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HISTORY AND ORIGIN OF
“CATHETER”
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DEFINITION:
A catheter is a hollow flexible tube that can be inserted into a body
cavity, duct or vessel. Catheters thereby allow drainage or injection of
fluids , distend a passageway or provide access by surgical
instruments.
The process of inserting a catheter is catheterization.
In most uses a catheter is a thin,
flexible tube: a "soft" catheter;
in some uses,
it is a larger, solid tube: a "hard" catheter.
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What is a Catheter made up of ?
Materials:
A range of polymers are used for the
construction of catheters, including silicone rubber
latex and thermoplastic elastomers.
Silicone is one of the most common choices because it
is inert and nonreactive to body fluids and a range of
medical fluids with which it might come into contact.
Materials:
CATHETER:
Polyvinylchloride (PVC)
Polyethylene (PE)
Fluoropolymers (PTFE) (TEFLON)
Polyurethane (PUR)
Silicone (SI) 4
Catheters
• Catheters are medical devices, typically in the form of a
tube, that are inserted into the body to remove fluid,
create an opening, or deliver a drug.
• The biocompatibility of catheters, as with other medical
devices, can be defined as the ability of the device to
perform its intended function without eliciting
undesirable side effects.
• Biocompatibility will be dependent on physical properties
of the device (e.g., rigidity, surface smoothness) and its
chemical nature
• is it allergenic, are there toxic leachables
• body’s reaction to the device SHOULD NOT affect its
function.
Silicones, polyvinyl chloride (PVC),
and latex rubber
• Silicones, one of the most thoroughly tested and widely-used
groups of biomaterials, are well known for their intrinsic
biocompatibility and biodurability
• SILICONE’s inherent chemical and thermal stability, low
surface tension and hydrophobicity
• Silicones have been successfully applied in short- and long-
dwelling catheters,drains, and shunts for over sixty years
• Silicone elastomer is a thermosetting material, capable of
being processed by various molding, dipping, and extrusion
methods. Once cross-linked into the desired configuration,
silicone catheters are thermally stable (-80 °C to +230 °C),
remaining essentially unaffected by repeated autoclaving.
They are usually dry-heat sterilized
• Silicone catheter raw materials are more
expensive than legacy materials such as
latex and PVC
• Urinary tract infections account for over
40% of all nosocomial infections, and
almost all these infections are associated
with indwelling catheters
Silicone use
• Silicone catheters and tubing appear to be less thrombogenic than
standard PVC tubing and catheters
• When silicone was compared to PVC intravenous (IV) catheters for
parenteral nutrition, a lower complication rate , higher rates of IV
therapy completion, and longer service life were demonstrated
• Phlebitis, an inflammation of the veins sometimes associated with
thrombosis, which is far less in silicone catheters than PVC
• silicone catheters were better at maintaining their physical properties
and flexibility over time when compared to the PVC catheters
• The silicone coating helps reducing mineral encrustation on the tip or
within the lumen of the urinary catheter
• all-silicone and silicone-coated catheters remained patent the longest
in urinary use
• formation of encrustations and blockage was significantly less in
patients with silicone catheters as compared to Teflon®-coated latex
or all-latex catheters
• Foley catheters made entirely of silicone had less potential for
bacterial migration compared to latex catheters with various coatings,
including a silver-containing hydrogel
PVC
• Polyvinyl chloride is generally referred to by the abbreviation PVC and has
the IUPAC name polychloroethene
• PVC is thermoplastic, although the pure polymer is hard and stiff addition of
chemicals known as plasticizers makes PVC soft and flexible. These
additives can be extracted in vivo causing several problems:
• -induction of an acute inflammatory reaction to the leached plasticizer,
increased polymer stiffness / brittleness, and an increased failure rate due to
breakage when compared to other biomaterials
• Plasticizer DEHP had produced a range of adverse effects in laboratory
animals, notably liver toxicity and testicular atrophy
• Becoming out dated
IUPAC: International Union of Pure and Applied Chemistry
DEHP: Di(2-ethylhexyl)phthalate – The most common plasticizer
BCF : Bioconcentration factor; HAL-Health advisory level;
MCL: Maximum contaminant level; MCLG: Maximum contaminant level goals; MPC:
Maximum permissible concentration
Latex rubber
• Latex rubber is most often obtained commercially from
the sap of the Pará rubber tree (Hevea brasiliensis),
named for the Brazilian state
• Due to human immunodeficiency virus (HIV) pandemic,
the use of latex gloves and condoms sharply increased
in the 1980s
• increased reports of latex allergies, especially among
healthcare workers
• Latex allergies usually present as a Type I (IgE-
mediated) immediate allergic reaction to proteins
contained in the natural rubber-other than proteins
several other additives are also responsible
• The conversion of medical facilities to “latex-safe”-is
being considered
Catheters produced from silicone
Strength
Radiopacity
Flexible
Atraumatic Tip
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PARTS OF A CATHETER
BODY
HUB
BODY
HUB TIP
TIP
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MEASUREMENT:
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Butterfly Catheters Foleys Catheter
(1way, 2way or
3way)
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Some Other Types of Catheters:
Hydrophilic Catheters :
Hydrophilic-coated catheters have a layer of polymer
coating that is bound to the catheter surface.
