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61

Urinary Catheterization of Mares

Brett Sponseller and Beatrice Sponseller

61.1 Purpose ● Sterile lubricant

● Pledgets of rolled cotton in a bucket of
● To obtain a urine sample for urinalysis and warm soapy water
detection of bacterial and viral pathogens. ● 4″ × 4″ gauze sponges soaked with 2%
● To drain the bladder when the patient is chlorhexidine scrub
unable to empty its bladder. ● 4″ × 4″ gauze sponges soaked with sterile
● To lavage the bladder, such as in cases of saline
sabulous cystitis. ● Types of catheter to choose from
● To collect timed volumes of urine for renal (Figure 61.1):
function analysis. – Foley catheter: range of sizes (26–30 Fr),
● To inject contrast for contrast imaging. 16″ in length (which are adequate for
● To assess hydration status, particularly in average‐sized mares of light breed).
nursing foals. Foley catheter is cuffed and therefore use-
● To obtain a minimum database for general ful as an indwelling urinary catheter for
health problems such as weight loss and the mare.
fever of unknown origin. – mare metal urinary catheter: diameter
8 mm, length 30 cm. It is more trau-
61.2 Complications matic than flexible catheters.
– a stallion urinary catheter can is flexi-
● Bacterial cystitis ble and long (diameter 6.6 mm, length
● Trauma 137 cm), and can be used for urinary
catheterization of mares.
61.3 Equipment Required – mare flexible plastic urinary catheter
(diameter 8.6 mm, length 40 cm) sim-
● 60 ml catheter‐tip syringe
ilar to the stallion urinary catheter, but
● Sterile urine specimen cup
shorter.
● Sterile gloves

Manual of Clinical Procedures in the Horse, First Edition. Edited by Lais R.R. Costa and Mary Rose Paradis.
© 2018 John Wiley & Sons, Inc. Published 2018 by John Wiley & Sons, Inc.
 61 Urinary Catheterization of Mares 505

Figure 61.1 Types of urinary catheter used in adult mares. A, The mare metal urinary catheter; B, the stallion
urinary catheter; C, the Foley catheter. Courtesy of Dr. Lais R.R. Costa.

61.4 Restraint and Positioning ● For the most part mares do not require
sedation prior to urinary catheterization.
● The degree of restraint will depend on the ● Restraint in stocks is generally recom-
age, training, and disposition of the horse. mended.

61.5 Procedure: Urinary Catheterization of the Mare

Technical action Rationale

The mare’s tail is wrapped. The tail is tied around
the mare’s neck with brown gauze (Figure 61.2a) or
other suitable material (Figure 61.2b).
The tail should never be tied to any objects.
See detailed instruction for wrapping of the tail with
brown gauze in Chapter 60, Figure 60.2a.
The mare’s tail needs to be kept away from the
perineum so that it can be cleaned properly without
interference.

The perineal area is thoroughly cleaned with cotton Use mild soap, for example Ivory liquid soap.
pledgets soaked in water. Detergents are too strong.
Use one hand (“clean hand”) to pick up the cotton A “clean hand/dirty hand” approach will minimize
pledget (Figure 61.3a). recontamination of the clean area and the clean
bucket of water.
Transfer the cotton pledget to the other hand
(Figure 61.3b), which is referred to as the “dirty
hand” (Figure 61.3c) because it will be in contact
with the perineum during cleansing.
Have an assistant pour a small amount of mild soap
onto the pledget of cotton.
Scrub the perineum, starting at the center of the
vulva and working toward the periphery
(Figure 61.3d).
Repeat the procedure until the perineum is
completely clean.
506 Clinical Procedures by Body Systems: Urinary System
Technical action
After cleansing with soap, disinfect the perineal
area with chlorhexidine scrub to provide a sterile
site. A rinse with sterile saline or water follows the
disinfection.
Choose the type of catheter to be used: flexible
catheter, Foley catheter, metal catheter or flexible
urinary catheter (Figure 61.1). Prepare your
material in a sterile field.
Put on sterile gloves.
Apply sterile water‐soluble lubricant to the dorsal
aspect of the introducing hand and to the catheter.
One hand is introduced through the vulva lips,
guarding the catheter under the fingers (Figure 61.4).
The introducing (non‐dominant) hand is advanced
over the brim of the pelvis (Figure 61.5a), gently
palpating the floor of the vagina to find the urethral
opening.
The urethral orifice is usually found within a
hand’s length cranial to the brim of the pelvis
on the ventral floor of the vagina. Using gentle
ventral pressure on the vaginal floor a small
depression may be felt.
Using your other hand, insert the catheter through
the vulva under the non‐dominant hand and
advance it into the urethral opening cautiously
to prevent contamination of the catheter during
advancement.
Advance the catheter under the hand that is in
the urethral sphincter and with gentle pressure
continue to advance the catheter into the bladder
(Figure 61.5b).
Collect a urine sample into an attached syringe
and/or attach a urine collection bag/system.
Urine samples for urinalysis, culture or
examination of sediment should be collected in a
sterile leak‐proof container.
If an indwelling urinary catheter is to remain in
place, the cuff of the Foley catheter should be
inflated with the appropriate amount of water
(Figure 61.5c).
Rationale
The procedure requires sterile technique and a
sterile field. Chlorhexidine scrub can be irritating to
the skin and thus needs to be rinsed.
The flexible catheters (the mare flexible urinary
catheter, the Foley catheter, and the stallion urinary
catheter) are less traumatic than the metal catheters.
If there is a need for an indwelling catheter then a
Foley catheter should be used. A Foley catheter may
need a stylet for ease of introduction.
Sterile surgical gloves are adequate for performance
of the procedure. Sterile OB sleeves may be used.
Lubricant mitigates damage to the urethra.
Care must be taken to maintain sterile technique
and avoid touching the sterile catheter on the tail
and non‐sterile areas of the perineum.
The urethra lies on the floor of the vagina.
Continued gentle digital pressure will cause the
urethral sphincter to relax.
Urine will generally flow into the catheter once
the bladder is attained. Gentle aspiration with an
attached syringe may be required. Maintain the
sterility of the catheter exterior to the urethra as
the catheter is advanced to avoid a urinary tract
infection.
Maintain sample sterility and catheter sterility
should culture of the urine be desired.
A sterile specimen cup or a red‐top evacuated tube
is appropriate for submission.
It is best to inflate the cuff with water rather than air.
The catheter should remain in place (Figure 61.5d)
until the cuff is deflated.
 61 Urinary Catheterization of Mares 507

