Urological Emergencies in Clinical Practice стр.133

Failure to Deflate Catheter Balloon for Removal of a Urethral Catheter

From time to time an inflated catheter balloon will not deflate when the time comes for removal of the catheter. No amount of drawing back on the balloon channel with a syringe will make the balloon go down, and attempts to burst the balloon by inflating the balloon with air or flushing the balloon inflation channel with water fail to work.

10. COMMON EMERGENCY UROLOGICAL PROCEDURES 177

Urological Emergencies in Clinical Practice

a

FIGURE 10.2 a: Nephrostomy insertion. A needle has been inserted into the renal pelvis and contrast has been instilled. b: A guidewire has been passed into the renal pelvis. c: The nephrostomy tube is advanced over the guidewire into the renal pelvis.

178 J. REYNARD AND N. COWAN

Urological Emergencies in Clinical Practice

FIGURE 10.2. Continued

10. COMMON EMERGENCY UROLOGICAL PROCEDURES 179

Urological Emergencies in Clinical Practice

FIGURE 10.2. Continued

180 J. REYNARD AND N. COWAN

Urological Emergencies in Clinical Practice

A little patience is required. Leave a 10-mL syringe firmly inserted in the balloon channel and come back an hour or so later. Sometimes, for no apparent reason, the balloon will have deflated and the catheter will be lying in the bed, having fallen out.

If this does not work, and the patient is female, then it is quite easy to burst the balloon using a needle introduced alongside your finger into the vagina (Fig. 10.3). Ask the patient to lie on her back, place a needle on your finger, apply copious lubrication, and gently insert the finger into the vagina. Pull down on the catheter with your other hand (or ask an assistant to do so), until you can feel the balloon of the catheter sitting at the bladder neck. By pulling the balloon onto the needle (which should be advanced a little so it advances just beyond the tip of your finger), the balloon can be deflated.

In male patients, balloon deflation with a needle can also be done, but ultrasound-guided balloon puncture will be required. Either the catheter should be clamped to allow the bladder to fill up, or the bladder can be filled with saline using a bladder syringe. As the bladder is so inflated, the bowel is pushed upward,


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