Makindo Medical Notes

Catheterisation should always be an aseptic, 'no-touch' technique. A 'no-touch' technique reduces the risk of introducing infection into the bladder. Touch only the plastic sheath that contains the catheter, and not the catheter.

Precautions

• Only competent staff (or training staff supervised by competent staff) should perform this procedure

Indications

• Acute urinary retention: A post-void bedside bladder scan will show the volume of retained urine, helping to confirm the diagnosis.
• Prior to urological or pelvic surgery
• Monitoring urinary output
• Measuring urinary volumes
• Self catheterisation for neurological conditions
• Bowel irrigation - often for severe haematuria to prevent clot retention and requires a larger catheter and should be done with specialist urological advice

Contraindications

• Suspected urethral injury e.g. trauma to the penis or pelvis - may be blood at the meatus
• Relative contraindication with Recent thrombolysis e.g. stroke thrombolysis as can cause localised bleeding

Complications

• Pain and discomfort
• Urethral strictures,
• Urethral perforation.
• Bleeding especially if on antithrombotics or anticoagulants
• Asymptomatic bacteriuria, cystitis, prostatitis, urethritis, epidymo-orchitis
• Pyelonephritis, Urosepsis

Preliminaries

• Take verbal consent. Use a chaperone and you will need help once you are wearing gloves.

Check you have the following equipment for this procedure

• Sterile gloves
• Catheterisation pack - antiseptic solution, drape, a container for urine, Sterile paper towels.
• a 12 - 14 Fr male Foley catheter
• Catheter bag
• Antiseptic solution
• Lignocaine gel
• 10ml saline-filled syringe

Steps

• Explain what you are doing and get the patient comfortable lying supine with legs slightly apart as flat as possible. Try to respect dignity and ensure privacy.
• Open the catheter pack on a flat surface usually a trolley and pour the antiseptic solution into the receiver. Open the rest of your equipment onto the sterile field without directly touching any of the components.
• Now wash hands with soap and dry. Drape the patient with the provided sterile cover with only the penis visible. Hold the penis with a sterile swab and clean the penis thoroughly. In the uncircumcised retract the foreskin and clean around the urethral meatus. If this is difficult be careful of the risk of paraphimosis. Ensure the area around the meatus is clean.
• Now take the lignocaine gel container and gently insert it to its hilt within the meatus and inject slowly trying to ensure as little reflux of gel as possible. Give it 5 minutes to work.
• Hold the penis straight and with your other hand hold the catheter by its plastic sleeve avoiding direct contact and slowly advance the entire catheter length up to hilt into the urethra.
• At some point urine will reflex and so be ready to place the end in a small container to catch this. If the patient is in retention this could be a significant volume. Now fill the balloon using 10ml of saline.
• Pain during inflation should alert you to the fact that the catheter may not be in the bladder and you should recheck the position. Attach the catheter bag. Gently pull on the catheter and there should be some give and then a stop as the bladder balloon prevents it from leaving the bladder.

Difficulties

• Phimosis where the foreskin is tight and is difficult to retract. The opening may be adequate to pass the catheter blind. If the opening is too narrow then consider a urological consult.
• Failure to pass the prostate then try a larger diameter catheter which overcomes anatomical distortion and allows passage. Another option is to try a silicone catheter, as it is more rigid than a silicone latex catheter.
• Failure to pass the bladder neck - try a smaller size.

Post Procedure

• Document in notes volume and any comments about urine e.g. blood
• Consider sending a urine sample if clinically indicated
• Make sure that you have replaced foreskin in a forward position to avoid paraphimosis
• Dispose of all used materials and wash hands