catheter

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Background

A catheter is a flexible tube made of latex, silicone, or Teflon that can be inserted into the body creating a channel for the passage of fluid or the entry of a medical device. For many years, the epidermal catheters used were plain tubes made of available industrial compounds, and design was largely based on current need. In the 1950s and early 1960s, a very common practice was to cut a suitable length of industrial polyvinyl chloride (PVC) or nylon tubing and have it sterilized with the other surgical equipment. Nowadays, there are many specialized catheter designs. For example, specific catheter designs allow catheters to be used in pulmonary, cardiac (vascular), neonatal, central nervous system, and epidural tissues. Catheters are designed to perform tissue ablation (tissue removal) and even serve as conduits for thermal, optics, and various medical devices.

The three major types of catheters are coronary, renal, and infusion. Coronary catheters are used for angiography (x-ray of blood vessels after injection of radiopaque substance), angioplasty (altering the structure of a vessel), and ultrasound procedures in the heart or in peripheral veins and arteries. The best-known renal catheters are Foley catheters, which have been commercially available since the 1930s. These catheters are equipped with an inflatable balloon at the tip and are used for urine incontinence, dying patients, and bladder drainage following surgery or an incapacitating injury or illness. The Foley catheter is relatively easy to use and used throughout the world in hospitals, nursing homes, and home-care settings.

History

The earliest precursor to the present day Foley catheter is documented in 3000 B.C. It is believed that Egyptians used metal pipes to perform bladder catheterizations. As early as 400 B.C., hollow reeds and pipes were used in cadavers to study the form and function of cardiac valves.

In 1844, Claude Bernard inserted a mercury thermometer into the carotid artery of a horse and advanced it through the aortic valve into the left ventricle to measure blood temperature. It is because of his work that the use of catheters became the method of standard for physiologists in the study of cardiovascular blood flow. Adolph Fick took another major step in the development of cardiac catheterization in 1870. His famous note on the calculation of blood flow is the basis for today's cardiac procedures.

Among the earliest published descriptions of human catheterization were done by Frizt Bleichroeder, E. Unger, and W. Loeb in 1912. They were among the first to insert catheters into the blood vessels without x-ray visualization. Interest in catheterization was also stimulated with the advent of chemotherapy. Early chemotherapy required the injection of drugs directly into the central circulation. Bleichroeder inserted catheters into dog arteries and assessed the effects after leaving them in place for several hours. He reported no complications or clots.

The Foley catheter came into existence in the 1930s. Frederick E. B. Foley began to experiment with different catheters of the time. He realized that urinary catheters would easily slip out of the bladder because there was no way to hold them in place. Foley experimented with different methods of securing the catheter until he came up with the idea of attaching a balloon-like device to the end of the catheter. The device would then be able to be placed and then inflated from the outside. By 1934, Foley catheters were on the market. Other than in material, the Foley catheter remains relatively unchanged in design today.

Raw Materials

Foley catheters are made from either silicone or latex rubber, depending on the use.

Design

Foley catheters are made of latex or silicone rubber. Silicone rubber catheters are believed to be superior to latex catheters, as silicone is more biocompatible, causes less cell death, less likely to become encrusted, and more resistant to bacterial colonization. The catheter can either have two or three outlets. In a two-way catheter, one outlet acts a urine output and the other inflates the balloon. A three-way Foley catheter has the same function as a two-way catheter, but uses the third outlet for bladder irrigation.

Foley catheters vary in size from 12 fr to 30 fr (4 to 10 mm) in diameter, with the standard being 14 fr (4.6 mm). The balloon itself varies in size from 5 cc to 30 cc, depending on the needed use. The balloon can either be filled with sterile water or air. The catheter can also be attached to a drainage bag.

The Manufacturing
Process

1. The first step in the manufacturing of a Foley catheter is the production of the long, thin tube that will be inserted into the bladder. The liquid rubber silicone is poured into a room temperature vulcanization (RTV) rubber mold. The mold is shaped like the desired catheter with either two or three outputs.
2. The silicone is then heat cured. This procedure can take anywhere from 0.5 to 40 hours. Once cooled, the tube is withdrawn from the mold.
3. A small opening is then punched in the distal end of the tube furthest away from the two outputs.
4. A thin band of cured latex is slipped over the tube by hand to form a sheath around the tube. It is positioned so that the latex covers the opening that has been punched in the tube.
5. To form the balloon, the entire length of the tube is dipped in latex, which creates an overcoat layer and bonds the band to the tube proximate to the distal and proximal ends of the band, forming the balloon. This adds to the thickness of the balloon and is used to adjust the outer diameter of the tube to the desired size.
6. The catheter is then transported to the packaging center where it is put into a kit with a needleless syringe (to fill the balloon) and a drainage bag.

