Catherisation is another essential skill you'll need throughout your career in medicine. Follow our handy guide, and be ready when faced with a real life patient catherisation. Medical Exam Tutor is an on-line e-learning platform designed to ease the transition from medical studies, to real life practice situations. Take a trial of our unique learning platform on our website: www.medicalexamtutor.com

1. INTERN SURVIVAL GUIDE
Male Catheterisation

2. Tutorial Overview
• Equipment Selection
• Equipment and Patient Preparation
• Procedure Steps
• Catheter Selection
• Indications, Documentation and Complications

3. Equipment Selection
1. Alcohol Wipes1. Alcohol Wipes1. Alcohol Wipes1. Alcohol Wipes 2. Catheterisation Pack2. Catheterisation Pack2. Catheterisation Pack2. Catheterisation Pack 3. Sterile Gloves:3. Sterile Gloves:
x 2 pairs in your size
3. Sterile Gloves:3. Sterile Gloves:
x 2 pairs in your size

4. Equipment Selection
6. Cleaning Solution6. Cleaning Solution
2 sachets of sterile water
6. Cleaning Solution6. Cleaning Solution
2 sachets of sterile water
8. Sterile Water &8. Sterile Water &
10ml Syringe (if latex10ml Syringe (if latex
catheter)catheter)
8. Sterile Water &8. Sterile Water &
10ml Syringe (if latex10ml Syringe (if latex
catheter)catheter)
7. Anaesthetic Gel7. Anaesthetic Gel
Instilligel x 2
7. Anaesthetic Gel7. Anaesthetic Gel
Instilligel x 2
9. Urinary Drainage /9. Urinary Drainage /
Colletction BagColletction Bag
9. Urinary Drainage /9. Urinary Drainage /
Colletction BagColletction Bag
5. Incontinence Sheet5. Incontinence Sheet5. Incontinence Sheet5. Incontinence Sheet4. Disosable Apron4. Disosable Apron4. Disosable Apron4. Disosable Apron

5. Equipment Selection
• 2 layers of packaging
• Outer has information on size,
length and volume for balloon
– Remove before placing onto
sterile field
• Inner is sterile with vertical and
horizontal serration for no
touch insertion
• Note Silastic catheters have a
prefilled 10ml syringe for
balloon
10. Select Catheter10. Select Catheter
Choose silastic or latex
Usually 14 Ch or 16 Ch
Have a few spare on trolley
10. Select Catheter10. Select Catheter
Choose silastic or latex
Usually 14 Ch or 16 Ch
Have a few spare on trolley

6. Equipment and Patient Preparation
1. Put all equipment on the bottom
shelf of the cleaned trolley
2. At bedside – perform hand hygiene
3. Discuss procedure with patient
4. Put on apron
5. Open catheter pack on top of trolley to
create a sterile field
6. Attach yellow waste bag as shown
7. Have urine collection bag close by
8. Open necessary equipment
- Place on the sterile field
1. Only then prepare the patient
- Positions patient
- Underwear removed
- Incontinence pad underneath

7. Procedure
1. Wash hands (scrub) and put on sterile
gloves
2. Draw up sterile water if using latex catheter
(with help)
3. Place fenestrated drape over penis
4. Cleaning
i. Hold penis in left hand with gauze
ii. Clean with right hand
iii. Hold soaked cotton balls with plastic
forceps
iv. Clean penis shaft and foreskin
v. Retract foreskin and clean glans
vi. Always clean distal to proximal
vii. Dispose of cotton balls

8. Procedure
5. Remove gloves and apply the second
sterile pair
6. Elevate the penis to c.90°
7. Slowly instil anaesthetic gel x 2
- Allow 3 minutes to take effect
8. Open catheter cover vertically
9. Hold penis with gauze in left hand
10. Gently pull penis towards end of bed

9. Procedure
11. Introduce catheter into urethral meatus
12. Advance catheter in the bag
13. Retract bag as catheter advances
14. On feeling resistance raise penis to c. 90°
15. Maintain gentle pressure to pass prostate
16. Once in the bladder
- Resistance disappears
- Urine appears in catheter bag
- Pinch catheter with left hand to stop the flow

10. Procedure
17. Remove cover from catheter
18. Attach collection bag to catheter port
- This is the port urine is coming out
17. Inflate catheter balloon with 10mls
water
- Through coloured port
- Only when urine seen in collection bag

11. Procedure
20. Replace foreskin with left hand
21. Clean and dry patient
22. Ensure dry before replacing
clothing (ask nurse for help)
23. Dispose of waste appropriately
and wash hands

12. Catheter Selection- Type
• Short term
– Can remain in situ for up to 4 weeks
– Usually brown in colour
– Made of Latex, Teflon of PVC
• Long term
– Can remain in situ for up to 12 weeks
– Clear or white in colour
– Most often made from silicone
– Designed to resist infection

13. Catheter Selection- Size
• Use the smallest size possible to maintain
drainage
• Larger sizes used only when clots or debris
present
• Measured in Chariers (Ch)
– The outer circumference of the catheter
– Usually a 14Ch or 16Ch catheter is ideal

14. Indications
• To relieve urinary retention
• To bypass urethral obstruction
• Management of incontinence
• Permit bladder irrigation
– E.g. post prostatectomy or TURP
• Empty bladder prior to surgical procedure
• To monitor urinary output
• Permit instillation of medication
– E.g. Cytotoxic agents in bladder carcinoma
• Required for certain investigations
– E.g. micturating cystourethrogram

15. Essential Documentation
• Date and time of procedure
• Verbal consent
• Indication for catheterisation
• Catheter
– Type
– Size
– Balloon inflated with 10mls water

16. Essential Documentation
• Catheterisation
– Performed under sterile technique
– Ease of insertion
– Urine flow prior to balloon inflation
• Post Catheterisation
– Foreskin replaced
– Volume drained
– Observation of urine: Clear, cloudy, bloody etc.
– Request nurse to monitor urine output

17. Complications
• Patient discomfort or pain:
– Advise the patient procedure is uncomfortable
– Use plenty of anaesthetic gel. Allow at least 3
minutes for the gel to work
– Handle the patient gently
• Urinary tract infection:
– Observe hand hygiene as per protocol
– Clean the patient properly
– Wear sterile gloves and ensure the field is sterile
– Do not touch the catheter, keep it covered in the bag
during insertion

18. Complications
• Damage to the urethra:
– Avoid by handling the tissues gently - do not force the
catheter past the prostate
– Ensure that the catheter is in the bladder before you
inflate the balloon (observe urine flow into the catheter
bag)
– If you cannot pass the catheter easily, then get more
senior help
• Blockage:
– Avoid this by choosing the correct catheter type and size
– Use a larger size with a 3rd port for irrigation if there is any
blood or clots or debris in the bladder

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