Urinary Catheterisation

chapter one
skill lab practical four
LECTURE: DR- MUSTAPHA AHMED MOHAMED
DEPARTMENT OF NUTRITION
SEMESTER SEVEN.
 By the completion of this teaching unit, the student will be able to:
1 List the indications for urinary catheterization.
 Indicate the appropriate catheter type/size.
2 Discuss the risks associated with catheterizations.
3 Describe the equipment for female/male/pediatric
 urinary catheterization.
4 Demonstrate a safe method of performing urinary
 catheterizations while maintaining strict aseptic technique
 Introduction

Urinary catheterization or Foley catheterization as it is

commonly referred to is an invasive procedure. It involves
introducing a plastic or rubber tube into the urethra then
advancing the tube into the bladder. Once in the bladder
the catheter provides for a continuous flow of urine.
The ability to insert a urinary catheter is an essential skill in
clinical areas. 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. They also
come in different varieties including ones without a
bladder balloon, and ones with different sized balloons -
you should check how much the balloon is made to hold
when inflating the balloon with water!
Urinary Chathetrasaion
 Universal precautions

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
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.
Intermittent catheterization

⦁ Collection of sterile urine sample.

⦁ Provide relief of discomfort from bladder
distention.
⦁ Decompression of the bladder.
⦁ Measure residual urine.
⦁ Management of patients with spinal cord injury,
neuromuscular degeneration, or incompetent
bladders.
Short-term indwelling catheterization

⦁ Post surgery and in critically ill patients to

monitor urinary output.
⦁ Surgical procedures involving pelvic or abdominal
surgery repair of the bladder, urethra, and
surrounding structures.
⦁ Urinary obstruction (e.g. enlarged prostate),
acute urinary retention
⦁ Prevention of urethral obstruction from blood
clots with continuous or intermittent bladder
irrigations
⦁ Instillation of medication into the bladder.
Long-term indwelling catheterization

⦁ Refractory bladder outlet obstruction and

neurogenic bladder with urinary retention.
⦁ Prolonged and chronic urinary retention.
⦁ To promote healing of perineal ulcers where
urine may cause further skin breakdown.
 Contraindications

Foley catheters are contraindicated in the presence of urethral

trauma. Urethral injuries may occur in patients with multisystem
injuries and pelvic fractures,etc. 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 urethrographic
(injecting 20 cc of contrast into the urethra).
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Equipment

Sterile gloves - consider Universal Precautions

Sterile drapes
Cleansing solution
Cotton swabs
Forceps
Sterile water (usually 10 cc)
Foley catheter (usually 16-18 French)
Syringe (usually 10 cc)
Lubricant
Collection bag and tubing
 Procedure.

 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
 Procedure.

 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.
 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 bacteriuria and its
complications. Catheters can also cause renal inflammation,
nephron-cysto-lithiasis, and pyelonephritis if left in for
prolonged periods.
 The most common short term complications are inability to
insert catheter, and causation of tissue trauma during the
insertion.
 The alternatives to urethral catheterization include
suprapubic catheterization and external condom catheters
for longer durations.
 Types and sizes of catheters

⦁ The size of the patient’s urethral canal

⦁ The expected duration of catheterization (e.g. intermittent or
indwelling)
⦁ Knowledge of any allergies to latex or plastic.
⦁ The indications for catheterizing the patient (i.e. clot retention,
child, bladder instillation).

⦁ Diameters:
⦁ 5Fr, 6fr, 8fr 10fr, 12fr, 14fr, 16fr, 18fr, 20fr, 22fr, 24fr, 26fr.
⦁ The higher the number the larger the diameter of the catheter.
⦁ 1Fr. = 3mm (i.e. a 24fr. catheter is 8mm in diameter)
 Paediatric chathetrazion .

⦁ Size- 5, 6, 8, 10Fr. or smaller depending on the size of the

urethra and age of child. Rarely are catheters left indwelling,
typically they are intermittent and are used to obtain sterile
urine sample to rule-out infection. In children <2years of age
a 5Fr. feeding tube can be used if a small diameter catheter is
not available. Using feeding tubes can cause urethra trauma, a
second pair of hands for assistance is recommended for very
young children.