Quality Control

Quality control is built into each step of the manufacturing process. The machine operations check the final product of each stage in the process. The thermoplastic materials are immersed in liquid to ensure that defects are not present and that there will not be any leakage.

Byproducts/Waste

Any material deemed to be defective is either discarded or recycled depending on the severity of the damage. Since the product is directly related to human health, the materials must be of the highest quality.

The Future

A new use of the catheter is being tested in medical facilities for the purpose of dissolving clots or blockages in the coronary arteries. Once the catheter is positioned in the coronary artery, the tip of the catheter acts much like a showerhead, spraying six jets of saline around the clot. These saline streams break down the clot and the vacuum-like natures of the pumps force the debris out of the artery. With the clot gone, doctors can proceed with balloon angioplasty to repair the fatty blockage, which caused the clot to lodge there in the first place. This method requires only mild intravenous sedation rather than the general anesthesia that would be required with bypass surgery. Such new technology lessens the physical and emotional strain on a patient.

In current ablation systems (catheter used for tissue destruction), the tip of a radio frequency ablation catheter can become quite hot. Blood can subsequently form coagulum on the catheter tip that prevents delivery of successful lesions. Another advance is active cooling of the catheter tip. This allows higher energy delivery at a cooler tip temperature without an increased risk of coagulum formation. The higher energy results in a better lesion.

Catheters are also being designed with safety features to prevent needlestick injuries along with Silver/Hydrogel-Coated Foley catheters to resist bacterial infection.

The fastest growing segment of the catheter industry, the coronary catheter market, is expected to reach four billion dollars by 2003, growing at 11.2% annually. The largest segment, however, is the renal market, which is comprised primarily of urinary catheters and dialysis catheters. Currently a four billion dollar segment, it is expected to reach 7.1 billion dollars in 2003.

Where to Learn More

Books

Topol, Eric J., ed. Textbook of Interventional Cardiology. Philadelphia: W. B. Saunders Co., 1993.

Periodicals

Mueller, R., and T. Sanborn. "The History of Interventional Cardiology." American Heart Journal 129 (1995):146-172.

Other

United States Patent Web Page. December 2001. <http://www.uspto.gov.com>.

[Article by: Bonny P. McClain]

A long, slender flexible hollow tube that can be inserted into a body cavity or blood vessel to extract fluid, administer drugs, or monitor blood pressure.

A thin tube inserted into one of the channels or blood vessels in the body to remove fluids, create an opening into an internal cavity, or administer injections.

A tubular, flexible instrument, passed through body channels for withdrawal of fluids from (or introduction of fluids into) a body cavity.

Balloon-tipped angiographic (Berman) catheter By permission from Darke P, Kelly DF, Bonagura JD, Color Atlas of Veterinary Cardiology, Mosby, 1995

• angiographic c. — one through which a contrast medium is injected for visualization of the vascular system of an organ. Such catheters may have preformed ends to facilitate selective locating (as in a renal or coronary vessel) from a remote entry site. They may be named according to the site of entry and destination, such as femoral–renal and brachial–coronary.
• arterial c. — one inserted into an artery and utilized as part of a catheter–transducer–monitor system to continuously observe the blood pressure of critically ill patients. An arterial catheter also may be inserted for x-ray studies of the arterial system and for delivery of chemotherapeutic agents directly into the arterial supply of malignant tumors.
• butterfly c. — a metal needle with flexible plastic ‘wings’ and a short length of tubing. The ‘wings’ assist in placement and facilitate fixation with tape.

  Butterfly catheter. By permission from Hall L, Clarke KW, Trim C, Veterinary Anaesthesia, Saunders, 2000

