Urethral Catheterization

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Procedure
1.Gather equipment.
2.Explain procedure to the patient.
3.Assist patient into supine position with legs spread and feet together.
4.Open catheterization kit and catheter .
5.Prepare sterile field, apply sterile gloves.
6.Check balloon for patency.
7.Generously coat the distal portion (2-5 cm) of the catheter with lubricant.
8.Apply sterile drape.
9.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.
10.Using dominant hand to handle forceps, cleanse peri-urethral mucosa with cleansing solution.
11.Cleanse anterior to posterior, inner to outer, one swipe per swab, discard swab away from sterile field.
12.Pick up catheter with gloved (and still sterile) dominant hand. Hold end of catheter loosely coiled in palm of dominant hand.
13.In the male, lift the penis to a position perpendicular to patient's body and apply light upward traction (with non-dominant hand) .
14.Identify the urinary meatus and gently insert until 1 to 2 inches beyond where urine is noted. 15.Inflate balloon, using correct amount of sterile liquid (usually 10 cc but check actual balloon size).
16.Gently pull catheter until inflation balloon is snug against bladder neck.
17.Connect catheter to drainage system.
18.Secure catheter to abdomen or thigh, without tension on tubing.
19.Place drainage bag below level of bladder .
20.Evaluate catheter function and amount, color, odor, and quality of urine.
21.Remove gloves, dispose of equipment appropriately, wash hands.
22.Document size of catheter inserted, amount of water in balloon, patient's response to procedure, and assessment of urine.

Complications

The main complications are tissue trauma and infection. After 48 hours of catheterization, most catheters are colonized with bacteria, thus leading to possible bacteruria and its complications. Catheters can also cause renal inflammation, nephro-cysto-lithiasis, and pyelonephritis if left in for prolonged periods. The most common short term complications are inability to insert catheter, and causation of tissue trauma during the insertion. The alternatives to urethral catheterization include suprapubic catheterization and external condom catheters for longer durations.


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).