The polymer absorbs and binds water to the catheter,
resulting in a thick, smooth and slippery surface.
Intermittent Catheters:
Intermittent catheters are hollow tubes used to drain
urine from the bladder.
Pediatric Catheters:
Usually its around 80cm.
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TYPES OF CATHETERS
SHAPES
Straight Catheter
Pigtailed Catheter
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Different Catheter Curves
For Different Purposes:
> Judkins Left (JL)
> Multipurpose
Judkins Left Judkins Right
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CATHETERS CAN BE BROADLY CLASSIFIED
UNDER THESE GROUPS:
DIAGNOSTIC CATHETERS
Used for Angiographs .
GUIDING CATHETERS
Used for Angioplasty.
• Guiding catheters are like angiography catheters only difference is that
guiding catheters are more stiffer & firm as it carries Balloon catheters, PTCA
wires and stent delivery system.
• Mild stiffness comes due to the wire braided design.
• Good Push ability .
• Good Tractability.
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PUNCTURE NEEDLES:
Used to cannulate or puncture the artery.
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Cannulas Lines
This is a an IV cannula. It is used to give IV
fluids and IV drugs.
If you wish to give the fluid quickly, the
cannula must be short and large bore
(Poiseuille’s law – flow is proportional to the
fourth power of the internal radius of the
tube and inversely proportional to the
length).
Emergencies (265ml/min)
Generally insert a 18G (green) or higher
when giving drugs. Emergency should be
brown (14G) which has a flow rate of about
265ml/min. Use antecubital fossae in
emergencies.
Lines
Cannulas
Blue 22G
Pink 20G
Green 18G
White 17G
Grey 16G
Brown 14G
Lines
Triple lumen Central Venous Pressure Catheter
• Inserted into either the
right subclavian vein or
internal jugular vein.
• Used for Central Venous
Pressure monitoring and to
administer drugs
(chemotherapy drugs),
taking blood, not good for
fluids.
• Single or triple lumen
Triple lumen Central Venous Pressure Catheter
• Inserted using Seldinger technique.:
Lines
• Lie patient flat. Infiltrate skin with LA 5ml of lignocaine
• Assemble the catheter and flush all the lumina
• Introduce needle and syringe 1cm below the junction of the middle
and medial thirds of the clavicle. Aim the needle to the sternal notch
and advance. Aspirate as you advance the needle.
• Once blood enters the syringe, remove the syringe keeping the needle
still in its position.
• Insert the guide wire, remove the needle, feed the dilator over the
guide wire, remove dilator, insert central line, remove guide wire
• Stitch in place, Order CXR to check position and exclude pneumotharax
Lines
Triple lumen Central Venous Pressure Catheter
• Complications of a central line insertion:
•
• Immediate: pneumothorax, haemothorax, damage to adjacent
vessels e.g. carotid arteries, primary haemorrhage
•
• Early: infection (skin commensals), secondary haemorrhage,
haematoma formation
•
• Late: thrombosis, catheter blockage.