• cardiac c. — a long, fine catheter especially designed for passage, usually through a peripheral blood vessel, into the chambers of the heart under fluoroscopic control. See also cardiac catheterization.
• cardiac biopsy c. — introduced intravenously under the direction of fluoroscopy, can be positioned in the right or left ventricle and an endocardial biopsy obtained.
• central venous c. — a long, fine catheter inserted into a vein for the purpose of administering through a large blood vessel parenteral fluids (as in parenteral nutrition), antibiotics and other therapeutic agents. This type of catheter is also used in the measurement of central venous pressure. See also central venous catheterization.
• column disk c. — an indwelling device for continuous peritoneal dialysis. It is implanted within the peritoneal cavity, resting against the body wall. The attached Silastic tubing is used for infusing and draining the dialysate at intervals.
• double-lumen c. — one having two channels; one for injection and one for removal of fluid.
• c. drainage — a catheter left in place to keep the bladder drained. Preferably should have a one-way valve to avoid aspiration of air and infection.
• elbowed c. — a catheter bent at an angle near the beak.
• indwelling c. — one especially designed so that it is held in place in the urethra for the purpose of draining urine from the bladder.
• over-the-needle c. — a large-bore sharp needle housed with an indwelling stilette, inside a thin-walled plastic tube. An incision is made over the filled vein, the needle-cannula inserted, the stilette withdrawn, then the needle, leaving the plastic cannula in situ.
• self-retaining c. — one constructed to remain in the bladder, effecting constant drainage.
• through-the-needle — the catheter is housed within the needle which is used to enter the blood vessel. After insertion, the needle may be removed by withdrawing, but leaving the catheter in place. A protective housing may be provided to cover the needle.
• tracheal c. — one with small holes at the terminal 1 inch, especially designed for removal of secretions during tracheal suctioning.
• ureteral c. — a long, extremely small gauge catheter designed for insertion directly into a ureter.
• urethral c. — any of various types of catheters designed for insertion via the urethra into the urinary bladder. See also catheterization.

A hollow, flexible tube that can be inserted into a vessel or cavity of the body to withdraw or instill fluids.

• Tools and Equipment - catheter: tube inserted into narrow opening for removal or introduction of fluids, esp. into urethra to drain urine and empty bladder

This article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (December 2007)

Catheter disassembled

In Medicine, a catheter (pronounced /ˈkæθɪtər/) is a tube that can be inserted into a body cavity, duct, or vessel. Catheters thereby allow drainage, administration of fluids or gases, or access by surgical instruments. The process of inserting a catheter is catheterization. In most uses, a catheter is a thin, flexible tube ("soft" catheter), though in some uses, it is a larger, solid ("hard") catheter. A catheter left inside the body, either temporarily or permanently, may be referred to as an indwelling catheter. A permanently inserted catheter may be referred to as a permcath (originally a trademark).

The ancient Syrians created catheters from reeds. "Katheter - καθετήρ" originally referred to an instrument that was inserted such as a plug. The word "katheter" in turn came from "kathiemai - καθίεμαι" meaning "to sit". The ancient Greeks inserted a hollow metal tube through the urethra into the bladder to empty it and the tube came to be known as a "katheter".

Contents 1 Uses 2 Inventors 3 Materials 4 Interventional procedures 5 See also 6 References 7 External links

Uses

Placement of a catheter into a particular part of the body may allow:

• draining urine from the urinary bladder as in urinary catheterization, e.g., the intermittent catheters or Foley catheter or even when the urethra is damaged as in suprapubic catheterisation.
• drainage of urine from the kidney by percutaneous (through the skin) nephrostomy^[1]
• drainage of fluid collections, e.g. an abdominal abscess
• administration of intravenous fluids, medication or parenteral nutrition with a peripheral venous catheter
• angioplasty, angiography, balloon septostomy, balloon sinuplasty, cardiac electrophysiology testing, catheter ablation. Often the Seldinger technique is used.
• direct measurement of blood pressure in an artery or vein
• direct measurement of intracranial pressure
• administration of anaesthetic medication into the epidural space, the subarachnoid space, or around a major nerve bundle such as the brachial plexus
• administration of oxygen, volatile anesthetic agents, and other breathing gases into the lungs using a tracheal tube
• subcutaneous administration of insulin or other medications, with the use of an infusion set and insulin pump
• A central venous catheter is a conduit for giving drugs or fluids into a large-bore catheter positioned either in a vein near the heart or just inside the atrium.
• A Swan-Ganz catheter is a special type of catheter placed into the pulmonary artery for measuring pressures in the heart.
• A Klein-Ma catheter is a catheter designed to have a narrow, tapered ending for insertion of enzymes from the Apis mellifera genus of honey bee in the ear to convert earwax into honey for simplified removal.
• An embryo transfer catheter is designed to insert fertilized embryos from in vitro fertilization into the uterus. They may vary in length from approximately 150 mm to 190 mm.
• An umbilical line is a catheter used in Neonatal Intensive Care Units (NICU) providing quick access to the central circulation of premature infants.
• A Tuohy-Borst adapter is a medical device used for attaching catheters to various other devices.
• A Quinton catheter is a double or triple lumen, external catheter used for hemodialysis.
• An intrauterine catheter, such as a device known as a 'tom cat', may be used to insert specially 'washed' sperm directly into the uterus in artificial insemination. A physician is required to administer this procedure.

