Urinary Catheterization

  • Is the introduction of a catheter through the urethra into the bladder for the purpose of withdrawing urine.
  • To relieve urinary retention
  • To obtain a sterile urine specimen from a woman
  • To measure the amount of residual urine in the bladder
  • To obtain a urine specimen when a specimen cannot secure satisfactory by other means
  • To empty bladder before and during surgery and before certain diagnostic examinations

***Several BASIC FACTS about the lower urinary tract system should be borne in mind when considering catheterization.

Necessary Equipment for Catheterization
  • Catheters are graded on the French scale according to the size of the lumen. For the female adult, No. 14 and No. 16 French catheters are usually used. Small catheters are generally not necessary and the size of the lumen is also so small that it increases the length of time necessary for emptying the bladder. Larger catheter distends the urethra and tends to increase the discomfort of the procedure. For male adult, No.18 and No. 20 French catheters usually used, but if this appears to be too large, smaller catheter should be used. No. 8 and No. 10 French catheters are commonly used for children.
Preparation of the Patient
  1. Adequate exploration
  2. Position – dorsal recumbent for the female and supine for the male using a firm mattress or treatment table, Sim’s or lateral position can be an alternate for the female patient
  3. Provision for privacy
Retention or Indwelling Catheter (Foley)
  • A catheter to remain in place for the following purposes:
    1. The gradual decompression of an over distended bladder
    2. For intermittent bladder drainage
    3. For continuous bladder drainage
  • An indwelling catheter has a balloon which is inflated after the catheter is inserted into the bladder. Because the inflated balloon is larger than the opening to the urethra, the catheter is retained in the bladder.
Procedure for Insertion
  1. Inflate the balloon with the prefilled syringe before inserting the catheter to check for balloon patency. Aspirate the fluid back into the syringe when it is determined that the balloon is patent.
  2. Hold the catheter with one hand and inflate the balloon according to the manufacturer’s instructions, as soon as the catheter is in the bladder and urine has begun to drain from the bladder. Usually 5 ml to 10 ml of sterile water is used
  3. If the patient complains of pain after the balloon is inflated, allow it to empty and replace the catheter with another one. The balloon is probably located in the urethra and is causing discomfort owing to distention of the urethra
  4. Exert slight tension on the catheter after the balloon is inflated to assure its proper placement in the bladder
  5. Connect the catheter to the drainage tubing and drainage bag if not already connected
  6. Tape the catheter along the interior aspect of the thigh fro a female patient. Be sure there is no tension on the catheter when it is taped to the patient
  7. Hang the drainage bag on the frame of the bed below the level of the bladder
Caring for the Patient with an Indwelling Catheter
  1. Be sure to wash hands before and after caring for a patient with an indwelling catheter
  2. Clean the perineal area thoroughly, especially around the meatus, twice a day and after each bowel movement. This helps prevent organisms for entering the bladder
  3. Use soap or detergent and water to clean the perineal area and rinse the area well
  4. Make sure that the patient maintains a generous fluid intake. This helps prevent infection and irrigates the catheter naturally by increasing urinary output
  5. Encourage the patient to be up and about as ordered
  6. Record the patient’s intake and output
  7. Note the volume and character of urine and record observations carefully
  8. Teach the patient the importance of personal hygiene, especially the importance of careful cleaning after having bowel movement and thorough washing of hands frequently
  9. Report any signs of infection promptly. These include a burning sensation and irritation at the meatus, cloudy urine, a strong odor to the urine, an elevated temperature and chills
  10. Plan to change indwelling catheters only as necessary. The usual length of time between catheter changes varies and can be anywhere from 5 days to 2 weeks. The less often a catheter is changed, the less the likelihood than an infection will develop
Removing the Indwelling Catheter and Aftercare of the Patient
  1. Be sure the balloon is deflated before attempting to remove the catheter. This may be done by inserting a syringe into the balloon valve or by cutting the balloon valve
  2. Have the patient take several deep breaths to help him relax while gently removing the catheter. Wrap the catheter in a towel or disposable, waterproof drape
  3. Clean the area at the meatus thoroughly with antiseptic swabs after the catheter is removed
  4. See to it that the patient’s fluid intake is generous and record the patient’s intake and output. Instruct the patient to void into the bedpan or urinal
  5. Observe the urine carefully for any signs of abnormality
  6. Record and report any usual signs such as discomfort, a burning sensation when voiding, bleeding and changes in vital signs, especially the patient’s temperature. Be alert to any signs of infection and report them promptly