Hematuria Catheter: Purpose, Design, Use, and Management

What is a Hematuria Catheter?

A hematuria catheter is a specialized medical device, typically a large-bore, three-way Foley catheter, designed to facilitate continuous bladder irrigation (CBI) and evacuate blood clots from the bladder, primarily used in patients experiencing gross hematuria (visible blood in urine).

Understanding Hematuria

Hematuria, the presence of blood in the urine, can range from microscopic (only detectable under a microscope) to gross (visible to the naked eye). Gross hematuria often indicates a more significant underlying issue within the urinary tract, such as trauma, infection, kidney stones, or post-surgical bleeding (e.g., after prostate or bladder surgery). When bleeding is substantial, blood can clot within the bladder, leading to urinary retention, severe pain, and potential bladder damage if not promptly addressed. It is in these critical scenarios that a hematuria catheter becomes indispensable.

What is a Hematuria Catheter?

A hematuria catheter is a specific type of urinary catheter engineered to manage significant bleeding within the bladder. Unlike standard two-way Foley catheters used for simple urine drainage, hematuria catheters are characterized by their larger lumen and often a third port. This design allows for the efficient removal of blood clots and the continuous inflow of irrigating solutions, which are crucial for preventing further clot formation and maintaining bladder patency.

Key Features and Design

The specialized design of a hematuria catheter distinguishes it from other urinary catheters:

• Large Bore (French Size): Hematuria catheters are significantly larger in diameter, typically ranging from 20 to 30 French (Fr), compared to the standard 12-18 Fr for routine drainage catheters. This wider lumen is essential for allowing the passage and evacuation of blood clots, which can otherwise obstruct smaller catheters.
• Three Lumens (Three-Way Catheter): Most hematuria catheters are "three-way" catheters, meaning they have three distinct channels:
  • Drainage Lumen: The primary channel for urine and irrigant outflow, designed to be wide enough for clots.
  • Balloon Inflation Lumen: A smaller channel used to inflate a retention balloon (typically 30mL or larger, compared to 5-10mL for standard catheters) at the catheter tip, securing it within the bladder to prevent accidental dislodgement.
  • Irrigation Lumen: A dedicated channel for the continuous inflow of sterile irrigating solution into the bladder.
• Robust Material: Constructed from durable materials like silicone or latex, designed to withstand the rigors of continuous irrigation and the presence of blood.
• Larger Retention Balloon: The balloon is often larger (e.g., 30mL, 50mL, or even 75mL) not only for secure retention but also to apply gentle pressure to the bladder neck or prostate, potentially aiding in hemostasis (stopping bleeding) in certain post-surgical contexts.

When is a Hematuria Catheter Used?

The primary indications for the insertion of a hematuria catheter revolve around the presence of gross hematuria and the risk or presence of clot retention:

• Post-Urological Surgery: Most commonly used after transurethral resection of the prostate (TURP), transurethral resection of bladder tumors (TURBT), or other bladder/prostate surgeries where bleeding is an expected complication.
• Gross Hematuria with Clots: For patients experiencing significant spontaneous bleeding from the kidneys, ureters, or bladder due to trauma, infection, kidney stones, or certain medical conditions, especially when clots are forming and obstructing urine flow.
• Bladder Tamponade: To relieve bladder tamponade, a condition where a large blood clot fills the bladder, preventing urine drainage and causing acute urinary retention and severe pain.
• Diagnostic Purposes: Occasionally used for diagnostic lavage to identify the source of persistent bleeding, though less common than its therapeutic use.

How it Works: The Irrigation Process

The core function of a hematuria catheter is to facilitate Continuous Bladder Irrigation (CBI). This process involves:

1. Inflow: Sterile irrigating solution (typically normal saline) is continuously infused into the bladder through the dedicated irrigation lumen. The rate of infusion is adjusted based on the severity of bleeding, aiming for clear or light pink drainage.
2. Outflow: The solution, mixed with urine and any blood or clots, drains out of the bladder through the large drainage lumen.
3. Clot Evacuation: The constant flow helps to prevent blood from clotting within the bladder and flushes out any existing clots. If large clots are present, manual irrigation (intermittent, forceful flushing with a large syringe) may be performed through the drainage port to break up and aspirate clots.

The goal of CBI is to prevent the formation of new clots, clear existing clots, and ensure unobstructed urine flow, thereby preventing bladder distension and associated complications.

Insertion and Management Considerations

Insertion of a hematuria catheter follows principles similar to other urinary catheters but requires specific attention due to its larger size and the clinical context. It is a sterile procedure performed by trained medical professionals (nurses, physicians, physician assistants).

Key management considerations include:

• Maintaining Patency: Regular monitoring of drainage color and flow is crucial. Any decrease in outflow or increase in bloodiness may indicate clot formation requiring manual irrigation.
• Fluid Balance: Careful tracking of input (irrigant volume) and output (total drainage) is essential to monitor fluid balance, as some irrigant may be absorbed by the bladder mucosa.
• Pain Management: Patients may experience bladder spasms or discomfort, requiring appropriate pain relief and antispasmodic medications.
• Infection Prevention: Strict aseptic technique during insertion and daily catheter care are vital to prevent catheter-associated urinary tract infections (CAUTIs).
• Removal: The catheter is typically removed once the urine drainage remains clear or light pink for a sustained period, indicating that the bleeding has subsided.

Potential Risks and Complications

While essential for managing hematuria, the use of a hematuria catheter is not without potential risks:

• Bladder Spasms: The presence of the catheter and the cold irrigating solution can irritate the bladder, leading to painful spasms.
• Catheter-Associated Urinary Tract Infection (CAUTI): As with any indwelling catheter, there is an increased risk of bacterial infection.
• Urethral Trauma: Due to its larger size, insertion carries a slightly higher risk of urethral irritation or trauma.
• Bladder Perforation: Although rare, forceful manual irrigation or improper insertion can potentially cause bladder injury.
• Electrolyte Imbalance/Fluid Overload: While less common with normal saline, excessive absorption of irrigant can, in rare cases, lead to fluid overload or electrolyte disturbances, especially in patients with pre-existing cardiac or renal conditions.
• Persistent Bleeding: The catheter itself does not stop the source of bleeding; it only manages the clots. If bleeding persists, further medical or surgical intervention may be required.

Who Administers and Manages?

The insertion, management, and removal of a hematuria catheter are medical procedures performed by licensed healthcare professionals. This includes:

• Urologists: Specialists in the urinary tract who frequently perform the procedures necessitating these catheters.
• Nurses: Play a critical role in the ongoing management, monitoring, manual irrigation, and patient education.
• Physician Assistants and Nurse Practitioners: Often involved in the insertion and management under physician supervision.

Conclusion and Clinical Significance

The hematuria catheter is a vital tool in urological and emergency medicine, specifically designed to address the critical issue of bladder clot retention due to significant hematuria. Its unique three-way, large-bore design facilitates continuous bladder irrigation, effectively preventing and clearing blood clots, thereby restoring urine flow and preventing severe complications. Understanding its purpose, mechanism, and associated care is crucial for healthcare professionals involved in the management of patients experiencing gross hematuria, ensuring optimal patient outcomes in challenging clinical scenarios.