Bookmark:           

Urinary Catheterisation

Contents

1. Indications
2. Contraindications
3. Complications
4. Equipment
5. Male Catheterisation
6. Female Catheterisation

    

    

    

1. Indications

• Monitoring of urine output
• Infravesical obstruction (benign prostatic hypertrophy/prostatic carcinoma, clot retention, stricture, inflammation)
• Following lower urinary tract surgery
• Neuropathic bladder drainage
• Investigations (urodynamics, cystogram)
• Urine collection

2. Contraindications

• Urethral trauma
  • Scrotal haematoma
  • Blood at the meatus
  • High riding prostate

3. Complications

• Tissue trauma
• Infection - most catheters are colonized with bacteria 48 hours after insertion leading to bacteruria and its complications
• Renal Inflammation
• Nephro-cysto-lithiasis
• Pyelonephritis

4. Equipment

• Sterile gloves

• Sterile catheter pack
  • Swabs
  • Sterile drapes

• Cleansing solution eg Savlon

• Instillagel (anaesthetic jelly)

• Foley Catheter
  • Make sure you have the correct gender catheter before commencing!
• Syringe and sterile water

• Collection bag and tubing

Figure 1 Catheter trolley fully set up

5. Male Catherisation

1. Confirm indication for catherisation from history and examination
2. Gather equipment
3. Explain procedure to the patient and obtain consent
4. Place patient in supine position and expose genitalia
5. Open catheter pack kit and catheter
6. Apply sterile gloves and create sterile field with drapes
7. Use dominant hand as "clean" hand and non-dominant as "dirty" hand. Your clean hand should NEVER touch anything that is not sterile.
8. Retract foreskin with dirty hand and with clean hand cleanse peri-urethral mucosa with cleansing solution, discarding swab away from sterile field.
9. Lift penis perpendicular with dirty non-dominant hand and inject Instillagel slowly into the urethral meatus and allow time for anaesthesia to take effect.
10. Pick up catheter with clean dominant hand and, whilst applying light upward traction on the penis with your dirty hand, insert the catheter into the meatus until 2 inches after urine starts to drain.
11. Inflate balloon of catheter with 10mls of sterile water
    Replace foreskin (very important) to prevent paraphimosis
12. Gently pull catheter balloon snug against catheter neck
13. Place drainage bag below level of catheter
14. Document insertion of catheter, size of catheter, assessment of urine (colour, amount drained), dipstick.
15. Send urine for microscopy, culture and sensitivity

6. Female Catherisation

1. Follow steps 1 to 7 of male catherisation except for females positioning differs - Place legs spread and feet together
2. Separate labia with non-dominant "dirty" hand and cleanse peri-urethral mucosa with cleansing solution.
3. Keep labia separated with non-dominant hand, identify the Urethra and inject Instillagel
4. Insertion of catheter then follows the same steps as for male cathterisation