DEFINITION

Urinary catheterization is the

insertion of a catheter through the urethra into the urinary bladder for withdrawal of urine. Straight catheters are used for intermittent withdrawals, while indwelling (Foley) catheters are inserted and retained in the bladder for continuous drainage of urine into a closed system.

 The ability to insert a urinary

catheter is an essential skill in medicine.

Catheters are sized in units called

French, where one French equals 1/3 of 1 mm. Catheters vary from 12 (small) FR to 48 (large) FR (3-16mm) in size.

CATHETER TYPES
A Foley catheter is retained

by means of a balloon at the tip which is inflated with sterile water. The balloons typically come in two different sizes: 5 cc and 30 cc. They are commonly made in silicone rubber or natural rubber.

 A Robinson catheter is a flexible catheter used for short term drainage of

urine. Unlike the Foley catheter, it has no balloon on its tip and therefore cannot stay in place unaided.

 A Coud catheter is

designed with a curved tip that makes it easier to thread the catheter past the prostate or obstructions in the urethral canal. A Coud catheter tip may be provided with a balloon or not.

 An irrigation catheter has a separate lumen to carry irrigation fluid into the bladder. This is

useful following endoscopic surgical procedures or in the case of gross hematuria.

PREPARATION FOR URINARY CATHETER INSERTION

Universal Precaution
The potential for contact with a patient's blood/body

fluids while starting a catheter is present and increases with the inexperience of the operator. Gloves must be worn while starting the Foley, not only to protect the user, but also to prevent infection in the patient. Trauma protocol calls for all team members to wear gloves, face and eye protection and gowns.

Indications
By inserting a Foley catheter, you are gaining access to the

bladder and its contents. Thus enabling you to drain bladder contents, decompress the bladder, obtain a specimen, and introduce a passage into the GU tract. This will allow you to treat urinary retention, and bladder outlet obstruction. and renal perfusion (and thus tissue perfusion also). in the diagnosis of GU bleeding.

Urinary output is also a sensitive indicator of volume status

In the emergency department, catheters can be used to aid

Contraindications
Foley catheters are contraindicated in the presence of

urethral trauma. Urethral injuries may occur in patients with multisystem injuries and pelvic factures, as well as straddle impacts. 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).

If this is suspected, one must perform a genital and rectal

Equipment
Sterile gloves - consider

Universal Precautions Sterile drapes Cleansing solution e.g. Savlon Cotton swabs Forceps Sterile water (usually 10 cc) Foley catheter (usually 16-18 French) Syringe (usually 10 cc) Lubricant (water based jelly or xylocaine jelly) Collection bag and tubing

PROCEDURE

FEMALE INSERTION

MALE INSERTION

 Gather equipment. Explain procedure to the patient Assist patient into supine position

with legs spread and feet together

Open catheterization kit and catheter Prepare sterile field, apply sterile

gloves

Check balloon for patency. Generously coat the distal portion

(2-5 cm) of the catheter with lubricant

Apply sterile drape

 If female, separate labia

using non-dominant hand. If male, hold the penis with the non-dominant hand. Maintain hand position until preparing to inflate balloon.

Using dominant hand to

handle forceps, cleanse peri-urethral mucosa with cleansing solution. Cleanse anterior to posterior, inner to outer, one swipe per swab, discard swab away from sterile field.

 Pick up catheter with gloved

(and still sterile) dominant hand. Hold end of catheter loosely coiled in palm of dominant hand. position perpendicular to patient's body and apply light upward traction (with nondominant hand)

In the male, lift the penis to a

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 catheter to 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

COMPLICATIONS
The main complications are tissue trauma and infection.

After 48 hours of catheterization, most catheters are colonized with bacteria, thus leading to possible bacteruria and its complications. Catheters can also cause renal inflammation, nephro-cysto-lithiasis, and pyelonephritis if left in for prolonged periods. to insert catheter, and causation of tissue trauma during the insertion.

The most common short term complications are inability

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 catheter exits body) and the catheter itself. Disconnecting drainage bag from catheter only with clean hands. Disconnecting drainage bag as seldom as possible. Keeping drainage bag connector as clean as possible and cleansing the drainage bag periodically. Use of a thin catheter where possible to reduce risk of harming the urethra during insertion. Drinking sufficient liquid to produce at least two liters of urine daily Sexual activity is very high risk for urinary infections, especially for catheterized women.