Malecot Catheter Size, Placement, Care, Removal, Uses

Malecot catheters have traditionally been utilized because of their greater bore size compared to that pigtail or balloon catheters. It is common practice to utilize a Malecot catheter as a drainage catheter during nephrostomy surgery, for abscess drainage, or for inserting a gastrostomy tube; nevertheless, this practice is not without risk. Malecot catheters can sometimes be hard to remove because stones or sludge are stuck in them. This happens when the diameter of the catheter grows and a fibrotic bridge or ingrowth of fibrous tissue forms.

Malecot catheters are used in a number of drainage procedures. Nephrostomy is an example of one of these procedures. A nephrostomy entails making a skin incision and introducing a Malecot catheter into the kidney. This makes it possible for urine to flow straight from the kidney into a bag that is linked to the opposite end of the catheter.

Malecot Size

Malecot drains come in a variety of sizes, each tailored to the specific needs of the procedure for which they are intended. The standard length is 30 cm, and the most popular sizes are 10 French, 12 French, and 14 French. It is also available in sizes ranging from 10 French to 24 French. The drain is typically implanted through a tiny incision and can be used to remove fluid from the body. It is important that the catheter be long enough to reach the location where the fluid needs to be drained, but it should not be overly lengthy because this might cause pain or even trauma to the tissue.

Malecot Placement

• Determine which kidney has to be drained by diagnostic imaging (plain film, IVP, retrograde pyelogram, ultrasound, or CT scan). The most comfortable positions are prone or slightly oblique. The flank should be prepared and draped in a standard manner. Using a fluoroscope, find and numb the area of skin that covers the collection system.
• In order to access the pyelocalyceal system, a small incision must be made in the skin using a scalpel blade. A needle of gauge 18 is then inserted vertically through the skin and into the correct location. When the obturator is taken off, the fluid should flow freely from the needle. This shows that the tip of the needle cannula is in the right place.
• Insert the pliable end of the J guide wire 3 additional inches into the collecting system after passing it through the center of the 18 gauge needle cannula. A fluoroscopic examination should be used to validate the position. It is important to keep the position of the guide wire steady while the needle cannula is being withdrawn over it. Care must be taken to avoid pulling out the guide wire itself.
• To assist the passage of the Malecot catheter, the musculofascial tract must be gradually dilated using the smallest to the largest dilator available. For the Malecot flower wings to stand up straight, insert the stylet within the Malecot catheter and lock it in place with the Luer lock.
• Pass the Malecot flower end of the catheter over the outer side of the guide wire, and then gradually push the Malecot flower end into the collecting system. A fluoroscopic examination should be performed to validate the position. To open the malecot flower, release the Luer lock and carefully pull out the stylet.
• The guide wire is pulled out with one hand while the shaft of the Malecot catheter is kept firmly in place with the other. Remove the 18 gauge needle once fluoroscopic visualization confirms the Malecot is in the proper position. To transfer urine from the Malecot catheter to a leg bag or drainage bag, use the urine bag connector.

Malecot Removal

A Malecot catheter is normally taken out in two steps. First, it is necessary to unplug the catheter from the drainage system. This can be accomplished by either detaching the tubing from the catheter or releasing the clamp from the tubing. The catheter can then be taken out of the body once it has been unplugged from the system.

Malecot catheters are frequently resistant to removal using the normal manual traction method, and open surgery may be required. If the complications associated with removal outweigh those involved with foreign body persistence, clinicians should consider observing the patient conservatively to ensure appropriate infection control.

Malecot Care

Malecot catheters must be properly maintained to avoid infection and ensure that they work as intended. Cleaning and disinfecting the catheter before and after each use should be done. Additionally, an antiseptic solution should be used to clean the catheter insertion site. A new catheter needs to be used if the current one gets clogged. In order to properly dispose of the catheter after usage, it's vital to follow the manufacturer's recommendations.

Malecot Uses

Malecot catheters are used for urine drainage in post-nephrectomy patients as well as preventative catheterization in male patients. The catheter is self-retaining, made of latex, and has a flower-like design at the tip that has four tiny wings to hold it in place and prevent unintentional removal. The insertion is non-traumatic and comfortable due to the smooth tip and surface. Once implanted by a professional, the drain continues in place for as long as drainage is necessary. The catheter's opposite side can be connected to a wide range of medical equipment.