What is the difference between catheterization and enema?

Many people think that catheterization and enema are actually the same thing, but there is still a big difference between them. Catheterization is to insert a catheter into our urinary system and excrete directly through the catheter without passing through the body's genitals. Enema is a surgery. After the operation, there is no need to carry the tube with you for a long time, so you can rest assured. It is generally judged based on your personal physical condition.

Clinical surgery

Catheterization is often used for urine retention, collecting urine for bacterial culture, accurately recording urine volume, understanding the cause of oliguria or anuria, measuring residual urine volume, bladder capacity and cystometry, injecting contrast agents, bladder irrigation, detecting urethral stenosis and preoperative preparation of pelvic organs, etc.

1. The patient lies on his back with his knees bent and legs abducted, and an oilcloth or a medium sheet placed under his buttocks. The patient should first clean the vulva with soapy water; male patients should turn back the foreskin for cleaning.

2. Use 2% mercurochrome, 0.1% chlorhexidine or 0.1% chlorhexidine solution to disinfect the urethral opening and vulva in a circular motion from the inside to the outside. Then cover the vulva with a sterile drape. For men, wrap the penis with a sterile drape to expose the urethral opening.

3. The operator wears sterile gloves and stands on the right side of the patient. He holds the penis with the thumb and index finger of his left hand. For females, separate the labia minora to expose the urethral opening. With the right hand, slowly insert the catheter coated with sterile lubricant into the urethra. Clamp the outer end of the catheter with hemostatic forceps and place its opening in a sterilized curved tray. For men, the insertion should be about 15-20cm, and for women, about 6-8cm. Loosen the hemostatic clamp and the urine will flow out.

4. If bacterial culture is required, collect midstream urine in a sterile test tube for examination.

5. After the operation, clamp the catheter and then slowly remove it to prevent urine in the tube from leaking out and contaminating clothes. If indwelling catheterization is required, fix the catheter with tape to prevent it from falling out, clamp the outer end with hemostatic forceps, and wrap the tube opening with sterile gauze to prevent urine from escaping and contamination; or connect a sterile plastic bag for urine retention and hang it on the side of the bed.

Enemas are generally divided into retention enemas and non-retention enemas.

Retention enema, as a kind of external treatment, has been widely used in clinical practice and has achieved relatively ideal clinical results, but there are also some problems. In order to ensure clinical effectiveness and reduce the occurrence of side effects, the author believes that retention enema should follow the following five degrees to achieve the desired effect.

1. Cleanliness

Before retention enema, the patient should be advised to empty his stool so that the enema solution can come into contact with the intestinal mucosa more widely and increase the absorption area. The anus should then be cleaned with a sitz bath and the perianal area should be disinfected with diluted iodine. A disposable rectal tube should be used to avoid bringing bacteria into the intestine.

2 Insertion depth

The depth of insertion is determined according to the purpose of enema. For example, if enema is performed due to uremia, the anal tube should be inserted into the sigmoid colon as far as possible, and the insertion depth should be more than 20 cm. If enema is performed due to rectal disease or pelvic inflammatory disease or prostatitis, the insertion depth can be more than 10 cm. The anal tube model should be 16~18, which is convenient for retaining enema fluid and conducive to drug absorption.

3. Temperature of the liquid

The medication solution should be heated before enema. When the temperature of the enema solution is lower than 34℃, intestinal peristalsis is weakened and function is reduced, which is not conducive to the full absorption of the drug. The temperature of the enema solution should be close to the intestinal temperature, generally between 37℃~38℃, which is 3℃~4℃ higher than the rectal temperature (37℃~37.5P℃). Enema solution that is 3℃~4℃ higher than the rectal temperature will stimulate the intestinal mucosa that is already in congestion, edema, erosion and ulceration, causing a defecation reflex.

4 drops of medicine

Retention enema is the infusion of fluid into the intestinal cavity. If the speed is too fast, the intestinal cavity will fill up quickly and the rectal pressure will increase, which will cause a defecation reflex. If the speed is too slow, the temperature of the heated solution will be difficult to maintain. 60 drops per minute is appropriate.

5. Acidity and alkalinity of the solution

Excessive acidity or alkalinity will damage the intestinal mucosa, causing inflammation, congestion, and edema of the intestinal mucosa, affecting the absorption of drugs. Preparation rooms with conditions should adjust the pH value of the enema solution to neutral when preparing it.