Catheterisation

Indications

  • Short term
    • Treatment of acute urinary retention
    • Preoperative prophylactic emptying of the bladder
    • Monitoring urine output in critically ill patients
    • Checking urinary residual volumes
  • Longer-term
    • Chronic urinary retention (obstruction or neuropathic bladder)
    • Management of incontinence
      • Often for functional e.g. in the terminally ill, frail patients

Intro

  • Wash hands, introduce self, check patient name and DOB/CHI, explain the procedure and gain consent
  • Establish patient allergies
  • Ask the patient (if not already done so) to undress; ensure patient dignity (e.g. offer cover with a towel/sheet, always pull curtain round if on the ward etc)
  • NB It is good practice to offer a chaperone for this.  Whilst it is not technically an examination, and in many cases there may not be a chaperone available (e.g. emergency/acute situations), you should offer one where possible.
  • Collect equipment
    • Catheter
      • Make sure to choose the correct sex (male catheters are much longer than female ones)
      • Check expiry date and the gauge (thickness of the catheter)
    • Sterile pack
      • Usually contains a sheet; tray; forceps; cotton wool; measuring tape
    • Sterile water
    • Instillagel (anaesthetic gel)
    • Syringe with 10ml sterile water (or as per instructions)
    • Two pairs of gloves
    • Bag for disposing of equipment
  • Put on the apron and both pairs of gloves (if using sterile technique- use sterile gloves)
  • Make sure the patient is comfortable; it may be a good idea to put an absorbant pad under the patient to prevent contaminating the bed covers

Procedure

  • Set up your equipment
    • Put the sterile water into the tray; place the sheet over the patient to expose the urinary meatus (you may need to rip a hole in the sheet to do this)
  • Cleaning
    • Men
      • Retract the foreskin (if present) and cleanse the glans and urethral meatus with cotton wool soaked in the sterile water, swabbing away from the urethral orifice (use one cotton wool ball per ‘wipe’)
    • Women
      • Part the labia with non-dominant hand, identify the urethral meatus and cleanse the area in a similar fashion, swabbing from the meatus in a downwards direction
  • Instillagel
    • Men
      • Hold the shaft of the penis with a gauze swab and insert ~11mls of local anaesthetic gel into the urethra (do this slowly and warn that it may sting)
      • Squeeze the end of the penis and remain there for a while (recommend 5 mins) to allow the anaesthetic to take effect
    • Women
      • Insert ~6mls of local anaesthetic gel into the urethra (also do this slowly and warn about stinging)
      • Allow the anaesthetic to take effect
  • Catheterisation
    • Change or remove outer gloves; NOTE that from now on it is good practice to have a sterile (dominant) hand and a non-sterile (non-dominant) hand
      • I.e. the sterile hand catheterises and does not touch anything but the catheter (or sterile equipment) whilst the non-sterile hand manipulates the urethra where necessary
    • Position tray close by to catch residual urine
    • Remove the catheter from packaging
    • Men
      • With the penis at 90° to the pelvis, insert the catheter into the meatus until urine flows
        • If resistance is felt, increase the traction on the penis slightly and apply steady, gently pressure
        • If not able to overcome resistance, do not continue with catheterisation
    • Women
      • Inset the catheter into the meatus until urine flows
    • Once urine starts to flow, inflate the catheter balloon with sterile water
      • Make sure that this is painless for the patient and that the catheter is secure by applying light tension on the catheter until resistance is felt
    • Attach the catheter to a drainage system (bag/urometer)
    • In men, ensure the foreskin is replaced back over the head of the penis
  • End
    • Collect urine sample if required
    • Make sure the patient is comfortable
    • Dispose of equipment and PPE appropriately
    • Wash hands and Thank patient
    • Document procedure in patient notes (or suitable alternative)
      • Include the reason for procedure, catheter used (may use sticker from catheter pack); anaesthetic gel used, any problems etc; signature and date

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