GUIDE WIRE:
Diagnostic guide wires are used to traverse vascular anatomy to aid in
placing catheters and other devices. Guide wires are used for both
Cardiology and Radiology angiographic procedures.
• PTFE coated Soft tip for the smoothness during the insertion
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Shape of the Tip :
J Tip / Straight Tip
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In1929 Werner Forssmann
demonstrated that a simple
Rubber catheter could be passed to
the pulmonary artery through the
Anti- Cubital Vein and
An angiographic film could be
obtained using radiographic
contrast.
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In 1953 ,
Sven –Ivar Seldinger invented
The technique of gaining access
Percutaneusly into an artery
without An arteriotomy.
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TECHNIQUE OF INSERTING A CATHETER
SELDINGER TECHNIQUE :
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4
1
2 5
3
6
COMPLETE APPARATUS:
> Needle
Guide Wire
Sheath
Catheter
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USES & APPLICATION s OF CATHETERS:
Placement of a catheter into a particular part of the body may allow:
• Row of tubes
• For big cavity drains
• It is an open drainage system
Drains
•Bottle to which the chest drain is attached.
Chest Drain Bottle
• There is a line called prime level which is filled
with sterile water.
• The chest drain tubing is connected to a tube
which is under the sterile water and therefore
acts as a water seal.
•After a chest drain has been inserted you can see
bubbling in the water as the air leaves the pleural
space.
•The chest drain bottle can be used to collect air,
blood, fluid and pus from the pleural space.
•The system can be driven by attaching suction to
the top of the bottle making it an example of a
active closed drainage system
Surgical Instruments
Rigid Sigmoidoscope
• Used for the inspection of the rectum and
lower sigmoid colon.
• After explaining to the patient what you
are about to do, you must attach a light
source and a air pumping device.
• The patient is placed in the left lateral
position and a digital rectal examination is
performed.
• The sigmoidoscope is then lubricated with
jelly and inserted pointing towards the
umbilicus.
• Air is pumped into the rectum to allow
you see the direction of the rectal lumen.
• Biopsies can also be taken of rectal
mucosa through the sigmoidoscope eg in
a case of ulcerative colitis
Drains
Vacuum Drain bottle (Redivac)
Suction source
Yankauer
Pre-cutted tube
Operating table
Bubble tube
Collection Chamber
Sep-T-Vac
Main Features
• Collection chamber
• Airtight cap: Connections for yankauers and
suction source
• Filter
• Product range
– 100% Disposable 0.8 l/1.2 l/2.0 l/3.0 l
– Liners 1.2 l/2.0 l/ 3.0 l
Sep-T-Vac
Collection chamber
Sep-T-Vac
Filter
• Sep-T-Vac filter:
– Gore Tex Hydrophobic shut-off filter. Gore Tex is
moisture sensitive and it automatically stops
aspiration when collected liquid is at the top of
the chamber.
– It is not a mechanical system an it prevents also
micro-particles and aerosol leakages
Surgical Suction
Objectives
• Operating Room: To remove biological fluids
and clean the operating field during and after
surgical procedures
• Vacuum source
• Connecting tubes (from wall collection
systems and from collection systems to the
cannula
Features Benefits
Wide range of sizes To fit to all hospital needs
Female molded connectors or Flexibility to answer to all
integral connector hospital needs
Clear Pvc formulation with striated
antistatic walls Safety for the patient
Flexibility to answer to all
Funnel or sure grip connector
hospital needs
Minimal coil memory To minimize hospital costs
Steri-guard package with sterile
inner pouch and two labels Two avoid money waste
Non conductive and conductive
types available Safety for the patient
Universal bubble tubing
Features and Benefits
Features Benefits
Clear bulk tubing
Can be cut to the exact length Savings for the hospital
Bubble every 91 cm can be cut to
form integral tapered or funnel Flexibility for the customer
connectors
Dispensed in single roll case Flexibility for the customer
Bronchial Suctioning
Anatomy
Bronchial Suctioning
Objectives
• Connecting tubes
• Suction catheters
• Mucus trap
Suctioning
Type of…..
