DO NOT USE FOR CLINICAL PRACTICE
Please use current guidelines available on the UHNM intranet for patient treatment
Please use current guidelines available on the UHNM intranet for patient treatment
INDICATIONS
Temporary catheterisation
- To relieve acute retention of urine
- To improve pelvic access during surgery
- To measure urine output during and after major surgery and during major illnesses
- Following major trauma
- if there is blood at the tip of the penis or significant pelvic fracture, seek urology opinion before catheterisation
Long-term catheterisation
- Male patients with urinary retention and prostatic hypertrophy who are unfit for prostatectomy
- Patients with neurological problems if intermittent self-catheterisation not feasible
- e.g. multiple sclerosis, myelodysplasia or spinal cord injury
- In elderly or severely incapacitated incontinent patients as a last resort
CONTRAINDICATIONS
- Previous radical prostatectomy. A urologist must catheterise
- urethral damage can easily occur
- Suspected urethral injury after pelvic trauma. Refer to urologist
- Blood at the tip of the penis. Seek urology advice
- Urinary tract infection. Avoid catheter if possible
EQUIPMENT
- Sterile gloves
- Sheet of water-repellent paper with hole cut in centre
- Dressing pack with cotton balls, gauze swabs, gallipots
- Skin antiseptic
- Tube of lidocaine HCL 20 mg/mL/chlorhexidine gluconate 500 micrograms/mL gel
- Appropriate urethral catheter. See Choice of catheter
- 10 mL syringe filled with sterile water
- Kidney dish
- Measuring jug
- Drainage bag
Choice of catheter
- Use catheter appropriate to task for which it is required
- Some female catheters are shorter than standard catheters
- do not use in men as balloon will damage urethra
Length of use
- Short-term (no more than 14 days), use ordinary latex catheter
- Longer term (more than 14 days), use silicone (Silastic) catheter with inflatable balloon
Diameter
- 12F or 14F usually suitable for women
- 14F or 16F usually suitable for men
Infection control
- Use silver-coated catheters for short period of catheterisation only
- not effective after approximately 5-7 days
- Consider for:
- critical care patients
- renal patients
- patients colonised with multi-resistant organism
- recommended by infection prevention and control team
PROCEDURE
- If not competent in procedure, organise supervision by a clinician experienced in the procedure
Consent
- Explain procedure and reassure patient
- Obtain and record consent
Male catheterisation
Preparation
- Lay patient supine
- Open sterile pack
- Don sterile gloves
- Assistant opens catheter, syringe, and antiseptic/sodium chloride 0.9% onto pack
- Unless using pre-filled syringe, operator draws up water into syringe and keeps sterile
- Place sterile towel to protect area
- Use left hand to hold penis and right hand to insert catheter
- Clean penis with swab soaked in sodium chloride 0.9% or antiseptic
- retract prepuce as necessary and clean glans
- Massage lidocaine 6-11mL/chlorhexidine gel carefully down urethra to sphincter
- Gently compress distal urethra to prevent gel escaping
- Before proceeding to catheterisation, allow at least 5 min to elapse in a conscious patient
Procedure
- If procedure difficult or painful, or bleeding occurs, abandon procedure
- Hold penis vertically at commencement of catheterisation
- As catheter advanced into bladder, gradually pull penis downwards to straighten urethra and to align catheter with prostatic urethra
- urine will begin to drain if present
- After urine starts to drain, advance catheter another 4 cm
- Inflate catheter balloon with 5-10 mL water
- this should not cause any pain or bleeding
- Connect catheter bag
- Gently withdraw catheter until there is resistance
- Replace prepuce (if present) to avoid danger of paraphimosis
Female catheterisation
Preparation
- Lay patient supine
- Place patient’s thighs apart, knees flexed and feet together
- Open sterile pack
- Don sterile gloves
- Assistant opens catheter, syringe, and antiseptic/sodium chloride 0.9% onto pack
- Unless using pre-filled syringe, operator draws up water into syringe and keeps sterile
- Place sterile towel to protect area
- Part labia to reveal urethral meatus
- disinfect meatus with an antiseptic swab
- As female urethra is short, expect to use one third as much anaesthetic gel as would be required in a male patient
- Insert nozzle of lidocaine/chlorhexidine gel into meatus and instil 4-5 mL of gel
- Before proceeding to catheterisation, allow at least 5 min to elapse in a conscious patient
Procedure
- Part labia to reveal meatus and insert catheter until urine clearly draining
- catheter will usually pass without difficulty
- Inflate balloon with 5-10 mL water
- Connect catheter bag
COMPLICATIONS
Urethral
Failure of catheter to reach bladder
- Obtain specialist help
- Do not make further attempts
Bleeding
- Occurs particularly if catheter inflated in urethra
- Remove catheter. Contact urologist
Obstructive renal failure
- Occurs in patients with chronic retention of urine
- Catheterisation followed by a spectacular post-obstructive diuresis
- profound metabolic consequences
- Be prepared to start an IV infusion
- patients may not be able to drink enough to replace their fluid losses
- Contact urology team
- best managed by urology as inpatients
SPECIMENS
- Record volume of urine that drains after catheter inserted
- Unless patient has evidence of sepsis, do not send any urine to microbiology
- not processed without a strong indication
AFTERCARE
- Connect catheter to a closed drainage bag that is emptied as necessary
- If system has to be opened (e.g. to change bag or to wash out clots occluding catheter), full sterile precautions essential
Infection risk
- Remove catheter as soon as possible to minimise risk of infection, especially ESBL
- An indwelling catheter almost always leads to bacteriuria within 2 weeks
- When bacteriuria established, even the most intensive antimicrobial treatment is unlikely to make urine sterile until catheter removed or replaced
- Without clinical evidence of infection, bacteriuria associated with an indwelling catheter does not require antimicrobial treatment
Bacteraemia or septicaemia
- May be caused by overmanipulation
- As soon as suspected, give fluids IV and broad spectrum antimicrobial effective against Gram-negative organisms. See Antimicrobial guidelines
Irritation and leakage
- Bladder irritation can produce severe and painful bladder spasms
- can cause bypassing of urine alongside the catheter
- try reducing amount of fluid in balloon, or use smaller or less rigid catheter
- If there is leakage around catheter, it is futile to replace with a larger one
- commits patient to a spiral of increasing catheter size
- urethra becomes steadily more dilated until it can retain no catheter
Suspected blocked catheter
Blood clots
- Effective bladder washout for blood clots is a specialised technique. Refer to urology
Not blood clots
- Use a 50 mL catheter syringe to pass 20-30 mL water or sodium chloride 0.9%
- if catheter drainage not achieved, refer to urology
REMOVAL OF CATHETER
- Lay patient supine
- Don clean gloves
- Take 10 or 20 ml empty sterile syringe
- Deflate catheter balloon using the empty syringe and gently remove catheter
- Do not cut catheter
Complications
Failure to deflate balloon
- If catheter balloon fails to deflate, do not try to burst it by overdistension
- bladder may burst first
- Try aspirating with syringe applied more firmly to balloon port, ensure there is no kink in the catheter
- If it fails to deflate after few attempts, contact urology team
Severe pain
- Make sure patient is supine, balloon is fully deflated and there is no resistance while removing it
- If pain persists, contact urology team for advice