Urinary Catheterization

Short term:

Long term (should be avoided if at all possible):

Trolley and catheter pack.
Plastic apron, 2 pairs of sterile gloves, cleansing agent (sterile saline), cotton swabs, sterile local anaesthetic gel (10 ml 2% lidocaine).
Sterile catheter: French size 14 or 16 (French size = external diameter (mm) x 3). Either standard length (unisex) or shorter (female). PTFE (coated latex) catheters can stay up to 4 weeks, and silicone up to 12 weeks. Standard catheters are '2 way' (drainage port and balloon inflation port), but '3 way' catheters (with one extra port) are needed when irrigation is desired e.g. to flush out clots in patients with haematuria.
10 ml sterile water, 10 ml syringe.
Drainage bag (± urometer) or leg bag.
Yellow waste disposal bag.

1. Preparation:

Wash hands, clean trolley, and collect equipment.
Explain to patient and get consent, checking for latex and lidocaine allergy.
Have patient supine, with hips flexed and abducted.
Don apron, open catheter pack, and open equipment.
Place protective, absorbent sheet under patient buttocks.
Wash hands, don 1st sterile gloves.
Place sterile drapes, with opening over genitalia for men, or below buttocks for women (over absorbent sheet).

2. Clean:

Retract foreskin with 'dirty' hand and cleanse glans or vulva with sterile saline.
Pick up cotton swabs with 'clean' non-dominant hand and pass to 'dirty' dominant hand.
Wipe away from the urethral orifice, then dispose and repeat, cleaning whole area.

3. Anaesthetise:

Hold the penis (or separate the labia) with a sterile swab or clean hand.
Anaesthetise the urethra with 10 ml of local anaesthetic gel by slow, gentle instillation.
Maintain gentle urethral compression to retain gel and wait 5 minutes.

4. Catheterise:

Remove gloves, wash hands, and don 2nd sterile gloves.
Place tray between patient's legs for outflow end of catheter to sit in.
Open the inner cover of the catheter.
Hold the penis at 90° from the pelvis (or open labia to see or palpate urethral orifice) and gently insert the catheter until urine flows. Usually 6-8 cm in women, or 15-25 cm in men.
Resistance may be felt at the urethral sphincter and can be relieved by asking the patient to relax.
If the catheter is accidentally inserted into the vagina, a fresh catheter must be used for the next attempt.
Check for urine drainage by gentle suprapubic pressure and collect sample for analysis.
Insert the catheter a further few centimetres so that the tip and balloon are fully in the bladder.
Inflate the balloon with 10 ml sterile water.
Observe for signs of pain, discomfort or urethral bleeding.
Once the balloon is inflated, gently withdraw the catheter until slight resistance is felt.
Attach a sterile closed drainage system.

5. Close:

Ensure foreskin (if present) is replaced back over the glans and cover patient back up.
Dispose of equipment including gloves, wash hands, and clean trolley.
Document procedure (who, when, why, how), the amount of urine drained, and any abnormal findings e.g. clots.

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