• Naso-Tracheal suctioning
• Endo-Tracheal suctioning
• Tracheostomy suctioning
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Ballard Suction Catheter
• Suction catheter contained within plastic
sheath
• System remains “closed”
• Be sure catheter is completely withdrawn
when finished
• Suction ‘OFF’
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Lock/ Unlock
Control Valve
Black Line
To
Suction
Patient Wye
ETT
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Lock/ Unlock Control Valve
LOCK
Unlock
To Apply
Suction
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Yankauer (tonsil sucker)
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Connecting
Tubing
Suction Lukens
Catheter Sputum Trap Suction Unit
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Suction catheters
Main features
• Tip: It is related to the efficiency in
aspiration (speed and suctioning capacity of
viscous mucus) and tissue damage
• Connector to vaccum
• With Touch Trol or Funnel or Sure Grip
Suction catheters
• Objective:
to collect mucus for
clinical analysis
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Rationale
• To remove secretions from lower airway
when patient intubated or trached
• Or cannot cough effectively
• To obtain sputum sample for culture and
sensitivity
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Suctioning
• Advance plastic tube down ETT or trach
• Apply vacuum to evacuate secretions
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Applying O2 Across Mouth of ETT
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SX SX
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With proper sized suction
catheter, catheter mid-position in ETT
draws approximately equal amounts from
both ends
of ETT.
ETT X
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Argyle
whistle tip
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Coudé tip suction catheter
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Thumb Control
Connecting
tubing to
20 - 22 suction
inches
long
14 Fr
Coude -
Angled tip
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Pathway of NT suction catheter
Sinus
Turbinate
Eustachian Tube
Uvula
Tongue
Epiglottis
Larynx
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Airway Instruments
Laryngoscope
• A laryngoscope has a
handle and a curved blade,
usually fitted with a light, it
moves the tongue and
epiglottis aside in order to
inspect the larynx.
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Swivel Adapter
port
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Airway Instruments
Oropharyngeal / Guedel Airway
• This is essentially a rigid, curved
plastic tube. It is an airway adjunct
• It is used to provide an airway for
a patient where there is an
impaired level of consciousness.
• It is sized by measuring the
distance from the angle of the
mandible to the patient’s mouth.
• Indications:
– Depressed consciousness
– Hypoxemia
– Airway Obstruction
Airway Instruments
Endotracheal Tube
• Then check the tube is in the trachea by:
– Auscultating: ensure bilateral breath
sounds
– Auscultate over the stomach (epigastric
region) to ensure no gurgling (that would
indicate oesophageal intubation)
– Measure end tidal CO2 tension: since
CO2 is produced in the lung, you can
confirm that the tube is in the trachea by
measuring the end tidal CO2 tension. If
the tube is in the oesophagus, then the
CO2 gas pattern would be absent.
– Do CXR and look for metallic mark
Airway Instruments
Endotracheal Tube
• Complications:
– Broken Teeth, lacerations of the
tissues of the upper airway,
– Intubation of the Oesophagus
Airway Instruments
Tracheostomy Tube
• Definitive airway
• Tracheostomy = surgical
opening into the trachea.
• Can be temporary or
permanent.
• It involves placing the
tracheostomy in between the 2
and 4th tracheal rings.
• Usually done in theatre under
GA.
Airway Instruments
Tracheostomy Tube
• Indications
– Patients who require long term intubation (>2
weeks) – better tolerated than ETT
– Severe maxillofacial injury (unable to
intubate)
– Post-laryngeal surgery (e.g. laryngectomy for
malignancy)
– Lung disease (e.g. COPD) to reduce dead
space and allow effective ventilation
– Obstructive sleep apnoea
– Upper airway obstruction
• Complications
– Tracheostomy stenosis,
– Infection
– Blocked tube,
– Tracheoesophageal fistula
– Surgical emphysema.
Parts of Tracheostomy Tube
Types of Tracheostomy Tubes
Bivona TTS Trach Tube Portex Cuffed Trach Tube