Urethral catheterisation
Tanaya Tanaya
Gutte ( Gutte
Intern) ortho 2nd unit
( Intern) ortho 2nd unit
Definition
Catheterisation of the bladder is the process of inserting
sterile ,flexible hollow tube called catheter through urethra into the
urinary bladder to drain urine, either temporarily or permanently for
diagnostic or therapeutic purpose.
Catheter can be :
A) Indwelling : Stays in place for continuous
drainage.Ex ; Foley catheter B)
Intermittent: inserted periodically to drain the urine and then
removed
Types of catheters
Gibbon catheter :ideal for relief of long standing urinary retention
Teiman neoplex catheter :slightely curved extremity which is tapered
Foley catheter
Plastic catheters: Hamilton Stewart catheter
Indications
Acute urinary retention (BPH,urethral stricture)
Accurate monitoring of urinary output (shock ,sepsis, AKI)
Perioperative indications(pelvic surgeries,long surgeries)
Urinary incontinence
Bladder irritation (After TURP)
To relieve bladder distension from obstruction.
Imaging and diagnostic procedures(urodynamic testing)
Sample collection.
Size of catheter
Adult female : standard size 14-16 Fr
Adult male: standard size 16-18 Fr
Pediatric cases : sizes vary from 5 to 14 depending upon the age
Urinary system
A pair of kidneys
A pair of ureters: connect the kidneys to bladder
Bladder: muscular destensible bag
Urethra : (about 18-20 cm long in males while 4 cm in females)
Procedure
Explain and take consent
Gather all the equipment
Position the patient supine with legs extended and slightly apart
Perform hand hygiene don sterile gloves drape the area using sterile
drapes
Males: Retract the foreskin and clean that glans penis .clean the
meatus outward with antiseptic soaked swab in circular motion .
Females:clean from front to back ( urethral opening to introitus)
Catheter insertion
Attach sterile syringe to the balloon port
Apply lignocaine gel into the catheter tip and also gently instill
lubricant into the urethra
Insertion steps
Males: with penis held 90 degrees upright slowly insert catheter .
Advance gently until urine flows (~15 to 20cm) .once urine
flows ,insert another 5-7cm to ensure balloon is well inside the
bladder.
Females:Ask the patient to relax pelvic floor muscles .Advance the
catheter until urine flows(~4-6cm) .Once urine flows, insert 2-3 cm
more .
Balloon inflation
After confirming urine return inflate balloon with 10ml sterile
water .Gently pull the catheter back until resistance is felt.
Balloon rests at bladder neck.
Post insertion care
Connect catheter to urine drainage bag .
Secure the catheter to thigh or abdomen using fixation tape. Three
15 cm lengths of 1.25 cm adhesive tapes will suffice
Ensure no kinks or traction on tubing .
Position urine bag below bladder level.
Collecting apparatus: urobag
They preferably should be made of transparent material so that
quality and quantity of the drainage can be observed
Incorporation of printed scale to measure the quantity.
Provision should be made for carrying handle which can either be
used by patient or attached to the side of the bed
An adequate length of collecting tubing of sufficient calibre should
be attached .
How long a Foley catheter stay in .
Short term : 2- 14 days
Medium term ( chronic cases): up to 28 days
Long term : every 4-6 weeks
Changing catheter
Blocked or kinked catheter
Cloudy, foul smelling urine (UTI)
Balloon leakage
Encrustation or obstruction
Removal of catheter
Wash hands , wear gloves
Explain the procedure to patient
Place kidney tray under catheter area
Drain urine from urobag completely
Deflate the balloon: by attaching empty syringe to balloon port and
aspirate completely
Gently pull the catheter out
Monitor first void within 6-8 hrs
Complications
UTI
Bladder spasm caused by irritation from catheter
Hematuria due to trauma to urethral mucosa
Catheter Blockage (kinks ,debris,encrustation)
Allergic reaction
Most commonly in males : false passage creation , prostatic bleeding,
paraphimosis
Most common in females: increased UTI risk,vaginal
misplacement ,urethral trauma
Thank you.
