Cystocentesis; the hows, whys, ins and outs

RE: Cystocentesis; the hows, whys, ins and outs

James Laidlaw — Fri, 02 Sep 2016 03:32:37 GMT

[quote user="Anthony Todd"]

[quote user="Emily Rainbow"]

I use intubeeze on the penis/spray the end of the catheter. No idea if it helps as usually under GA but makes me feel better!

[/quote]

The end of the Intubeez wouldn't be Luer by any chance, or can you jam it on a Slippery Sam etc??

No. tried it too big and I think catheters are all Luer, come to remember.

[if you've got a really, really sore throat Intubeez sprayed down helps a lot!]

[/quote]

I know a nurse that did this and then had breathing difficulties so please don't!!!

RE: Cystocentesis; the hows, whys, ins and outs

Anthony Todd — Thu, 01 Sep 2016 23:56:05 GMT

[quote user="Emily Rainbow"]

I use intubeeze on the penis/spray the end of the catheter. No idea if it helps as usually under GA but makes me feel better!

[/quote]

The end of the Intubeez wouldn't be Luer by any chance, or can you jam it on a Slippery Sam etc??

No. tried it too big and I think catheters are all Luer, come to remember.

[if you've got a really, really sore throat Intubeez sprayed down helps a lot!]

RE: Cystocentesis; the hows, whys, ins and outs

Emily Rainbow — Thu, 01 Sep 2016 20:35:38 GMT

I use intubeeze on the penis/spray the end of the catheter. No idea if it helps as usually under GA but makes me feel better!

RE: Cystocentesis; the hows, whys, ins and outs

Anthony Todd — Thu, 01 Sep 2016 20:07:14 GMT

[quote user="bob lehner"]Odd thing to do - sticking lidocaine up your urethra - still, whatever makes you happy....[/quote]

You wait until you have a stent put in your ureter via your urethra,mate....

RE: Cystocentesis; the hows, whys, ins and outs

David Mills — Thu, 01 Sep 2016 19:29:33 GMT

[quote user="bob lehner"]

l[quote user="Anthony Todd"]lidocaine never caused irritation to the urethra for me.[/quote]

Odd thing to do - sticking lidocaine up your urethra - still, whatever makes you happy....

[/quote]

Apparently female adult film stars have a lot of use for intubeaze spray...

RE: Cystocentesis; the hows, whys, ins and outs

bob lehner — Thu, 01 Sep 2016 18:47:45 GMT

l[quote user="Anthony Todd"]lidocaine never caused irritation to the urethra for me.[/quote]

Odd thing to do - sticking lidocaine up your urethra - still, whatever makes you happy....

RE: Cystocentesis; the hows, whys, ins and outs

Anthony Todd — Thu, 01 Sep 2016 16:43:44 GMT

[quote user="Evelyn Barbour-Hill"]I can't say I've been so enormously impressed as Anthony[/quote]

I was impressed by the idea of a spinal; lidocaine never caused irritation to the urethra for me.

RE: Cystocentesis; the hows, whys, ins and outs

Evelyn Barbour-Hill — Thu, 01 Sep 2016 12:31:01 GMT

[quote user="Hannah Wynne Richards"]

0.3 ml lidocaine without adrenaline + 0.05 ml morphine or xylasine

Wynne

[/quote]

Thanks, Wynne and Mariette.

[quote user="Thomas Johnson"]I've used Minims Proxymetacaine, I assume as it's not irritant to the conjunctiva it should be okay in the urethra.[/quote]

Ditto.

I can't say I've been so enormously impressed as Anthony or Gillian, but it does help.

RE: Cystocentesis; the hows, whys, ins and outs

Thomas Johnson — Thu, 01 Sep 2016 08:35:33 GMT

[quote user="Gillian Mostyn"]

I can understand the theory, and have worried about the irritation caused by the injectable being a problem. However, why would it cause such a lot of damage to the urethral lining so as to be dangerous, and yet it is injected into tissues all over the place, including various mucosae, without worrying about resulting tissue damage?

[/quote]

I've used Minims Proxymetacaine, I assume as it's not irritant to the conjunctiva it should be okay in the urethra.

RE: Cystocentesis; the hows, whys, ins and outs

Hannah Wynne Richards — Thu, 01 Sep 2016 08:16:04 GMT

0.3 ml lidocaine without adrenaline + 0.05 ml morphine or xylasine

Wynne

RE: Cystocentesis; the hows, whys, ins and outs

Evelyn Barbour-Hill — Thu, 01 Sep 2016 01:11:37 GMT

[quote user="mariette asselbergs"]You know you are in when you suddenly go in, and can inject without any resistance.[/quote]

What volume do you use?

