Catheter

“ To pass the catheter in the upright position, the patient is placed against a wall or firm object, with his heels eight or ten inches apart and five from the wall, that he may rest easily during the operation. The surgeon sets himself opposite the patient and grasps the penis with the two middle fingers of the left hand, the palm upwards; he next exposes the meatus with the thumb and forefinger, and his right hand holding the catheter by its middle obliquely across the left side of [Pg 134] the patient, he draws the penis on to the instrument till the triangular ligament is gained. ”

“ If the bladder cannot otherwise be relieved a catheter should be used, and as a precaution to avoid wetting the bedclothes it is well to have a catheter made long enough by affixing a piece of India rubber tubing to the end of it to reach a vessel at the side of the bed. ”

“ In the adult the cause which produces the over-distension must be removed if possible; but, as a rule, the patient has to be provided with a catheter, which he can pass before the bladder has filled to overflowing. A soft flexible catheter should be given in preference to a rigid or semi-rigid one. The best form is the red-rubber catheter, and he should be taught the need of keeping it absolutely clean. In the case of children incontinence of urine means irritability; in adults it means overflow. ”

“ At other times the obstruction can be overcome by introducing the catheter with its stem held upwards and outwards, so that on entering the nose the beak dips in beneath the anterior end of the inferior turbinal. As the catheter is pushed gently inwards its outer extremity is brought round with a circular movement so that it gradually assumes the horizontal position. No force must be used. As the catheter is pushed farther in, it may rotate to a varying degree according to the formation of the nasal cavity. ”

“ Frequent use of the catheter, without any treatment to prevent the further enlargement of the diseased gland, or to reduce its size, permits the part to go on enlarging, and, besides, the constant use of the catheter irritates the prostatic portion of the urethra, causing thickening of the lining membrane, and sooner or later a more or less complete organic stricture of this canal, depending upon thickening of the lining mucous membrane, as well as upon the encroachment of the gland itself upon this canal. ”

“ To many men with enlarged prostate the passing of an instrument night and morning is no great hardship, while to others the idea of leading what is called a “catheter life” appears intolerable, or, having for a time been patiently carried out, is found not only severely trying but greatly disappointing.
In some people the very first passing of a catheter sets up a local and constitutional disturbance, the bladder being rendered irritable and intolerant, the temperature going up, and shiverings and perspirations manifesting themselves. ”

“ The next systole sends a powerful stream of blood into the catheter, which is immediately checked by fixing the gutta percha end of the previously set manometer on this conducting catheter. Now begins the observation which richly repays the tedious and bloody preparation. The heart pumps out the manometer with surprising rapidity.... We have repeated this experiment six times.”—“Ueber die Druckverhältnisse im Innern des Herzens,” Pflüger’s Archiv., Vol. ”

“ Pass a soft rubber catheter, along the floor (bottom) of the nose until its end is seen passing down behind the soft palate into the throat. Grasp this with a pair of forceps and pull it forward into the mouth. Tie a stout string to the end of the catheter (about 1-1/2 feet long) and tie the other end of the string around the centre of a plug of lint or gauze, 1-1/2 inches long and three-quarters of an inch wide. Then pull the catheter back through the nostril, very gently. This will pull the plug into the posterior opening of the nose, and plug it. . ”

“ Traumatic.—When produced by the patient herself it is either by violent exercise, running up and down stairs, walking and dancing, occasionally by pressure upon the abdomen or by the use of the knitting-needle, catheter, or similar instrument. The more expert or daring only attempt to enter the uterine cavity, as the organ itself may be pierced; if the catheter is successfully introduced, the attachment of the ovum is severed, and with the knitting-needle the sac is punctured. ”

“ But, above all things, we must have recourse to the catheter when the patients cannot make water, and get them to sit in hot baths of a relaxing nature, and use emollient cataplasms. When the urine flows involuntarily, we must treat them upon the astringent plan with tonic remedies, and make them use dry food and cold drink. ”

“ There is always more or less danger of retention of urine, from the pressure that has been exerted on the bladder; and if it be allowed to continue too long its removal becomes exceedingly difficult. If on making the attempt the urine does not flow, the catheter must be used, and the sooner the better. The pain arising from retention of the urine has often been supposed to arise from inflammation of the womb, or bowels—neither patient nor physician knowing its real source, till the passage by the catheter gave relief. ”

“ The catheter should be tied in, and left for two, sometimes for three days, when it can generally be removed with safety, and a bougie should be passed at intervals of three or four, till the wound is healed. To prevent recurrence of the stricture, it is a wise precaution to pass an instrument at intervals for many months after the cure is apparently complete. ”

“ The pain is not commonly severe at first, and if he can make water, which in all such cases it is desirable to prevent by having recourse to the catheter, it is more or less colored or mixed with blood. If the urine should not escape into the cavity of the abdomen, the ordinary inflammation which must necessarily ensue takes place and affects the internal surface of the bladder. ”

“ Fig. 9, Plate 61.—The lateral lobes, b b, of the prostate are enlarged. The third lobe, a, projects at the neck of the bladder, distorting the vesical outlet. A small calculus occupies the prostatic urethra, and being closely impacted in this part of the canal, would arrest the progress of a catheter, and probably lead to the supposition that the instrument grated against a stone in the interior of the bladder, in which case it would be inferred that since the urine did not flow through the catheter no retention existed. ”

“ Had the ancients solid bladder sounds? They must have been well aware of the characteristic grating sensation conveyed to the skilled hand on striking a stone with a metal instrument, for we have several references in the classics to the manœuvre of pushing back, by means of a catheter, a stone impacted in the urethra. Rufus of Ephesus (Περὶ λιθιώσης κύστεως) says of impacted urethral calculus: ‘Those that are stuck fast push back with the catheter if you prefer not to do lithotomy’ (ἐρείδοντας οὖν εἰ μὴ θέλοις τέμνειν ἀπῶσαι τῷ αὐλίσκῳ) . ”

