Male feline urethral de-obstruction/urinary catheter placement is apart of the required skills to master as a VTS-ECC; additionally a well-rounded knowledge & understanding of the WHY and WHAT is happening to these patients during this medical emergency.
So far, this is what I’ve learned...
🐈 STRESS is the #1 cause for urethral obstruction in male cats
🐈 Future reconstruction occurs in nearly 50% of initial offenders
🐈 With repeated urethral obstructions, a surgery called a “PU” or Perineal Urethrostomy may be necessary ,in order to decrease the risk for future obstructions.
🐈 Urethral obstructions are a medical emergency and can easily cause death in untreated/severe cases.
🐈 Owners typically report unusual vocalizing in the litter box and/or persistent “yowling”, straining to urinate, decreased appetite/anorexia, profound lethargy, unusual gait/limping in hindend, “perceived” constipation, bloody urine, little to no urine in the litterbox, inappropriate urination, aggressiveness, unusual hiding/hissing and sometimes just overall ADR (“aint doin right”)
🐈 De-obstruction is VITAL & HIGHLY EMERGENT in these moderate to severe cases.
🐈 De-obstruction with placement of indwelling urinary catheter, IVF therapy, analgesia management and monitoring of urine inputs & outputs for 1-3 days is the best-case-scenario/typical course of treatment. Other interventions /nursing care may be needed depending on the severity of the case.
🐈 As the Veterinary Technician/Nurse, during triage, gently palpating the bladder is the first step to easily help confirm obstruction for the doctor, as these are not cases you want to waste any time with.
Hours of waiting can possibly be the death of some of these moderate to severe cases. So…#calltoaction #vettechsofinstagram #vetnursesofinstagram get comfy feeling bladders, cause when they’re blocked, it will literally feel like a rock or a tight water ballon about to pop. You can't miss it and be GENTLE.
***Also!! If you’re not using a stethoscope on all your patients, ya gotta start my friend! Utilization of a stethoscope is a valuable & essential skill for a veterinary technician/nurse to be apart of their physical exam.
🐈In severe cases, you may see the patient come in:
-yowling/vocalizing
-lateral/uncoordinated/ataxic
-pale mm, prolonged CRT
-hyperpnea
-hypothermic
-non-responsive (obtunded/stuporous)
The patient may also present with a mild to profound bradycardia (110bpm-140bpm= mild to moderate, 100bpm-60bpm or less= profound) due to the potassium build up that’s now within the blood stream (appreciated most when the potassium levels are greater than about 5.0 mEq/L)
🐈On EKG, you may see TALL tented T waves, lack of P waves, widening of QRS complexes, and prolonged QT intervals.
*Real patient example:
🐈 On bloodwork, you may appreciate hyperkalemia followed by hyponatremia (remember the Na:K channels???) And also possibly azotemia= (elevated BUN, Creatinine, Blood Phosphorus)
In severe cases, the “sine” wave my be present which can indicate that cardiac arrest is imminent!! Immediate intervention is necessary!
(see video below*)
💎 ”DROP A GEM” (#whatwouldwaltersay #walterbrownvtsecc @skinnigolive):
In severe cases that present with significant bradycardia and/or with the sine wave, a QUICK, FIRSTLINE life-saving measure (with permission first from the doctor) is to give 1 -2 puffs of Albuterol (bronchodilator/ beta-2-agonist), which will TEMPORARILY drive the potassium back into the cells, long enough for medical intervention.
*Terbutaline can serve the same purpose; however, Albuterol consistently emerges as the preferred option due to its rapid inhalation delivery method, particularly in situations where establishing IV access may pose an initial challenge.
An additional life-saving intervention/treatment is to administer a calcium gluconate bolus (again with DVM approval first) slowly over 5-15 mins to protect the heart from the active cardiotoxic effects of the hyperkalemia.
Following the above mentioned: giving a slow 50% dextrose bolus IV will stimulate endogenous insulin production & continue to help force potassium back into the cells (thus reducing the hyperkalemia)
And in worst case scenarios... (proceeding the 50% dextrose bolus) you can administer a dose of REGULAR insulin IV, however you must immediately follow it with a 50% dextrose CRI (at a range of 2.5%-7.5% dextrose-dvm and blood glucose reading dependent) in order to prevent hypoglycemia, followed by hypotension.
🙈 Don't forget to advocate for pain management!!
"Cats with urethral obstructions need immediate pain relief, possibly even before IV catheterization, Dr. Rudloff says."-DVM 360 article by Dr. Laurie Anne Walden.
For stabilization & urethral catheterization: a combination of a narcotic/tranquilizer and benzodiazapine (such as methadone + midazolam, buprenorphine + midazolam, ketamine + midazolam, or propofol + midazolam).
-Midazolam and Alfaxalone could be safest in cats with cardiovascular instability
-Acepromazine can be added as an anxiolytic (anxiety reducer) and to relieve urethral spasms
-Epidural or coccygeal anesthetic block prior to unblocking (case dependent)
-Lidocaine gel applied to the penis/prepuce and/or as lubricant for the urinary catheter placement (must then be sterile)
-You can also inject a small dose of 20% lidocaine during the initial unblocking (sterilely)
For maintenance: Methadone or Buprenorphine, +/- Gabapentin (with or without) the narcotic, plus continual intravenous administration of acepromazine for urethral spasms (this is very case and doctor preference dependent).
A #MILAcentralsamplingline #triplelumen can be essential for these cases proceeding initial stabilization and unblocking when administering high concentrations (5% or greater) of 50% dextrose and/or with vasopressor intervention.
After initial stabilization & the patient is hospitalized, as the Veterinary Technician/Nurse, there are a handful of patient parameters you should pay close attention to, along with performing serial or continuous diagnostics ordered by your doctor:
-patient mentation (BAR vs. QAR vs. depressed/dull vs. obtunded vs. stuporous vs. comotose)
-body temperature (no less than 100.0 F)
-body weight (a gain in weight can be a sign pointing towards fluid overload)
-continuous pain assessments (my favorite pain assessment scales: The Colorado State University Pain Scale , Glasgow Feline Composite Measure Pain Scale, The Feline Grimace Scale)
-auscult the patients heart & lungs continuously (listening for any arrhythmias, bradycardia, gallop rhythm, lung crackles, wheezes or generalized increased lung sounds)
-respiratory watch for "fluid overload" signs (avoiding a respiratory rate no > 32rpm, or trending upward)
-monitor fluid rate (rates can be from 2.5x-5x maintenance!!)
-urine output vs. urine input (these values should reach a point where they match, also normal urine output for cats is 20 to 40 milliliters of urine per pound of body weight per day or 1-2 ml/kg/hour)
-watch for "POD" Post-Obstructive-Diuresis (a sudden and significant increase in urine production, along with possible polydypsia)
-continual monitoring of the patients PIVC and/or Central Line (maintaining venous access is vital to ensuring you patient is getting all essential therapies and fluids)
-serial or continuous EKG (watching for bradycardic/tachycardic arrythmias)
-serial blood pressures (when indicated)
-serial bloodwork (typically BG, Lactate, PCV/TS, renal values, & electrolytes)
🫶🏻 I hope you enjoyed reading this and learned something new! If you have any questions or feedback for me, don't hesitate to reach out.
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