URINARY BLADDER CATHETERISATION

Cristi Francis CRRI

Catheterization of the urinary bladder is the insertion of a hollow tube through the urethra into the bladder for removing urine.

INDICATIONS Relieve Urinary Retention. Obtain a Sterile Urine Specimen from a

Female Patient. Measure Residual Urine. Empty the Bladder Before, During, or

After Surgery. Allows accurate measurement of urine

output.

CONTRAINDICATIONS Traumatic injury to the lower urinary

tract is a contraindication for urethral catheterization in women.

HOWEVER ,Suspected bladder injury is not a contraindication to placement of a urethral catheter

SIZESNumber 8Fr. and 10 Fr. are used for children. Number 14 Fr. and 16 Fr. are used for female adults. Number 20 Fr. and 22 Fr. are usually used for male adults.

TYPESIntermittent Catheter. An

intermittent catheter is used to drain the bladder for short periods (5-10 minutes). It may be inserted by the patient.

Retention/Indwelling Catheter. This type of catheter is placed into the bladder and secured there for a period of time.

Eg: Foley’s Catheter.

Supra Pubic Catheter. This type of catheter is inserted into the bladder through a small incision above the pubic area. It is used for continuous drainage.

PROCEDURE Gather all equipment Explain the Procedure to the Patient. Provide for Privacy and Adequate

Lighting. Positioning Male - Supine Position Female - Dorsal recumbent Position

INSERTION OF FOLEY’S CATHETER Cleanse the genital and

perineal areas with warm soap and water. Rinse and dry.

Wash hands and put on sterile glove.

Catheterization is an aseptic procedure for which sterile equipment is required. Open the sterile drape and place on the patient's thighs

Apply sterile lubricant liberally to the catheter tip. Lubricate at least six inches of the catheter. Leave the lubricated catheter on the sterile field.

MaleRetract the foreskin using the thumb and fore finger of non dominant hand (the gloved hand that has touched the patient is now unsterile and should not be used to hold the catheter)

Using the forceps hold and cotton covered on antiseptic solutionswab the center of the meatus in a circular manner,continue outwardprogressively larger circle. Clean the entire glans.

Hold the shaft at a 90-degree angle. Advance the catheter into the urinary meatus till you encounter resistance at the prostatic sphincter.

Pause and allow the sphincter to relax.

Lower the shaft and continue to advance the catheter.

Never force the catheter to advance. Discontinue the procedure if the catheter will not advance or the patient has unusual discomfort.

When the catheter has passed through the prostatic sphincter urine will start to flow.

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 Urobag

Place the drainage bag below the level of the bladder

Remove gloves, dispose of equipment appropriately, wash hands

Document size of catheter inserted, amount of water in balloon

Female Place the thumb and

forefinger of your nondominant hand between the labia minora, spread and separate upward. The gloved hand that has touched the patient is now contaminated.

Using the forceps, pick up a cotton ball saturated with antiseptic solution

Swab from above the meatus downward toward the rectum.

Clean each side of the meatus.

Insert the lubricated catheter into the female patient's urinary meatus

Angle the catheter upward as it is advanced.

Do not force the catheter.  

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 Remove gloves, dispose of equipment appropriately, wash hands

Document size of catheter inserted, amount of water in balloonConnect catheter to the Urobag.

Secure the catheter to the inner aspect of the female patient's thigh

Place drainage bag below level of bladder

COMPLICATIONS INFECTIONS including urethritis, cystitis,

pyelonephritis, and transient bacteremia Paraphimosis, caused by failure to

reduce the foreskin after catheterization Urethral strictures Urethral perforation Bleeding

Noninfectious complications of short- and long-term catheterization include accidental removal, catheter blockage, gross hematuria, and urine leakage, and these are at least as common as clinically significant urinary tract infections in this patient population.

A larger than standard catheter should be used when the indication for placement is continuous bladder irrigation for hematuria and clots. A 3-way catheter (with an additional port) is often used in conjunction with a large-volume reservoir to create a “Murphy drip” for continuous irrigation.

Prophylactic antibiotics are recommended for patients with a prosthetic heart valve or an artificial urethral sphincter.

The timing of long-term indwelling urinary catheter changes should be individualized. Indications for changing the catheter include obstruction (eg, by encrustation or mucus), symptomatic infection, or leakage around the catheter.

Thank You for your patient listening