Urethral Catheterization

IndicationsTop

Urinary retention (acute or chronic), post urologic procedure, accurate and timely monitoring of urine output (in severely ill patients, eg, hemodynamically unstable or unable to fully cooperate), urinary bladder hemorrhage with blood clots, urine sample collection for testing (if not possible otherwise), urinary incontinence, high-grade pressure ulcers or similarly severe wounds of other types that cannot be kept clear despite wound care and other urinary management strategies.

ContraindicationsTop

Acute prostatitis, significant urethral stricture, urethral trauma (suspected, eg, blood per meatus in patients with pelvic fractures).

ComplicationsTop

Urethral injury, false passages, infection, failure to catheterize.

Patient PreparationTop

Obtain informed consent.

Patient positioning: Men should be placed in a supine position with lower limbs straight. Women should be placed in a supine position with lower limbs abducted and knees flexed.

EquipmentTop

Urethral catheter, size usually 18 French (F; 1F = 1 Charrière [Ch] = 1/3 mm) in men and 16F in women; lidocaine lubricant gel; disinfectant solution; sterile gauze swabs; sterile gloves; sterile drapes; 10 mL syringe; purified water; urine collection bag.

ProcedureTop

1. Male catheterization: Grasp the penis with one hand, retract the foreskin, and disinfect the skin. Using a conical tip, introduce the xylocaine lubricant gel into the urethra and coat the tip of the catheter with the gel. Verify balloon integrity by filling it with purified water, and then empty the balloon. Hold the penis perpendicular to the trunk and gently pull upwards. Introduce the catheter with smooth movements into the urethra until urine outflow is seen (it is best to advance until the catheter hub is at the meatus), then fill the balloon and reduce the foreskin. Connect the catheter to a collection bag and verify continued urine flow.

2. Female catheterization: Spread the minor labia and swab the urethral orifice using a gauze swab soaked with disinfectant solution. Using a conical tip, introduce the lubricant gel into the urethra and coat the catheter tip with the gel. Verify balloon integrity by filling it with purified water, and then empty the balloon. Introduce the catheter to a depth of 10 to 12 cm or until urine outflow is observed, then fill the balloon with purified water. Connect the catheter to a collection bag and verify continued urine outflow.

Resistance that makes it impossible to introduce a urethral catheter, particularly in men, can be managed by using a larger catheter (20F). If this is unsuccessful, you may attempt catheterization using a Tiemann (or coudé) catheter; this type of urethral catheter is significantly more rigid, has a curved tip, and is not fitted with a balloon. It must be inserted very gently with its curved portion directed upwards. If urethral catheterization is not successful, ask for a urologist’s assistance.

Use the nondominant hand to grasp the penis or spread the labia apart. Consider this hand contaminated and do not reposition the hand or use it to handle a sterile catheter.

After The ProcedureTop

Maintain the urethral catheter in place for the shortest time possible and disconnect the bag only for catheter flushing. Collect small-volume urine samples by disinfecting and puncturing the terminal portion of the catheter using a sterile needle and syringe. Larger-volume samples are collected from the bag after disinfecting the catheter-tube-bag connection site. Do not routinely replace the catheter at predetermined time intervals; replace the catheter if it is blocked (and flushing is unsuccessful) or in patients with symptomatic urinary tract infection who must remain catheterized.