WELCOME

TO
MORNING SESSION
Presented by: Dr. Sadia Nowshin
Intern Doctor
Department of Urology
Bangladesh Medical College
 Urethral
Catherization
 Q: What is Catherization?
Urinary catheterization is a procedure of introduction of a latex tube into the
Urinary Bladder with proper lubrication in order to ensure drainage of the urine
for diagnostic or therapeutic purpose.
 Parts of Catheter
Catheters
 Catheters vary by caliber, tip configuration, number of ports, balloon size, type of material,
and length.
 Caliber is standardized in French (F) units—also known as Charrière (Ch) units. Each unit
is 0.33 mm, so a 14-F catheter is 4.6 mm in diameter.
 Sizes range from 12 to 24 F for adults and 8 to 12 F for children.

 Smaller catheters are usually sufficient for uncomplicated urinary drainage and useful for
Urethral Stricture and Bladder Neck Obstruction;

 Bigger catheters are indicated for bladder irrigation and some cases of hemorrhage (eg,
postoperatively or in hemorrhagic cystitis) and pyuria because clots could obstruct smaller
caliber catheters.
 Tips are straight in most catheters (eg,
Robinson, whistle-tip) and are used for
intermittent urethral catheterization (ie,
catheter is removed immediately after
bladder drainage).
 Foley (double-lumen latex) catheters
have a straight tip and an inflatable
balloon for self-retention.
 Other self-retaining catheters may have
an expanded tip, shaped like a
mushroom (de Pezzer catheter) or a 4-
winged perforated mushroom (Malecot
catheter); they are used in suprapubic
catheterization or nephrostomy.
 Elbowed catheters, which may have
balloons for self-retention, have a bent
tip to ease catheterization through
strictures or obstructions (eg, prostatic
obstruction).
Ports are present in all catheters
used for continuous urinary
drainage. Catheters have 2 way or
3 way ports for Urinary Drainage
balloon inflation, irrigation, or both
(eg, 3-way Foley).
 Balloons on self-retaining catheters have different
volumes, from 2.5 to 5 mL in balloons intended for use in
children and from 10 to 30 mL in balloons used in adults.
Larger balloons and catheters are generally used to
manage bleeding; traction on the catheter pulls the balloon
against the base of the bladder and puts pressure on
vessels, decreasing bleeding but potentially causing
ischemia. It is recommended that the balloon be filled with
plain water only.

 Stylets are flexible metal guides inserted through the

catheter to give stiffness and to facilitate insertion through
strictures or obstructions and should only be used by
physicians experienced with the technique.
Materials commonly used to make Urinary
Catheters :

 Silicone

 Latex

 Polyurethane
Types of Catheters
 Plain Rubber catheter
 Folley’s Bichannel or Tri-Channel
Self retaining Catheter
 Melacots Catheter
 Condom Catheter
Indication
A. Therapeutic Indications:

1. Urinary retention (causes may be due to)

1. Obstructive: Benign prostatic hyperplasia, strictures, stones, stenosis
and tumours.
2. Infectious and inflammatory conditions: Cystitis, urethritis, prostatitis
(in men), vulvo-vaginitis (in female)
3. Pharmacologic: Drugs with anticholinergic and alpha-adrenergic
agonist properties.
4. Neurologic: Brain and spinal cord injury, multiple sclerosis,
cerebrovascular accident and dementia can lead to urinary retention.
2. Perioperative : In pelvic and abdominal surgeries such as in urological
and gynecological procedures.
3. Post operative management of urinary retention due to anesthesia
Urinary Incontinence
4. Hygiene reasons
5. Monitoring of urinary output measurement in acutely ill patients
6. Delivery of chemotherapeutic drugs
7. Bladder irrigation
B. Diagnostic:

● Measurement of urodynamic

● Collection of sample for urinalysis

● Radiographic studies (such as in cystogram)

Catherization
Technique
Equipment
● Catheterization tray consists of :
1. Disposable sterile gloves,
2. Drapes, one fenestrated,
3. Cotton balls/Gauge with Gully pot
4. Forceps
5. Prefilled 10cc syringe with sterile water to inflate the balloon,
6. Sterile specimen container for urine sample collection

● Sterile catheter, latex (rubber) or silicone: 2 way or 3 way

● Catheter-secure device or adhesive tape
● Urinary drainage bag
● Medicated lubricant
 Steps in Female Catherization
● Place the patient in the supine position with the knees flexed and separated
and feet flat on the bed, about 60 cm apart. If this position is uncomfortable,
instruct the patient either to flex only one knee and keep the other leg flat on
the bed, or to spread her legs as far apart as possible. A lateral position may
also be used for elderly or disabled patients.

● With the thumb, middle and index fingers of the non-dominant hand, separate
the labia majora and labia minora. Pull slightly upward to locate the urinary
meatus. Maintain this position to avoid contamination during the procedure.

● With your dominant hand, cleanse the urinary meatus, using forceps and
chlorhexidine soaked cotton balls. Use each cotton ball for a single downward
stroke only.
● Place the drainage basin containing the catheter between the patient’s thighs.

● Pick up the catheter with your dominant hand.