RE: Cystocentesis; the hows, whys, ins and outs

Anthony Todd — Wed, 31 Aug 2016 22:21:57 GMT

[quote user="mariette asselbergs"]Cat in sternal position at the end of the table so its tail is hanging down.[/quote] etc

Thanks Mariette, wish you'd told me in 1970......

RE: Cystocentesis; the hows, whys, ins and outs

mariette asselbergs — Wed, 31 Aug 2016 20:11:50 GMT

You can get ampuls of 2, 5 and 20 ml of lidocaine 1 or 2% without adrenaline.

Cat in sternal position at the end of the table so its tail is hanging down.

Smallest needle 25G (orange) 1/2 inch is enough in most cats, if very fat or large then maybe use 3/4 inch length.

You do as in sheep: except I first inject a tiny amount subcut so they don't move. Then move the tail up and down and find where there is a little dip between C1 and the sacrum. Hold your indicator finger there and inject the needle until you get to the bone, stay right in the midle and carefully find where you can enter between the vertebra and the sacrum,

You know you are in when you suddenly go in, and can inject without any resistance. If there is resistance then you are not in the right place. Within a minute you feel that the lail will be just hanging down limp. That is your proof (plus the fact that you can now investigate the penis without any protest of the cat.

If you only use lidocaine then it will work for maybe an hour at the most. If you add xylazine or morphine then it will last for 4-8 hours.

We managed a cat with a pelvic fracture and problems urinating by giving this every day for 5 days, then draining the bladder with a catheter. He was so relieved for the painrelief! And after 5 days he started urinating by himself, has just been rehomed.(Was a stray)

No risks or complications I can think of other than possibly nerve damage if you are very rough?

And yes, I think your observation about the risk of urethral damage is pertinent.

Mariette[quote user="Anthony Todd"]

Wow; sounds a real advance! Never occurred to me but obvious really, so not surprising many would say!

As a newbie [never likely to do it but..]?

Brand/supplier of lignocaine without adrenaline?

How do you position the cat?

Needle bore and length?

Depth of insertion and when do you stop?

How do you know you're in the right place?

Any problems, sequelae or complications?

How long does it last?

Only downside I can see is the possibility of urethral trauma unless you were very mindful of the real danger of urethral trauma.

[/quote]

RE: Cystocentesis; the hows, whys, ins and outs

Anthony Todd — Tue, 30 Aug 2016 14:27:58 GMT

Wow; sounds a real advance! Never occurred to me but obvious really, so not surprising many would say!

As a newbie [never likely to do it but..]?

Brand/supplier of lignocaine without adrenaline?

How do you position the cat?

Needle bore and length?

Depth of insertion and when do you stop?

How do you know you're in the right place?

Any problems, sequelae or complications?

How long does it last?

Only downside I can see is the possibility of urethral trauma unless you were very mindful of the real danger of urethral trauma.

RE: Cystocentesis; the hows, whys, ins and outs

mariette asselbergs — Tue, 30 Aug 2016 14:14:41 GMT

I have been using epidurals in cats as I used to in sheep, between the first tail vertebra and the sacrum, 0.3 ml lidocaine without adrenaline plus 0.05 xylazine or morphine. It relaxes the cat immediately (if you are in the right place) because they suddenly feel painrelief. And with the added xylazine it also works for a few hours so that is helpful too. Also great for pelvic fractures and rectal prolapses and anal gland abscesses.

Mariette

RE: Cystocentesis; the hows, whys, ins and outs

Anthony Todd — Tue, 30 Aug 2016 12:38:29 GMT

[quote user="Gillian Mostyn"]And they used the gel with me .....so I guess the physical trauma of placing the catheter could be just as irritant?[/quote]

When I had my stone I suggested passing the camera etc, under local and the consultant just laughed and said "er, no".... and for a couple of weeks I could see why.

That's the reason why I always tried to pass the catheter just with local only, and no a GA, as,even under Acp, they sure reacted to pain therefore minimised urethral trauma!

Of course a GA relaxes the urethra more and in one embarrassing episode the cat went to the RVC and was relieved under GA after I'd tried for about an hour.........

My money's still on Walpoles or similar in the case mentioned.

RE: Cystocentesis; the hows, whys, ins and outs

Gillian Mostyn — Tue, 30 Aug 2016 12:02:27 GMT

[quote user="Glen McIntosh"]

I remember several years ago attending a CPD lecture where the speaker showed us a post mortem picture of a horribly inflamed urethra following lignocaine infusion in a blocked cat that subsequently died.

The speaker said that injectable lignocaine is terribly irritant to the mucosal lining of the urethra

[/quote]

Without going into any unwanted details, I've had bladder catheterisation for diagnostic reasons and the pain and urethral spasm for the next 4 to 5 days was b$%^y awful! And they used the gel with me .....so I guess the physical trauma of placing the catheter could be just as irritant?