“ If consciousness returns, the patient begins to cough and mucus or membrane is expelled from the air-passages. On the other hand, it is useless to continue artificial respiration if the obstruction is not relieved; aspiration must be employed if special instruments are at hand. The fact that a number of surgeons have lost their lives as the result of sucking through a catheter in the attempt to save the child is sufficient to condemn this practice; but good results have been obtained by passing a catheter low down into the trachea and blowing through it with a syringe or even with the mouth. ”

“ Having safely entered the skull, he spreads the scissors to enlarge the opening.
"The surgeon removes the scissors and introduces a suction catheter into this hole and evacuates the skull contents. With the catheter still in place, he applies traction to the fetus, removing it completely from the patient." H. R. 1833 Hearing 3, 8-9.
In cases in which the physician inadvertently dilates the woman to too great a degree, the physician will have to hold the fetus inside the woman so that he can perform the procedure. ”

“ The string should be tied round the catheter 1⁄2 an inch from the meatus, its ends gathered together and tied in a knot about 1 inch farther on. The foreskin is then drawn back, the ends passed beneath the glans and tied round the penis behind the corona; the superfluous string is snipped off, and the foreskin brought forward. The catheter is cut off obliquely 1⁄2 an inch beyond the string and then stopped with a spigot, direction being given to the patient to withdraw the spigot, and [Pg 140] push the catheter a little further in when he wants to make water. ”

“ When the patient is under the influence of ether and the bladder emptied with the catheter, an incision is made in the linea alba from the umbilicus to the pubes. The belly-wall of a woman advanced in pregnancy is very thin, and, unless the surgeon be cautious, the knife will come in contact with the uterus before he is aware of it. ”

“ No force should be employed. The end of the catheter is bent to suit the conditions met with. A bead of pus exuding from the hiatus semilunaris will often serve as a useful guide. If there be any uncertainty as to the catheter having entered the frontal sinus, its exact situation can be determined by the Röntgen rays (Figs. 334, 335) .
A Politzer’s inflation bag is now connected with the end of the frontal canula, and air is blown through it. ”

“ In a wound of the bladder, an elastic gum catheter should be kept in the urethra, frequently without a stopper, until the wound is presumed to be healed—unless its presence should prove injurious, from excess of irritation, not removed by allowing the urine to pass through it by drops as it is brought into the bladder. ”

“ On June 18th, 1847, I exhibited, in University College 359Hospital, ether to a man, aged forty-two, with stricture of the urethra, caused by an accident. He passed his urine only in drops, and the attempts to pass a catheter had all failed. It was Mr. Liston’s intention to divide the urethra in the perinæum, but when the patient was placed fully under the influence of ether to the fourth degree of narcotism, a catheter (No. 1) passed into the bladder, and the operation was not required. ”

“ I may here observe, that I have never yet been foiled in passing the catheter, though very many severe and difficult cases have fallen to my lot; in other words, I have never been obliged to abandon my attempts to obtain an exit for the urine by its natural passage, and, as a last resource, to mutilate and endanger a patient by making an unnatural aperture in his bladder. Yet circumstances may soon occur to me in which the introduction of an instrument along the urethra shall be impossible; no man, it has been said, can be always wise or always fortunate ”

“ The simulation of this affection may be detected by giving the patient a full dose of opium at night, without his knowledge, and introducing the catheter during sleep, or, by taking him by surprise during the day, and introducing the same instrument; when, if he be an impostor, it will be found that the urine has not drained off, guttatim, as it was secreted, but that the bladder possesses the power of retention. ”

“ When the bladder is penetrated, care must be taken to provide for the removal of the urine, either by an elastic catheter, or, if this cannot be retained, by perineal incision. A freely communicating external wound prevents the employment of the catheter from being essential. A soldier of the 57th Regiment was wounded, on the 18th June, 1855, by a musket-ball, which entered the left buttock, fractured the pelvis, and came out about three inches above the os pubis and one inch to the right of the median line. ”

“ Immediate abatement of all painful symptoms follows skilful and prompt measures; and the superior science of one man over others is made apparent to the most ignorant observer. In over-distended bladder from paralysis, the catheter can in general be passed without difficulty. It should be of a large size, and its introduction should be repeated as often as nature calls for relief, perhaps three or four times during the twenty-four hours, until the viscus regains its tone ”

“ Great as is the relief afforded by the catheter, which has often saved life, yet it is a fact that its frequent and prolonged use often renders disease of the prostate very intractable and often wholly incurable. ”

“ The presence of the catheter, which is passed up the urethra for the first time, is cruel the first day, painful the second, inconvenient the third, scarcely felt the fourth; pessaries introduced into the vagina, bougies into the rectum, tents in the nasal fossæ, the canula in the nasal canal, produce, in different degrees, the same phenomena. It is upon this remark that is founded the possibility of introducing instruments into the trachea to aid respiration, and into the œsophagus to afford artificial deglutition. This law of habit may even transform a painful into a pleasant impression ”

“ Immediate recourse must be had to the firm silver catheter, proportioned in size to the tightness of the stricture, and the difficulties afforded to its introduction must be overcome by skill and perseverance; it is no easy matter to pass the instrument in many cases, and particularly when ineffectual attempts have been made previously. By gentle insinuation, and perseverance in moderate pressure, properly directed, the obstacle can always be overcome,—and that without the infliction of any injury to the parts. ”