the catheter can be inserted into any superficial vein. The most commonly used veins are the cephalic (saphenous) vein, the medial and lateral saphenous vein. Central venous access can be obtained through the jugular vein and saphenous vein.

The lateral saphen vein is more accessible in dogs, whereas in cats it is easier to insert a central catheter through the medial saphen vein. Catheters inserted into the hind leg are more difficult to keep clean and are not recommended for patients with urinary incontinence or diarrhea.

With intravenous injections, the advantage remains with the peripheral veins. The veins should be soft and elastic, without compactions or knots. It is better to inject drugs into large veins, in a straight section corresponding to the length of the catheter.

When choosing a catheter, you must focus on the following criteria:

Vein diameter (the diameter of the catheter must be less than the diameter of the vein).
Required rate of solution administration (the larger the catheter size, the higher the rate of solution administration).
Potential time the catheter remains in the vein (no more than 3 days).

When catheterizing veins, preference should be given to modern Teflon and polyurethane catheters. Their use significantly reduces the frequency of complications and with high-quality care, their service life is much longer. The most common cause of failure and complications during catheterization of peripheral veins is the lack of practical skills of the catheter inserter, violation of the technique for placing a venous catheter and caring for it. This is largely due to the lack of generally accepted standards for peripheral venous catheterization and catheter care in veterinary medicine.

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1. Valve for introducing substances, for example, heparin solution. In the photo it is blue, but it can be green, pink, gray or other - the different colors help determine the size of the device.
2. Part of the stylet that is removed after installation.
3. A cap is screwed onto the cannula to close the entrance to the vein.
4. Cannula – here you need to connect a system or a syringe without a needle.

Preparing dogs and cats for peripheral catheter placement

Lay out a clean diaper or sheet (it is ideal if you iron or steam it with an iron).
Lay down and calm your pet.
Shave the fur where you are going to place the IV.
It's better if it's a paw. In any case, the location will be determined by the veterinarian.
The animal's paw should be straightened so that the vein is not pinched. You can fix it (the paw) with a splint - a board bandaged to the paw.
The puncture site is disinfected.

A standard peripheral vein catheterization kit includes:

Sterile tray.
Sterile beads moistened with disinfectant solution.
Sterile “pants”.
Band-Aid.
Peripheral intravenous catheters in several sizes.
Tourniquet.
Sterile gloves.
Scissors.
The bandage is medium.

Placement of the catheter must begin by ensuring good lighting of the manipulation site.
Next, hands are thoroughly washed and dried.
A standard set for vein catheterization is assembled, and the set should contain several catheters of different diameters.
Apply a tourniquet 10-15 cm above the intended catheterization area.
Select a vein by palpation.
A catheter of the optimal size is selected, taking into account the size of the vein, the required insertion speed, and the schedule of intravenous therapy.
Re-treat your hands using an antiseptic and put on gloves.
The catheterization site is treated with a skin antiseptic for 30-60 s and allowed to dry.
The vein should not be palpated repeatedly! Fixing the vein (it is pressed with a finger below the intended site of catheter insertion).
Take a catheter of the selected diameter and remove the protective cover from it. If there is an additional plug on the cover, the cover is not thrown away, but held between the fingers of your free hand.
The catheter is inserted on the needle at an angle of 15° to the skin, observing the indicator chamber. When blood appears in it, reduce the angle of the stiletto needle and insert the needle into the vein a few millimeters.
Having fixed the stiletto needle, slowly move the cannula completely from the needle into the vein (the stiletto needle is not yet completely removed from the catheter).
Remove the tourniquet.

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Do not insert a needle into the catheter after it has been dislodged from the needle into the vein! The vein is clamped to reduce bleeding, and the needle is finally removed from the catheter.
The needle is disposed of taking into account safety rules.
Remove the plug from the protective cover and close the catheter or connect the infusion system.
The catheter is fixed on the limb.

Complications after venous catheterization are divided into:

Mechanical (5-9%).
Thrombotic (5-26%).
Infectious (2-26%).

It is necessary to monitor the condition of the fixing bandage and change it if necessary, as well as regularly inspect the puncture site in order to identify complications as early as possible. If swelling, redness, a local increase in temperature, obstruction of the catheter, leakage, or pain in the animal to which the drug is administered occurs, it is necessary to remove the catheter and seek help from a veterinarian.

When changing an adhesive bandage, do not use scissors, because the catheter can be cut off, causing it to enter the bloodstream. It is recommended to change the catheterization site every 48-72 hours. To remove a venous catheter, you need a tray, a ball moistened with a disinfectant solution, a bandage, and scissors.

Despite the fact that catheterization of peripheral veins is a much less dangerous procedure than catheterization of central veins, if the rules are not followed, it can cause a complex of complications, like any procedure that violates the integrity of the skin. Most complications can be avoided with good manipulation technique, strict adherence to the rules of asepsis and antisepsis, and proper care of the catheter.

How to remove an intravenous catheter from a dog or cat?

Another frequently encountered medical procedure that the owner can handle independently is the removal of an intravenous catheter (branula). This manipulation is not complicated and may be required for a number of reasons. Firstly, if the branula remains in the vein for more than 5 days, secondly, if your pet’s paw in which the branula is placed is swollen below the catheter installation site, and thirdly, if the dog or cat almost chewed the catheter on its own .

It should be noted that intravenous catheters are usually placed in peripheral veins located on the extremities of animals. Catheters are fixed to the skin and fur by applying several rounds of adhesive tape. To remove an intravenous catheter, simply cut the adhesive tape perpendicular to the applied tours, then slowly peel it away from the fur and pull the plastic tube out of the vein. At the site where the branula enters the vein, tightly apply a swab moistened with alcohol and bandage the paw tightly for an hour. During this technically simple procedure, you should remember that the adhesive plaster should be cut only perpendicular to the tours, but not parallel to them.