In urethral catheterisation, a flexible tube is inserted into the bladder via the urethra. Urine can then drain freely from the bladder for collection. There are various indications for urethral catheterisation, such as the treatment of acute urinary retention, preoperative bladder emptying prior to urological or pelvic surgery, and the monitoring of urine output.
The process of urinary catheterisation can be divided into four steps; explanation and consent, preparation, procedure and aftercare. The procedure itself is different in men and women – due to the differing pelvic anatomy.
Explanation and Consent
- Confirm the patients identification
- Check full name, DOB, and hospital number
- Confirm against patients wristband
- Explain rationale for the procedure
- Describe the procedure
- State the importance of the procedure
- Explain the risks of the procedure to the patient
- Inability to pass the catheter into the bladder
- Trauma to the urethra or bladder neck
- Infection (can be minimised by sterile equipment and aseptic non-touch technique)
- Paraphimosis, from failure to replace the prepuce
- Bladder spasm (due to presence of catheter balloon)
- Ask about relevant past medical history
- Previous urethral trauma, urethral strictures, or lower urinary tract surgery
- Blood clotting disorders or medication that affects blood clotting (e.g. warfarin)
- Recent haematuria, penile discharge, or urinary tract infection
Check that the patient is happy to go ahead with the procedure. Ask the patient if they would like a chaperone present. Preferably, the patient has washed their genitals beforehand or has had assistance to do so
Preparation
Chose the correct catheter size, based upon sex of the patient, length of time of insertion, and any allergies to latex
- Catheter size (diameter measured in Ch) should be the smallest as possible to drain urine
- Patients with urine debris or clots may require a larger diameter catheter
When in the treatment room, prepare your equipment on an appropriate equipment trolley.
- Decontaminate your hands
- Clean your trolley and plastic tray with appropriate aseptic agent (e.g. Chlor-clean), allowing to dry fully. Decontaminate your hands
- Gather the equipment into the plastic tray on the trolley and move to the patients bedside
- Equipment required catheter pack, catheter, drainage bag, instillagel, saline vial, chlorhexidine wipe, sterile forceps, 2x pairs sterile gloves, apron, and inco pad
- Catheter pack should contain J-tray, sterile swabs, cotton wool balls, plastic pot, and sterile drape
Once at the patient’s bedside
- Re-confirm the patients identification
- Expose the patient from the waist down
- Throughout the procedure, ensure the patients dignity is maintained
Prepare your sterile field next to the patient’s bedside
- Open the outer packaging of the catheter pack onto the trolley and decontaminate your hands
- Carefully open the catheter pack, touching only the outside border, and arrange the contents of the catheter pack using the sterile forceps. Place the cotton wool balls in the plastic pot. Discard the forceps once used.
- Clean the top of the saline vial with the chlorhexidine wipe, open the vial, and pour the saline onto the cotton wool balls
- Open the sterile gloves package onto the sterile field
Procedure
- Put the sterile gloves on
- Take the sterile drape and tear a hole in the centre, draping over the penis
- A sling may be made from sterile gauze, placed around the patient penis, to aid mobility of the penis during the procedure
- Using at least 5 cotton wool balls, clean the glans of the penis and penile shaft from tip to base
- Best practice is to use one hand to pick the cotton wool balls and hold the sling whilst using the other to clean the penis
- Hold the penis erect and inject 11ml instillagel into the urethra and gently squeeze the tip to prevent leakage
- Remove your gloves and decontaminate your hands
- Carefully open the catheter and syringe onto your sterile field
- Open another sterile gloves package
- Decontaminate your hands
- Put the sterile gloves on and open up the syringe
- Place the J-tray between the patients legs
- Carefully open the catheter from its sterile packaging, exposing only the catheter tip
- Without touching the catheter directly, insert the catheter along the urethra into the bladder
- If any resistance is felt, ask the patient to cough to ease insertion
- Once the urine begins to flow, advance the catheter a further 5cm
- Inject the contents of the syringe into the catheter to inflate the balloon in the catheter
- Monitor the patient for any signs of discomfort
- Gently withdraw the catheter to ensure the balloon is secure against the bladder neck
- Attach the catheter to the drainage bag
- Attach the drainage bag to the patients leg, patients bed, or catheter stand
- Replace the foreskin
- Discard all waste into the correction disposal bins and ensure the patient is comfortable
- Remove your gloves and decontaminate your hands
Aftercare
Instruct the patient to:
- Regularly wash with warm soapy water at least twice a day, washing in a direction away from the urethra
- Do not pull on the catheter
- Inform the nursing staff if any pain or discomfort
Thank the patient and leave the patient’s bedside. Ensure the correct catheterisation documentation is filled out completely and placed in the patients notes.