Urethral Catheterization

The whole practice of catheter insertion

1. Firdaoessaleh+
+
Urology+Division++
Department+of+Surgery+
Faculty+of+Medicine+
Universitas+Indonesia+

2. Definition: A urethral catheter is a
hollow tube inserted into the
urinary bladder via the urethral
meatus for various purposes.
Who may catheterise? any
doctors or nurses, even trained
patients who are competent
Competence? usually measured
by attendance at an
educational workshop followed
by observation and supervision
in practice.
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3. DRAINAGE
• Acute or chronic retention
• Prostatic hyperplasia
• Hypotonic bladder
• Pre & post pelvic surgery
• To empty the bladder during labour
INVESTIGATIONS
• To obtain an uncontaminated urine
• Measurement of urine output
• In Urodynamic investigations
• Contrast X ray investigations
THERAPEUTIC
• Bladder irrigation / clot removal
• Intravesical Chemotherapy
• Last resort of intractable incontinence
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4. ABSOLUTE
Contraindication: Pelvic
Fracture Urethral Injuries
or Straddle injuries
Clinical Signs:
! Blood at meatus
! Gross hematuria
! Perineal hematoma
! High riding prostate
! " Immediate referral
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5. Urethral catheterization is an invasive procedure
Risks include:
! Urethral trauma and bleeding from inappropriate
catheter size or use of force.
! Urethral strictures as a result of trauma.
! Urinary tract infections related to poor sterile
technique or long-term catheterization.
! Bladder spasms and pain.
Always obtain consent from the patient! Explain
the procedure, including complications.
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7. It is important to choose the correct
catheter for the individual patient.
Considerations include:
! Material type
! The make
! Fr size, length
! Balloon infill volume
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8. ! The Foley (baloon) catheter is
an indwelling catheter.
! Straight catheters without the
balloon are used for clean
intermittent catheterization.
! Triple lumen (three-way)
catheters can be used to
instill medications, or
continuous bladder irrigation
! The coudé (curved) catheter
" semirigid curved tip, for
prostate enlargement.
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9. Material determines the duration a catheter remains in situ:
! Short Term (7 days)
Plastic/PVC, Uncoated latex
! Medium Term (28 days)
Bonded latex (Teflon)
! Long Term (up to 12 weeks).
• Silicone elastomer coated
(Suitable for latex allergy)
• Silver / hydrogel coated
(Decrease bacterial infection)
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10. Circumference size of the catheter is usually in
French units (1 Fr = 0.33 mm). Size selection guideline:
20-24 Fr • Hematuria with clots
• Prostate enlargement
16-18 Fr • Normal adult male
14-16 Fr • Normal adult female
12-14 Fr • Urethral Strictures
• Adolescents
10-12 Fr • Prepubertal children
6-8 Fr • Infants
4-6 Fr • Newborns
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11. ! Usually : 10 mL of sterile water
! Special : Prostatic surgery 30 mL
(check the inflation volume!)
! NEVER fill the balloon with:
• Saline / Tap water, as crystals of
salt may form in the inflation
channel preventing deflation of
the balloon at a later stage.
• Air, because the balloon would
float above the urine, preventing
drainage.
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12. Catheterization set:
! Sterile gloves
! Drapes
! Cotton balls / gauze
! Chlorhexidine
! Lubricant gel (xylocaine)
! Sterile Catheter
! 10cc syringe
! Sterile water
! Adhesive tape
! Forceps
! Urinary drainage bag
! Urine specimen container
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14. 1. Positioning & visualization of urethral
meatus.
2. Swab clean the urethral meatus,
Lubricate the catheter tip with sterile
jelly.
3. Hold the catheter in the dominant hand,
introduce the catheter tip into the
meatus, and gently push catheter inside
the urethra.
4. If you insert catheter into the vagina,
start again with a new sterile catheter.
5. Female urethra is short. Once you see
urine flowing, push the catheter 3 to 5
cm further, then inflate the balloon.
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16. 1. Exposure of glans penis and hold the
penile shaft perpendicular with non-
dominant hand
2. Swab clean the urethral meatus and glans,
apply lidocaine jelly inside the urethra
3. Lubricate the catheter tip, gently Insert into
urethra with dominant hand.
4. If resistance is met ask the patient to relax,
or use coude tip catheter in enlarged
prostates.
5. Never inflate the balloon until urine has
been visualized and is draining.
6. If the foreskin is retracted in uncircumcised
patients, return it to prevent paraphimosis.
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1. Thomsen TW, Setnik GS. Videos in clinical medicine. Male urethral
catheterization. N Engl J Med. May 25 2006;354(21):e22.
2. Hadfield-Law L. Male catheterization. Accid Emerg Nurs. Oct
2001;9(4):257-63.
3. Selius BA, Subedi R. Urinary retention in adults: diagnosis and
initial management. Am Fam Physician. Mar 2008;77(5):643-50.
4. Newman DK. The indwelling urinary catheter: principles for best
practice. J Wound Ostomy Continence Nurs. Nov-Dec 2007;34(6):
655-61
5. Gerard LL, Cooper CS, Duethman KS, Gordley BM, Kleiber CM.
Effectiveness of lidocaine lubricant for discomfort during pediatric
urethral catheterization. J Urol. Aug 2003;170(2 Pt 1):564-7

19. ! Firdaoessaleh
THANK YOU
Urology Division, Department of Surgery
Faculty of Medicine, Universitas Indonesia
THANK+YOU+Firdaoessaleh+2013+
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