● Insert the lubricated tip of the catheter into the urinary meatus.

● Advance the catheter about 5-5.75 cm, until urine begins to flow then advance
the catheter a further 1-2 cm.
● Attach the syringe with the sterile water and inflate the balloon. It is
recommended to inflate the 5cc balloon with 7-10cc of sterile water, and to
inflate the 30cc balloon with 30-35cc of sterile water.

● Improperly inflated balloons can cause drainage and leakage difficulties.

● Gently pull back on the catheter until the balloon engages the bladder neck.
 Steps in male catheterization
● Place the patient in the supine position with legs extended and flat on
the bed.

● Prepare the catheterization tray and catheter and drape the patient
appropriately using the sterile drapes provided. Place a sterile drape
under the patient’s buttocks and the fenestrated (drape with hole) drape
over the penis
.
● Apply water-soluble lubricant to the catheter tip.

● With your non-dominant hand, grasp the penis just below the glans and
hold upright.
● If the patient is uncircumcised, retract the foreskin. Replace the foreskin at the
end of the procedure.

● With your dominant hand, cleanse the glans using chlorhexidine soaked cotton
balls. Use each cotton ball for a single circular motion.

● Place the drainage basin containing the catheter on or next to the thighs.

● With you non-dominant hand, gently straighten and stretch the penis. Lift it to
an angle of 60-90 degrees. At this time you may use the urojet to anesthetize
the urinary canal, which will minimize the discomfort.
.
● With your dominant hand, insert the lubricated tip of the catheter into the urinary
meatus.

● Continue to advance the catheter completely to the bifurcation i.e. until only the
inflation and drainage ports are exposed and urine flows (this is to ensure proper
placement of the catheter in the bladder and prevent urethral injuries and
hematuria that result when the foley catheter balloon is inflated in the urethra)

● Note: If resistance is met during advancement of the catheter: Pause for 10-20
seconds. Instruct the patient to breathe deeply and evenly. Apply gentle pressure
as the patient exhales

● If you still meet resistance, stop the procedure and repeat above steps.
● Attach the syringe with the sterile water and inflate the balloon. It is
recommended to inflate the 5cc balloon with 7-10cc of sterile water, and to
inflate the 30cc balloon with 35cc of sterile water. Improperly inflated balloons
can cause drainage and leakage difficulties.

● Gently pull back on the catheter until the balloon engages the bladder neck.
.
● Attach the urinary drainage bag and position it below the bladder level. Secure
the catheter to the thigh. Avoid applying tension to the catheter.

● Remove drapes and cover patient. Ensure drainage bag is attached to bed
frame. Remove your gloves and wash hands.

● Note: Never inflate a balloon before establishing that the catheter is in the
bladder and not just in the urethra. If the patient reports discomfort, withdraw
the fluid from the balloon and advance the catheter a little further, then re-
inflate the balloon.
 Long term Catherization
PROS and Cons
● Maintain proper hygiene
● Fix the catheter to the Thai or lower abdomen
● Change catheter after every 3 weeks(Silicon Coated) or 3 months(100 %
Silicon)
● Continue with a low dose antimicrobial coverage if patient has a track
record of UTI
● Send the catheter tip for C/S if any indication.
● Avoid and be careful about accidental pull of the urethral catheter
Contraindication of urethral catherizations

Relative contraindications are the following:

● Urethral strictures
● Current urinary tract infection (UTI)
● Urethral reconstruction or bladder surgery
● Urethral trauma
Precautions while doing Catherization

● Ensure a Medical Personal to do the catherization

● Maintain the proper technique to do a sterile
procedure
● Ensure appropriate size for the particular patient
● Ensure Proper lubrication with tropical anesthetic
agent
● Ensure urine drainage before inflation of the balloon
● Fixation of the catheter must be ensured.
● Drainage bag must be attached properly to the
catheter.
● Accidental pull of the catheter must be taken care of.
Complications of bladder catheterization
include all of the following:
● Urethral or bladder trauma with bleeding or microscopic hematuria (common)
● UTI (common)
● Creation of false passages
● Scarring and strictures
● Bladder perforation (rare)
● Paraphimosis in uncircumcised males if the foreskin is not repositioned
How to properly drain a Foley catheter
 Illustration of how to
empty a urinary drainage
bag.
Illustration of a closed urinary drainage method.
Preventing infection:
Everyday care of the catheter and drainage bag is important to reduce the risk of infection. Such
precautions include:
● Urinary catheterization should be done in a sterile aseptic manner.
● Cleansing the urethral area (the area where the catheter exits body) and the catheter itself.
● Disconnecting the drainage bag from catheter only with clean hands
● Disconnecting the drainage bag as seldom as possible.
● Keeping the drainage bag connector as clean as possible and cleaning the drainage bag
periodically.
● Use of a thin catheter where possible to reduce the risk of harming the urethra during insertion.
● Drinking sufficient liquid to produce at least two litres of urine daily
● Sexual activity is very high risk for urinary infections, especially for catheterized women.
Trained Proper Proper
personnel Size care

Sterile Proper
Atmospher Lubrication
e
THANK YOU