CATHETERIZATION following endoscopic surgical procedures or in the

case of gross hematuria.

DEFINITION
- Urinary catheterization is the insertion of a PREPARATION FOR URINARY CATHETER
catheter through the urethra into the urinary bladder INSERTION
for withdrawal of urine. Straight catheters are used Universal Precaution
for intermittent withdrawals, while indwelling (Foley) - The potential for contact with a patient's
catheters are inserted and retained in the bladder blood/body fluids while starting a catheter is present
for continuous drainage of urine into a closed and increases with the inexperience of the operator.
system. - Gloves must be worn while starting the Foley, not
- The ability to insert a urinary catheter is an only to protect the user, but also to prevent infection
essential skill in medicine. in the patient.
- Catheters are sized in units called French, where - Trauma protocol calls for all team members to
one French equals 1/3 of 1 mm. Catheters vary wear gloves, face and eye protection and gowns.
from 12 (small) FR to 48 (large) FR (3-16mm) in
size. Indications
- By inserting a Foley catheter, you are gaining
CATHETER TYPES access to the bladder and its contents. Thus
A Foley catheter is retained by means of a balloon enabling you to drain bladder contents, decompress
at the tip which is inflated with sterile water. The the bladder, obtain a specimen, and introduce a
balloons typically come in two different sizes: 5 cc passage into the GU tract. This will allow you to
and 30 cc. They are commonly made in silicone treat urinary retention, and bladder outlet
rubber or natural rubber. obstruction.
- Urinary output is also a sensitive indicator of
volume status and renal perfusion (and thus tissue
perfusion also).
- In the emergency department, catheters can be
used to aid in the diagnosis of GU bleeding.

Contraindications
- Foley catheters are contraindicated in the
presence of urethral trauma. Urethral injuries may
occur in patients with multisystem injuries and
pelvic fractures, as well as straddle impacts.
- If this is suspected, one must perform a genital
and rectal exam first. If one finds blood at the
meatus of the urethra, a scrotal hematoma, a pelvic
fracture, or a high riding prostate then a high
suspicion of urethral tear is present. One must then
perform retrograde urethrography (injecting 20 cc of
contrast into the urethra).
A Robinson catheter is a flexible catheter used for
short term drainage of urine. Unlike the Foley Equipment
catheter, it has no balloon on its tip and therefore - Sterile gloves - consider Universal Precautions
cannot stay in place unaided. - Sterile drapes
- Cleansing solution e.g. Savlon
A Coudé catheter is designed with a curved tip that - Cotton swabs
makes it easier to thread the catheter past the - Forceps
prostate or obstructions in the urethral canal. A - Sterile water (usually 10 cc)
Coudé catheter tip may be provided with a balloon - Foley catheter (usually 16-18 French)
or not. - Syringe (usually 10 cc)
- Lubricant (water based jelly or xylocaine jelly)
An irrigation catheter has a separate lumen to carry - Collection bag and tubing
irrigation fluid into the bladder. This is useful
PROCEDURE COMPLICATIONS
- Gather equipment. - The main complications are tissue trauma and
- Explain procedure to the patient infection. After 48 hours of catheterization, most
- Assist patient into supine position with legs spread catheters are colonized with bacteria, thus leading
and feet together to possible bacteruria and its complications.
- Open catheterization kit and catheter Catheters can also cause renal inflammation,
- Prepare sterile field, apply sterile gloves nephro-cysto-lithiasis, and pyelonephritis if left in for
- Check balloons for patency. prolonged periods.
- Generously coat the distal portion (2-5 cm) of the - The most common short term complications are
catheter with lubricant inability to insert a catheter, and causation of tissue
- Apply sterile drape trauma during the insertion.
- The alternatives to urethral catheterization include
suprapubic catheterization and external condom
catheters for longer durations.

COMBATING INFECTION
Everyday care of catheter and drainage bag is
important to reduce the risk of infection Such
precautions include:
- Cleansing the urethral area (area where the
If female, separate labia using a non-dominant catheter exits the body) and the catheter itself.
hand. If male, hold the penis with the non-dominant - Disconnecting the drainage bag from the catheter
hand. Maintain hand position until preparing to only with clean hands. Disconnecting drainage bags
inflate the balloon. as seldom as possible.
- Using a dominant hand to handle forceps, cleanse - Keeping the drainage bag connector as clean as
peri-urethral mucosa with a cleansing solution. possible and cleansing the drainage bag
Cleanse anterior to posterior, inner to outer, one periodically.
swipe per swab, discard swab away from sterile - Use of a thin catheter where possible to reduce
field.​ risk of harming the urethra during insertion.
- Pick up the catheter with a gloved (and still sterile) - Drinking sufficient liquid to produce at least two
dominant hand. Hold end of catheter loosely coiled liters of urine daily
in palm of dominant hand. - Sexual activity is very high risk for urinary
infections, especially for catheterized women.
In the male, lift the penis to a position perpendicular
to patient's body and apply light upward traction
(with non-dominant hand) ​
- Identify the urinary meatus and gently insert until 1
to 2 inches beyond where urine is noted ​
- Inflate balloon, using correct amount of sterile
liquid (usually 10 cc but check actual balloon size)​
- Gently pull catheter until inflation balloon is snug
against bladder neck
- Connect the catheter to the drainage system.
Secure catheter to abdomen or thigh, without
tension on tubing
- Place drainage bag below level of bladder
- Evaluate catheter function and amount, color,
odor, and quality of urine
- Remove gloves, dispose of equipment
appropriately, wash hands ​
- Document size of catheter inserted, amount of
water in balloon, patient's response to procedure,
and assessment of urine