PROCEDURES - 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

Confirm indication for catherisation from history and examination
Gather equipment
Explain procedure to the patient and obtain consent
Place patient in supine position and expose genitalia
Open catheter pack kit and catheter
Apply sterile gloves and create sterile field with drapes
Use dominant hand as "clean" hand and non-dominant as "dirty" hand. Your clean hand should NEVER touch anything that is not sterile.
Retract foreskin with dirty hand and with clean hand cleanse peri-urethral mucosa with cleansing solution, discarding swab away from sterile field.
Lift penis perpendicular with dirty non-dominant hand and inject Instillagel slowly into the urethral meatus and allow time for anaesthesia to take effect.
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.
Inflate balloon of catheter with 10mls of sterile water
Replace foreskin (very important) to prevent paraphimosis
Gently pull catheter balloon snug against catheter neck
Place drainage bag below level of catheter
Document insertion of catheter, size of catheter, assessment of urine (colour, amount drained), dipstick.
Send urine for microscopy, culture and sensitivity
 
6. Female Catherisation

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