(a) (b)

Figure 61.2 The mare’s tail should be wrapped, pulled away from the perineal area, and secured by tying
around the neck. (a) Brown gauze can be used to wrap and tie the tail around the neck. (b) A neoprene tail
wrap can also be used to wrap the tail. In this case a small rope should be used to tie the tail to the mare’s neck.
Courtesy of Dr. Lais R.R. Costa.

(a)
(b)

(c) (d)

Figure 61.3 The perineal area should be thoroughly cleaned with cotton pledgets soaked in water. (a) Pick
up the cotton pledget with one hand (the “clean hand”). (b) Transfer it to the other hand (the “dirty hand”). (c)
Have an assistant pour antiseptic scrub onto the cotton pledget. (d) Scrub the perineum, starting at the vulva
and working around in a circle towards the periphery. Courtesy of Dr. Lais R.R. Costa.
508 Clinical Procedures by Body Systems: Urinary System

(a) (c)

Figure 61.4 Urinary
catheterization of the
mare. Wearing sterile
gloves with sterile
water‐soluble lubricant
applied to the dorsal
aspect of the hand and
fingers of the introducing
hand, introduce the non‐
dominant hand through
the vulva lips, while
the other hand holds
the catheter. (a) A Foley
catheter with a pliable
stylet. (b) A metal mare
urinary catheter. (c) A
stallion urinary catheter.
(b) Courtesy of Dr. Lais
R.R. Costa.
 61 Urinary Catheterization of Mares 509

(a) (b)

(c)

(d)

Figure 61.5 Placement of indwelling urinary catheter. (a) While the introducing (non‐dominant) hand is
advanced over the brim of the pelvis, gently palpate the floor of the vagina to find the urethral opening, which
is located about a hand’s length cranial to the brim of the pelvis on the ventral floor of the vagina. Use your
other hand to guide the catheter through the vulva under the non‐dominant hand and advance it into the
urethral opening cautiously to prevent contamination of the catheter during advancement. (b) Verify that the
catheter is in the urethral sphincter. Palpate rostral to the urethral opening to verify that the catheter is placed
through the urethral opening and into the urinary bladder and not into the cervix. (c) Instill the appropriate
amount of water in the bulb of the Foley catheter to prevent the catheter from slipping out of the bladder.
(d) An indwelling urinary catheter retained in the bladder.

Bibliography and Further Reading

Divers, T. (2010) Catheterization of the and J. Stephen), Blackwwell, Oxford,

bladder, in Diagnostic Techniques in
Equine Medicine, 2nd edn, W.B. Saunders,
Philadelphia, pp. 102–104.
Hollis, A. (2008) Urinary catheterization, in
The Equine Hospital Manual (eds K. Corley
pp. 84–85.
Schumacher, J. and Moll, H.D. (2006)
Collecting urine, in Manual of Equine
Diagnostic Procedures, Teton NewMedia,
Jackson, WY, pp. 81–87.