Urethral Catheterisation

Intermediate procedure

The Risks:
Because of the risk of bladder weakness or altered anatomy through scarring the Klinic does not perform catheterisation on people with a history of:

• Damage or injury to the urethra or bladder
• Repeated urinary tract infections (infection of the urethra, bladder or kidneys)
• Surgery to the urinary tract
• Catheterisation of men with an enlarged prostate gland may be difficult or impossible and repeated attempts to catheterise people is not undertaken by Klinicians.

• 1.Minimise the pressure exerted on the bladder neck when the patient is standing.
• 2.Reduce the risk of serious injury should the balloon be accidentally inflated inside the urethra

Catheter lengths:
There are 2 lengths of adult catheters available; a longer length catheter for men and a shorter length catheter for women.

Using a male length catheter in women:
As the female urethra is shorter than the male urethra much of the catheter shaft will protrude beyond the body. This extra length can form a loop where urine will collect and stagnate thus increasing the risk of infection. For this reason a female catheter should be used in female patients wherever possible. Extra vigilance is necessary to avoid looping of the catheter tubing if a male length catheter is used in female patients.

Using a female length catheter in males:
A female length catheter may not reach fully into the bladder of a male and could result in balloon inflation occurring inside the urethra with a potential for:

• 1.Urethral stretching (accompanied with extreme pain and potential urethral damage.)
• 2.Rupture of the balloon membrane which could leave fragments of the catheter tubing inside the urethra or bladder. These may require surgical removal. For this reason Klinic Klinicians NEVER use female length catheters in males.

Suitable catheter sizes:
Catheters are sized in units called “French” (often denoted as “fr” or “ch”). One French equals 1/3 of 1 mm. Catheters vary from 12fr (small) up to 48fr (large) (3-16mm) in size.
To avoid stretching of the urethra and bladder sphincters Klinicians do not use catheter sizes larger than 18fr

Draining the bladder via a catheter:
Drainage bags are available in a range of capacities from 350 to 2000mls, in a range of inlet tube lengths and with or without an outlet tap to drain the bag. Bags with taps can be emptied by opening the tap at the bottom of the bag into a suitable container or into the toilet.
In order to reduce the risk of infection the connection between the catheter and the bag should remain unbroken unless there is a need to change the drainage bag for a new one. Direct contact between the catheter and the mouth or nose is not recommended as some bacteria found in saliva is capable of causing severe bladder and kidney infections.
Blowing into a catheter should be avoided as exhaled air is contaminated with micro-organisms which are capable of causing severe bladder and kidney infections.
Sucking on catheters is also not recommended as the vacuum created in the bladder may cause tissue damage and interfere with normal bladder filling.

Complications:
The main complications are tissue injury on insertion and infection. After 48 hours of catheterisation, most catheters are colonised with bacteria (bacteria are living on the catheter in high numbers without causing the body to react to them.) For this reason the Klinic does not recommend leaving people catheterised for longer than 24 hours.

A catheter should be comfortable to wear and should not pull. If it does pull, feel painful or rub causing soreness then the catheter should be removed.

Avoiding complications:
Because of the risk of infection it is recommended that a catheterised person should:

• Drink enough fluid to produce approximately 4 pints of urine each 24 hours (at least 1 glass of non-alcoholic fluid every hour) in order to “flush” the bladder.
• Avoid constipation (a full bowel makes catheterisation difficult and irritation of the urethra likely.)
• Empty their drainage bags regularly to avoid them becoming so full that urine builds up in the tubing and the bladder causing discomfort and leaking around the catheter.

To reduce the risk of infection:

• Use sterile equipment including the catheter, gloves and lubricating jelly
• Cleanse the area thoroughly prior to inserting the catheter
• Maintain a good, clean technique
• Encourage the "patient" to bath or shower prior to insertion (use unscented soap to avoid irritation.)
• Wash their hands before and after dealing with the catheter (antimicrobial skin cleansers and/or alco-gel hand rubs are ideal.)
• Clean the catheter tubing where it enters the urethra using downward strokes - away from the entry point (never up and down cleaning motions.)

Other things to avoid include:

• Attempting to pull a catheter out without deflating the balloon
• Lifting the catheter above the level of the groin. (This could cause urine to flow back up the catheter tube increasing the risk of infection.)
• Allowing the tubing to get kinked as this could obstruct the flow of urine which may cause leakage around the catheter and damage to the bladder
• Clamping the catheter tube as this may damage the balloon channel which may make it difficult to deflate the balloon for removal.
• Disconnecting the drainage bag from the catheter tubing unless they need to change the bag for a new one.

Having sex when a catheter is inserted
Catheters should not present too much of a problem providing a few simple instructions are followed:

• Both partners should thoroughly wash their genitalia.
• Female patients may wish to tape the catheter up onto the stomach so that it is out of the way and secured (to avoid tugging of the catheter.)
• To reduce the risk of infection Where a woman is catheterised, a condom should always be worn where penetration of the vagina is intended and barriers should be used when performing oral sex close to a catheter.
• Where a man is catheterised, a condom should always be worn over the penis and catheter if penetration (including oral penetration) is intended.
• Use water soluble lubrication like KY jelly (in quantity). Do NOT use Vaseline.
• When ended both partners should wash their genitals thoroughly.

Remember that if pain or discomfort is experienced then medical advice may be required.

Universal precautions should be taken throughout the procedure

Equipment

• Sterile gloves
• Sterile drapes
• Cleansing solution e.g. Savlon
• Cotton swabs Sterile water (usually 10mls)
• Foley catheter (usually 12-18 French)
• Syringe (usually 10mls)
• Lubricant (water based jelly)
• Collection bag and tubing

• Gather all the equipment.
• Explain procedure to the patient
• Female patients should lie in a supine position (on their back) with legs spread and feet together. Male patients should lie in a supine position, legs together.
• Check all the packaging is not torn or wet and that all sterile equipment is in date.
• Open catheterisation kit, catheter and all other sterile equipment
• Wash hands and apply sterile gloves
• Check balloon by inflating it slowly with 10mls of sterile water. Deflate the balloon.
• Generously coat the end portion (2-5 cm) of the catheter with water based lubricant
• Apply sterile drape (took under the bottom in females, under the scrotum in males.
• 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.
• Using dominant hand cleanse the area around the urethra with cleansing solution. Use front to back and inner to outer motion when cleansing and take care not to touch un-cleansed skin with the sterile gloves. Use one swipe per swab and discard each swab away from sterile field.
• Pick up catheter with gloved (and still sterile) dominant hand. Hold the end of the catheter loosely coiled in palm of dominant hand.
• In the male, lift the penis to a “pointing straight up” position (perpendicular to patient's body) and apply light upward traction (with the non-dominant hand.) This will straighten the urethra from its relaxed “S” shape to a “J” shape, making insertion of the catheter easier.
• Identify the urinary meatus (opening of the urethra) and gently insert the whole length of the catheter slowly into the urethra. Urine should be seen coming out of the catheter at this point.
• Once urine has been seen, inflate the balloon, using the correct amount of sterile liquid (10mls - but check the actual balloon size.)
• Gently pull catheter until inflation balloon is snug against the bladder neck (do not tug the catheter.)
• Connect the catheter to a drainage system and place drainage bag below the level of the bladder
• If appropriate, secure the catheter to the thigh without tension on the tubing making certain that the catheter is not above the level of the bladder and that no kinks or “U” bends in the catheter are created.
• Remove gloves, dispose of equipment appropriately, wash hands

lili (July 2008)