Urinary Catheterization

Medically reviewed on Jun 11, 2018

What Is It?

In urinary catheterization, a catheter (hollow tube) is inserted into the bladder to drain or
collect urine. There are two main types of urinary catheterization: indwelling
catheterization and clean intermittent catheterization (CIC).

Indwelling catheterization
In this type of catheterization, one end of the catheter remains inside the bladder. A small,
inflated balloon at the tip of the catheter inside the bladder keeps the end of the catheter
from slipping out. Urine flows from the bladder through the catheter and collects in a
drainage bag. If the patient is not bedridden, this drainage bag can be worn on the leg,
where it can be hidden under a skirt or slacks. If the patient is bedridden, the drainage
bag usually is attached to the lower portion of the hospital bed (near the floor). This
position allows gravity to help the urine drain.

An indwelling catheter can be used for short-term or long-term care.

CIC
In CIC, the urinary catheter does not remain inside the bladder. It is inserted into the
bladder only long enough to allow the bladder to drain. Then, it is removed. CIC can be
done by the patient or by the patient's caregiver.
For short-term catheterization after surgery, and in certain paralyzed patients, CIC often
is better than an indwelling catheter. This is because CIC is less likely to cause a urinary-
tract infection in these situations.

What It's Used For

Urinary catheters are used to remove urine from the bladder in the following situations:

 To relieve a physical obstruction to urine flow, such as a urinary-tract stone, a

bladder tumor or an enlarged prostate.
 To drain urine when the bladder's muscles or nerves are not working properly. This
can be caused by a spinal cord injury, multiple sclerosis or some other nerve
problem. Also, certain medications can interfere with the bladder's normal
emptying.
 To treat incontinence (difficulty holding in urine until you reach the toilet) when
other methods have failed.
 To drain urine in patients who are unconscious. This includes patients who are in
a coma or under general anesthesia.
 To measure urine output in infants and children who are not toilet trained.
 To measure urine output in adults who are incapacitated because of critical illness
or surgery.
 To obtain a clean urine sample for tests to detect bacteria infections in the urine.
A clean urine sample is one that is not contaminated by bacteria from the patient's
hands, genitals or rectum. With a catheter, a clean urine sample can be obtained
directly from inside the bladder.
 To collect urine during diagnostic studies of the urinary tract.

Preparation

Indwelling catheterization
Health care personnel will open the kit that contains the sterile supplies and gloves
beforehand, taking care to not touch the inside of the kit to avoid bacterial contamination.
CIC
All equipment (catheter, lubricant, urine receptacle) should be assembled beforehand.
Caregivers should wear clean, disposable gloves when performing CIC on a patient. For
self-catheterization, you should wash your hands thoroughly prior to inserting the
catheter; gloves are not mandatory for self-catheterization.

How It's Done

Urinary catheters come in different diameters. For adult patients, catheters generally are
less than one-quarter of an inch in diameter.

Indwelling catheter

The clothing will be removed from the lower portion of your body, and you will lie on your
back. If you are a woman, your knees will be bent and your legs spread apart. This will
allow the caregiver access to your urethra. If you are a man, your knees can be either
straight or bent.

A health care professional (often a nurse) will clean the opening of your urethra with an
antiseptic solution. Then, he or she will inject a lubricating jelly into your urethra. This
injection will be done with a special syringe that has a smooth plastic tip instead of a
needle. Once your urethra is lubricated, the tip of the urinary catheter will be inserted
gently into the urethra's opening. Slowly, the catheter will be advanced up the urethra into
your bladder. When the catheter tip reaches the bladder, urine will begin to flow down
through the catheter tube. At this point, the health care professional advances the
catheter a bit further.

Just below the catheter tip, there is a balloon that has its own connecting tube. The
balloon is inflated with a small amount of sterile water or saline (salt solution). The inflated
balloon keeps the catheter from falling out of the bladder.
Once the catheter is in place, the drainage bag will be attached. The drainage bag should
remain below the level of the bladder to ensure that urine drains properly with no backflow.

CIC
CIC catheters can be made of red rubber (latex) or plastic. Some are reusable, while
others are disposable, single-use models.

People who do CIC catheterization on themselves will want to be next to a toilet or have
a urine-collection receptacle ready. Wash your hands and the catheter with warm, soapy
water. Clean the opening of your urethra, and spread lubricant on one end of the catheter.
Insert the lubricated catheter tip into your urethra, and advance the catheter gently until
urine begins to flow. Allow urine to drain completely into a toilet or urine receptacle. Once
urine stops flowing, gently withdraw the catheter. If the catheter is reusable, wash it in
soapy water and allow it to air dry in a ventilated container. Then wash your hands again
before resuming your normal activities.

If you are a caregiver who is doing CIC on a patient, the steps are basically the same.
However, you should wear clean, disposable gloves during the procedure.

Follow-Up

Indwelling catheters

Each day, your caregiver will clean the area around your urethra. In female patients, this
area also must be cleaned after every bowel movement. Your caregiver probably will
empty the urine drainage bag about once every eight hours (sooner, if the bag is full). The
catheter itself will be changed periodically, according to a schedule developed by your
nurse or doctor.

Sometimes, the catheter becomes obstructed with debris, such as mucus, protein
deposits, or tiny mineral crystals. When this happens, urine flow may stop temporarily. To
deal with this problem, your caregiver will flush the catheter with a special solution. To
help prevent repeated obstructions of the catheter, your doctor may prescribe medication
to make your urine more acidic. You also will be asked to drink more fluids to help flush
your urinary tract.

If you have had an indwelling catheter for a long period of time, your bladder muscles
may go into spasm. These bladder spasms can force urine to leak around the catheter. If
this happens, your doctor can prescribe antispasmodic medication.

CIC
The process needs to be repeated every six to eight hours, or as directed by your doctor.
Reusable catheters need to be sterilized periodically according to the manufacturer's
directions.

Risks

When the catheter is inserted

Insertion of a urinary catheter carries a risk of the following problems:

 The urethra or bladder can be damaged. Very rarely, the bladder wall is punctured.
 The catheter can be inserted into the vagina by mistake. This happens most often
in infant girls.
 When indwelling catheters are inserted, the catheter balloon can be inflated inside
the urethra, instead of the bladder, injuring the urethra's wall. This complication
happens more often in males than in females, because the urethra is longer in
men.
After the catheter is inserted
Whenever a catheter enters the bladder, there is a risk that bacteria will get into the
urinary tract. In many cases, the bacteria grow in the urine without causing any symptoms
of a urinary tract infection. Sometimes, however, the bacteria cause symptoms of a
urinary tract infection, including a fever and changes in the urine's smell and appearance.

After long-term use of an indwelling catheter

In people who need an indwelling catheter for long-term care, the following complications
can occur:

 The urethra can be damaged or scarred.

 A long-term inflammation or infection of the kidneys can develop.
 "Stones" made of mineral deposits can form inside the kidneys or bladder, or on
the catheter tip or balloon.
 The scrotum, prostate or nearby structures can become infected.

When To Call A Professional

In someone with a urinary catheter, the following symptoms can be signs of infection or
other complications. Contact your doctor or home-care nurse if you have any of these
symptoms:

 Fever, with or without chills

 Pain in the abdomen, flank or lower back
 Urine that smells foul or unusually strong
 Urine that is thick, cloudy or tinged with blood
 (Indwelling catheter) Little or no output of urine into the drainage bag, in spite of
attempts to irrigate the catheter
 (Indwelling catheter) Leakage of urine past the catheter