Inventors

A flexible catheter was invented in the Americas during the 18th century. Extending his inventiveness to his family's medical problems, Benjamin Franklin invented the flexible catheter in 1752 when his brother John suffered from bladder stones. Dr. Franklin's catheter was made of metal with segments hinged together with a wire enclosed to provide rigidity during insertion.^[2][3]

The modern application of the catheter was in use at least by 1868 when Dr. N.B.Sornborger patented the Syringe and Catheter (patent #73402) with features for fastening it to the body and controlling the depth of insertion.

David S. Sheridan was the inventor of the modern disposable catheter in the 1940s. In his lifetime he started and sold four catheter companies and was dubbed the "Catheter King" by Forbes Magazine in 1988. He is also credited with the invention of the modern "disposable" plastic endotracheal tube now used routinely in surgery. Prior to his invention, red rubber tubes were used, sterilized, and then re-used which often led to the spread of disease and also held a high risk of infection. As a result Mr Sheridan is credited with saving thousands of lives.

In the early 1900s, a Dubliner named Walsh and a famous Scottish urinologist called Norman Gibbon teamed together to create the standard catheter used in hospitals today. Named after the two creators, it was called the Gibbon-Walsh catheter. The Gibbon and the Walsh catheters have been described and their advantages over other catheters shown. The Walsh catheter is particularly useful after prostatectomy for it drains the bladder without infection or clot retention. The Gibbon catheter has largely obviated the necessity of performing emergency prostatectomy. It is also very useful in cases of urethral fistula. A simple procedure such as dilatation of the urethra and passage of a Gibbon catheter often causes the fistula to close. This catheter is also of use in the treatment of urethral stricture and, as a temporary measure, in the treatment of retention of urine caused by carcinoma of the prostate.

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 unreactive to body fluids and a range of medical fluids with which it might come into contact. On the other hand, the polymer is weak mechanically, and a number of serious fractures have occurred in catheters^{[citation needed]}. For example, silicone is used in Foley catheters where fractures have been reported, often requiring surgery to remove the tip left in the bladder.

There are many different types of catheters for bladder problems. A typical modern intermittent catheter is made from polyurethane and comes in different lengths and sizes for men, women and children. The most advanced catheters have a thin hydrophilic surface coating. When immersed in water this coating swells to a smooth, slippery film making the catheter safer and more comfortable to insert. Some catheters are packed in a sterile saline solution.

Interventional procedures

Different catheter tips can be used to guide the catheter into the target vessel. Refer to^[4] for a picture of different catheter tips and their respective names.

See also

• Breast implant
• Cannula
• Foley catheter
• Forensic engineering
• French catheter scale chart
• Gastrostomy
• G-Tube
• Jejunostomy
• Murphy drip
• Peripheral venous catheter
• Seldinger technique
• Stent

References

1. ^ http://www.jvir.org/cgi/content/full/11/8/955#SEC8 Practical approach to nephrostomy
2. ^ "Benjamin Franklin: In Search of a Better World". Minnesota Historical Society. http://benfranklinexhibit.org/resume. 
3. ^ "Benjamin Franklin and Medicine". Annals of Internal Medicine. http://www.annals.org/content/143/11/830.full.pdf. 
4. ^ http://www.merit.com/PDFs/IMPRESS400741001-B.pdf

External links

Wikimedia Commons has media related to: Catheters

• Practical approach to nephrostomy

This entry is from Wikipedia, the leading user-contributed encyclopedia. It may not have been reviewed by professional editors (see full disclaimer)

Dansk (Danish)
n. - kateder

Nederlands (Dutch)
katheter, sonde

Français (French)
n. - cathéter

Deutsch (German)
n. - Katheter, Röhrchen

Ελληνική (Greek)
n. - (ιατρ.) καθετήρας

Italiano (Italian)
catetere

Português (Portuguese)
n. - sonda (f), cateter (m)

Русский (Russian)
катетер

Español (Spanish)
n. - catéter, sonda

Svenska (Swedish)
n. - kateter

中文（简体）(Chinese (Simplified))
导尿管, 导管, 尿液管

中文（繁體）(Chinese (Traditional))
n. - 導尿管, 導管, 尿液管

한국어 (Korean)
n. - 도뇨관

日本語 (Japanese)
n. - カテーテル

العربيه (Arabic)
‏(الاسم) قسطرة (طب)‏

עברית (Hebrew)
n. - ‮צנתר‬

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