Every clinician has their own approach to treating and managing a cat with obstructive FLUTD signs. Working in an emergency setting, once I have confirmed an obstructed bladder via palpation, I focus on trying to relieve the obstruction as quickly as possible.
The first step is obtaining consent from the client to administer pain relief (an opioid IV or IM), place an IV catheter, collect blood for biochemistry, electrolyte and blood gas analysis, and temporarily relieving the obstruction. At our hospital, we achieve temporary relief of the obstruction generally within 15 minutes of the patients arrival at our hospital.
We do this in 3 steps:
1) Assess the tip of the penis, occasionally a crystal/mucus plug is all that is blocking the penis.
2) If this is not the case, next I pass a pre-lubricated 22g IV catheter tip (without the stylet) into the penis with a 10ml syringe, containing 0.9% NaCl, connected for hydropulsion. In the vast majority of cases, this helps to dislodge the urethral blockage enough to enable some urine to pass (urination suggests active urination by the cat).
3) Once urine is flowing, I pass a 12 or 14cm rigid catheter and then tape it to the tail, and leave this in to allow constant drainage.
If the 22g IV catheter does not relieve the obstruction, then I would use a rigid catheter and progressively advance it up the urethra whilst hydropulsing with the saline the entire time. Once unblocked, then I will tape it to the tail as previously described.
Quick tip: once you have the catheter in the tip of the penis, pull the prepuce straight out to straighten the penis and thus the penile urethra. Otherwise, the bend in the penile urethra may hinder the passage of the catheter.
The benefits I see of placing a temporary urinary catheter include:
• Immediate relief to the patient and reduces their stress levels.
• Provides a sample of urine for urinalysis.
• Allows you time to run through in more detail the diagnostic and treatment plan with clients.
• Buys you time to stabilise the patient for their anaesthetic later to place a closed system indwelling urinary catheter, like a slippery Sam, and then bladder lavage.
Quite often, your patient would present unwell enough that you should have no issues (resistance to) passing this temporary urinary catheter, provided you have provided pain relief on presentation. In patients that are fractious, I usually forgo the temporary catheter and focus on stabilising the patient. The aim is to have them stable as soon as possible for sedation or a general anaesthesia to place a longer indwelling urinary catheter.