Draining the bladder by passing a hollow tube through the urethra has been practiced for centuries, although not always with the same degree of comfort and safety possible today.
Original urinary catheters were fashioned from materials such as lead; today, most are made of silicone or latex. The two most common variants are ‘straight’ and Foley catheters. Foley catheters are equipped with an inflatable balloon at the tip which prevents accidental removal. The indications and contraindications to transurethral catheterization are similar for male and females. The techniques, however, are different and will be outlined separately.
It is important that Foley catheterization is performed with sterile technique to avoid infections. As well, the size of the catheter must be carefully chosen to avoid unnecessary trauma to the urethra.
Indications for catheterization include:
Contraindications for catheterization include:
Urinary Catheter - 16 French (Adult) or 12 F (Child) or 10 F (Toddler) The higher the number, the larger the diameter
Urine Drainage Bag and Tubing
Xylocaine Viscous (Urethral injection kit most helpful in males)
Catheter Tray (usually prepackaged with the following)
1. Explain the procedure to the patient including the indication and the likelihood of some discomfort. Obtain verbal consent where possible.
2. Position the patient supine with her hips abducted and feet together (frog leg position).
3. Place the catheter tray on a stand next to your dominant hand.
4. Open the tray in an aseptic fashion and place any additional equipment such as the catheter on the sterile field.
5. Put on sterile gloves.
6. If using a Foley catheter, test the balloon by inflating and deflating it with the water-filled syringe.
7. Open the Povidone - Iodine solution and pour it over the cotton swabs. Cleaning solution can also include savlon or 2% chlorhexidine auqeous solution, depending on availability.
8. Lubricate the tip of the catheter.
9. Place the sterile drape around the genital area and then place the urine collection container between the patient’s legs.
10. Gently separate the labia majora and minora with your non-dominant hand, exposing the urethra and vaginal orifice. This hand is no longer sterile and may not return to the sterile tray or equipment.
11. Using your sterile hand, cleanse the genitalia three times with Povidone- Iodine. This is done with three separate swabs, each making a single pass from front to back. Discard the swabs away from your sterile field.
12. Grasp the catheter in your sterile hand - hold it about two cm from the tip and coil the remainder in your hand.
13. Insert the catheter gently into the urethra. If resistance or pain is felt, stop then gently try again.
14. Continue to insert the catheter until urine begins to flow, collecting any urine in the sterile container.
15. Inflate the balloon and withdraw the catheter until it feels snug against the bladder neck. Remember, DO NOT inflate the balloon until urine begins to flow.
16. Connect the catheter to the drainage tubing and tape it to the patient’s inner thigh.
17. Position the drainage bag below the level of the bladder. This could be done by attaching the bag to the bedside frame. Avoid putting the bag on the floor.
male catheterization video (Dalhousie University Common Common Currency)
Explain the procedure to the patient including the indication and the likelihood of some discomfort. Obtain verbal consent where possible.
Position the patient supine with legs slightly abducted at the hips
Place the catheter tray on a stand next to your dominant hand.
Open the tray in an aseptic fashion and place any additional equipment such as the catheter on the sterile field. The catheter is usually ‘double wrapped’ with a sterile inner wrapper.
Put on sterile gloves.
If using a Foley catheter, test the balloon by inflating and deflating it with the water-filled syringe. The inflation valve will indicate the balloon capacity - usually 5 - 10 ml.
Open the Povidone - Iodine solution and pour it over the cotton swabs.
Lubricate the tip of the catheter.
Place the sterile drape around the genital area and then place the urine collection container between the patient’s legs.
Firmly (but politely) grasp the patient’s penis with your non-dominant hand. This hand is no longer sterile and cannot return to the sterile tray or equipment.
If the patient is uncircumcised, retract the foreskin using your unsterile hand.
Using your sterile hand, cleanse the glans penis, starting at the urethral meatus and circling outwards. Include the distal shaft of the penis. Repeat twice, discarding the swabs away from your sterile field.
If you plan to use Xylocaine viscous anaesthesia, place the injector tip inside the urethral meatus and inject slowly.
Using your unsterile hand, gently place traction on the penis upward to straighten the urethra.
Pick up the catheter with your sterile hand, holding it ~ 2 cm from the tip and coiling the rest into your hand. Insert the catheter into the urethra. Gently advance the catheter ‘to the hilt’, i.e. To the shoulder of the flared end. If you meet resistance, back up and gently try again. Never force.
Inflate the catheter balloon with saline and then gently pull the catheter back until the balloon comes up against the bladder neck. If there is resistance to balloon inflation or if the patient feels pain, re-advance the catheter to ensure it is in the bladder. Urine should now drain from the catheter into the sterile container.
Connect the catheter to the drainage tubing. Tape the catheter to the patient’s inner thigh.
Replace the foreskin in uncircumcised patients.
Catheters need to be maintained as closed drainage systems, and it is very important that all connections are securely tightened to avoid any urine spilling out and to prevent infection. Connections may need to be secured with waterproof tape.
Empty the urine bag every 6-8 hours.
Avoid putting the drainage bag on the floor.
Clean the urethral area (where the catheter exists the body) and the catheter itself with soap and water every day. Also, thoroughly cleanse the area after all bowel movements to prevent infection.
Make sure the tubing is securely fastened to the patient's inner thigh.
Make sure the tubing is kept free from kinks so that the urine can flow freely.
Prior to removing the catheter, use a 10cc syringe and withdraw the sterile water from the catheter valve to deflate the balloon. Slowly pull on the catheter to remove it from the body.
If there is difficulty in visualizing the urethra:
If the catheter is inserted into the vagina, leave it in place and start again with another sterile catheter. Once the second catheter is well-positioned in the bladder, remove the catheter from the vagina.
If resistance is met during advancement of the catheter, pause for a few seconds. Instruct the patient to breathe deeply and evenly to help relax his muscles. Apply gentle pressure with a twisting motion as the patient exhales. Never force the catheter, as this could cause trauma to the urethra.
Complications of Foley catheterization include:
authors: David LaPierre, Aug 09
reviewers: Carolyn Beukeboom, Sept 11