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urinary catheter insertion

The ability to insert a urinary catheter is an essential skill in medicine
Catheters are sized in units called French, where one French equals 1/3 of 1 mm. Catheters vary from 12 (small) FR to 48 (large) FR (3-16mm) in size
They also come in different varieties including ones without a bladder balloon, and ones with different sized balloons - you should check how much the balloon is made to hold when inflating the balloon with water

Universal precautions

The potential for contact with a patient's blood/body fluids while starting a catheter is present and increases with the inexperience of the operator. Gloves must be worn while starting the Foley, not only to protect the user, but also to prevent infection in the patient. Trauma protocol calls for all team members to wear gloves, face and eye protection and gowns


Indications

By inserting a Foley catheter, you are gaining access to the bladder and its contents. Thus enabling you to drain bladder contents, decompress the bladder, obtain a specimen, and introduce a passage into the GU tract. This will allow you to treat urinary retention, and bladder outlet obstruction

Urinary output is also a sensitive indicator of volume status and renal perfusion - and thus tissue perfusion also

In the emergency department, catheters can be used to aid in the diagnosis of GU bleeding

In some cases, as in urethral stricture or prostatic hypertrophy, insertion will be difficult and early consultation with urology is essential

Contraindications

Foley catheters are contraindicated in the presence of urethral trauma. Urethral injuries may occur in patients with multisystem injuries and pelvic factures, as well as straddle impacts. If this is suspected, one must perform a genital and rectal exam first. If one finds blood at the meatus of the urethra, a scrotal hematoma, a pelvic fracture, or a high riding prostate then a high suspicion of urethral tear is present. One must then perform retrograde urethrography - injecting 20 cc of contrast into the urethra

Equipment

Sterile gloves - consider Universal Precautions
Sterile drapes
Cleansing solution e.g. Savlon
Cotton swabs
Forceps
Sterile water -usually 10 cc
Foley catheter -usually 16-18 French
Syringe - usually 10 cc
Lubricant - water based jelly or xylocaine jelly
Collection bag and tubing


Procedure


Gather equipment

Explain procedure to the patient

Assist patient into supine position with legs spread and feet together

Open catheterization kit and catheter

Prepare sterile field, apply sterile gloves

Check balloon for patency

Generously coat the distal portion (2-5 cm) of the catheter with lubricant

Apply sterile drape

If female, separate labia using non-dominant hand. If male, hold the penis with the non-dominant hand. Maintain hand position until preparing to inflate balloon

Insertion of an urinary catheter
in a female


Insertion of an urinary catheter
in a male

Using dominant hand to handle forceps, cleanse peri-urethral mucosa with cleansing solution. Cleanse anterior to posterior, inner to outer, one swipe per swab, discard swab away from sterile field

Pick up catheter with gloved (and still sterile) dominant hand. Hold end of catheter loosely coiled in palm of dominant hand


In the male, lift the penis to a position perpendicular to patient's body and apply light upward traction -with non-dominant hand

Identify the urinary meatus and gently insert until 1 to 2 inches beyond where urine is noted

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 drainage system

Secure catheter to abdomen or thigh, without tension on tubing

Place drainage bag below level of bladder

Evaluate catheter function and amount, color, odor, and quality of urine

Remove gloves, dispose of equipment appropriately, wash hands

Document size of catheter inserted, amount of water in balloon, patient's response to procedure, and assessment of urine