RE: Cystocentesis; the hows, whys, ins and outs

Anthony Todd — Mon, 29 Aug 2016 10:36:57 GMT

[quote user="Glen McIntosh"]I remember several years ago attending a CPD lecture where the speaker showed us a post mortem picture of a horribly inflamed urethra following lignocaine infusion in a blocked cat that subsequently died.[/quote]

Can't say I have ever had any signs of an urethritis from lignocaine ever but I always ended by instilling Panolog in the urethra.

Never ever had signs of toxicity even though, in some, I could use 20ml of local but probably 19.5 ml comes out anyway.

I wonder if the example Glen quoted had been near Walpole's? A drop on the tip of a cat penis turns it very white straight away.

Jackson had a lovely slide showing the urethral mucosa beautifully "planed" by a sharp-tipped metal catheter.....

I could never understand why whistle-tipped catheters were ever used to unblock, as the side openings could force crystals etc into the urethral wall and not flush them out.

Next time someone gets a nice kidney dish full of struvite decant the urine and replace with some local and see if the crystals dissolve.... then report here!!

RE: Cystocentesis; the hows, whys, ins and outs

Anthony Todd — Mon, 29 Aug 2016 10:25:17 GMT

[quote user="Hannah Wynne Richards"] Since most will run straight out, I don't think toxicity would be an issue[/quote]

I used to squeeze the distal end of the penis with the cannula in situ to try to force the crystals/etc. back into the bladder or not, to flush them out of the penis.

Frankly, do both, 'cos it can take a while but, now I know lignocaine is acidic [?!?!] I'd flush and count to 10 before flushing a bit more 'cos it will partially dissolve the struvite.

Never, ever, trim an "irrigating cannula", the ones for lacrimal ducts, AGs etc.! When cut the end becomes very sharp and very urethra traumatic!!

RE: Cystocentesis; the hows, whys, ins and outs

Glen McIntosh — Mon, 29 Aug 2016 10:14:22 GMT

[quote user="Michael Woodhouse"]Lignocaine is acidic. I wonder if that has anything to do with the effectiveness?[/quote]

The speaker said that injectable lignocaine is terribly irritant to the mucosal lining of the urethra (but probably only briefly painful given its local anaesthetic effects).

The speaker pointed out that, in human medicine, injectable lignocaine is never used for local urethral anaesthesia. Instead they use lignocaine or xylocaine containing gels for local anaesthesia to aid in urethral catheter placement etc.

These gels were advocated by the speaker for use in blocked cats rather than straight up injectable lignocaine.

I think that if you do use injectable lignocaine, you would need to carefully calculate the maximum dose you would use in cats to prevent toxicity. Most of the time it won't matter because the urethra is intact and as Hannah says, most of it will drain out. However, urethral tears can and do happen from time to time, and it is quite possible that you could inject a high, possibly toxic, dose of lignocaine into the cat inadvertently in those circumstances.

RE: Cystocentesis; the hows, whys, ins and outs

Hannah Wynne Richards — Mon, 29 Aug 2016 09:35:42 GMT

Since most will run straight out, I don't think toxicity would be an issue

Wynne

RE: Cystocentesis; the hows, whys, ins and outs

Anthony Todd — Mon, 29 Aug 2016 01:49:41 GMT

[quote user="Michael Woodhouse"]

Lignocaine is acidic. I wonder if that has anything to do with the effectiveness?

[/quote]

Well, it will dissolve struvite so can only be good for that but oxalate, I think not.

I've always used it without adrenaline if possible but I may be wrong. With adrenaline is more acidic [see below]

http://www.ncbi.nlm.nih.gov/pubmed/23730153

Maybe all our flushing was just dissolving crystals rather than moving them....

You'd definitely need 5 mls then!

RE: Cystocentesis; the hows, whys, ins and outs

Michael Woodhouse — Mon, 29 Aug 2016 00:21:15 GMT

Lignocaine is acidic. I wonder if that has anything to do with the effectiveness?

RE: Cystocentesis; the hows, whys, ins and outs

Anthony Todd — Mon, 29 Aug 2016 00:15:40 GMT

[quote user="Nicola M"]

Is the 2-5ml range based on weight of cat?

[/quote]

Er, no it's just a rough amount, and usually it's nearer 2ml, needed to be sure the urethra is anaesthetised. But it's rational to use it to flush out the crystals and plug too.

Thank goodness Walpole's Soln, plugged in the early days isn't recommended; it necrotises the urethra, as the pH is so acid!

RE: Cystocentesis; the hows, whys, ins and outs

Nicola Cole — Sun, 28 Aug 2016 22:34:25 GMT

Is the 2-5ml range based on weight of cat?