Definition of catheter Definition of urethral catheterization Classes of catheter Indications Contraindications Materials needed Procedure Complications

1. Urinary Catheters and
urethral catheterization
By
Dr Obumneme Chuma

2. Outline
• Introduction
• Indications
• Contraindications
• Classes
• Sizes
• Materials
• Procedure
• Complications
• Catheterization in female
• Conclusion

3. Introduction
• Urethral catheters are tubes inserted into the bladder per- urethral
to allow drainage, injection of fluid, or access to organ for surgert
• Made from materials that have biocompatible properties.
• Urethral catheterization is the aseptic procedure of introducing a tube
or a catheter through the urethra into the urinary bladder for various
purposes

4. • Urethral catheterization is a routine medical procedure that facilitates
direct drainage of the urinary bladder.
• Patients of all ages may require urethral catheterization, but patients
who are elderly or chronically ill are more likely to require indwelling
catheters, which carry their own independent risks.
• The basic principles underlying urethral catheterization are gender-
neutral, but the specific aspects important in the technique of male
catheterization are critical to successful passage.

5. Indications
Diagnostic:
• To collect uncontaminated urine specimen for laboratory investigation
• To distend the bladder prior to abdominopelvic ultrasound.
• Monitoring of urine in critically ill patients, ICU and post-op patients.
• Urinary tract imaging- cystography, RUCG, MCUG
• To measure residual urine volume if ultrasound is not available.
• For diagnosis of urethral stricture.

6. Therapeutic:
• To relieve AUR
• Continuous irrigation of bladder following prostatectomy.
• Instillation of drugs: cytotoxics, BCG, antibiotics.
• Short term urinary diversion.
• Intermittent decompression to treat neurogenic bladder.
• Palliative care in terminal I’ll or incontinent patient, severely impaired
and not correctable by surgery.

7. Other uses of catheter
• Improvised chest drain
• For tube caecostomy
• Improvised as gastrotomy or jejunostomy tube.
• As intraabdominal drain.

8. Contraindications
Absolute
• Suspected or confirmed urethral injury.
Relative
• Urethral stricture
• Uncooperative patient

9. Classes
Based on duration of use
1. Indwelling catheters
2. Intermittent catheters
3. External catheter
Based on no of channel
1. 1way: for drainage
1. 2way: drainage & inflation
2. 3way: additional irrigation
Based on material
1. Plastic 2. Latex 3. Silicone and silicone-coated 4. Teflon 5. Polyvinyl & polyethylene
6. Metal 7. Silver alloy

11. • Latex : suitable for measurement of residual urine; flexible,
inexpensive; prone to infection, encrustation of salt and protein and
can cause stricture from catheter allergy.
• Lasts 3-4weeks as indwelling
• Polyvinyl & polyethylene are for short term use.
• Silicone and Teflon: good for long term use(8-12weeks). Decreased
incidence of allergy, urethritis and stricture.
• Metal: stainless steel

12. Female metal catheter:
• Very rare situations in which the urethra cannot be catheterized by
usual Foley’s
• Evacuation of bladder prior to gynecological or obstetric surgeries
• Diagnosis of vesicovaginal fistula.
Male catheters- curved along it’s length because of anatomy of male.
Problems: high incidence of urethral injury and creation of false
passage.
Should not be left In situ for longer than 2days.

13. • Based on design
1. Foley’s catheter: has balloon at tip. Can be 2- or 3-way
2. De Peezer(mushroom) catheter: lacks balloon.
has bulbous tip to keep it in position.
useful for suprapubic cystotomy
3. Malecot catheter: lacks balloon
has filamentous tip which helps to retain its position
4. Gibbon: lacks balloon & used per urethra only

14. • Tieman
• coude tip
• Robinson catheter
• Counsel
• Nelaton
• Jacques

15. Based on retention
1. Non self retaining: Jacques, Nelaton, Robinson
2. Self retaining: Foley, Malecot, DePezzer etc

21. Sizes and colour codes
• Catheter is expressed in charriere units. Charriére French scale (0.33
mm equals 1 Fr) . D=Fr/3. Diameter=D
• The French size of the catheter depends on the patient and the
catheter’s purpose.
• pediatric boys will need a French size between 5- 12 Fr.
• Adult should be catheterized with a 16- or 18-Fr catheter. •
• Larger French catheters (20 to 30 Fr) are used to evacuate blood clots
in postoperative prostate surgery patients or in patients who are
bleeding from the kidney or bladder.

24. Materials for catheterization
Catheter tray
Povidone-iodin/Savlon
Sterile cotton balls
Water-soluble lubrication gel
Sterile drapes
Sterile gloves
Urethral catheter
Prefilled 10-mL syringe
Urinometer connected to a collection bag

25. Procedure
• Explain the procedure, benefits, risks, complications, and alternatives
to the patient or the patient’s representative.
• Position the patient supine, in bed, and uncover the genitalia.
• Open the iodine/chlorhexidine/savlon preparatory solution and pour
it onto the sterile cotton balls.
• Open a sterile lidocaine 2% lubricant with applicator or a 10-mL
syringe and sterile 2% lidocaine gel and place them on the sterile
field.
• Don the sterile gloves and use the nondominant hand to hold the
penis and retract the foreskin (if present).

26. • Use the sterile hand and sterile forceps to prep the urethra and glans
in circular motions with at least 3 different cotton balls. Use the
sterile drapes that are provided with the catheter tray to create a
sterile field around the penis.
• Using a syringe with no needle, instill 5-10 mL of lidocaine gel 2% into
the urethra. Place a finger on the meatus to help prevent spillage of
the anesthetic lubricant. Allow 2-3 minutes before proceeding with
the urethral catheterization
• Hold the catheter with the sterile hand. Apply a generous amount of
the nonanesthetic lubricant to the catheter

27. • While holding the penis at approximately 90° and stretching it upward
to straighten out the penile urethra, slowly and gently introduce the
catheter into the urethra. Continue to advance the catheter until the
proximal Y-shaped ports are at the meatus.
• Wait for urine to drain from the larger port to ensure that the distal
end of the catheter is in the urethra. The lubricant jelly–filled distal
catheter openings may delay urine return. If no spontaneous return
of urine occurs, try attaching a 60-mL syringe to aspirate urine. If
urine return is still not visible, withdraw the catheter and reattempt
the procedure (preferably after using ultrasonography to verify the
presence of urine in the bladder)

28. • After visualization of urine return (and while the proximal ports are at
the level of the meatus), inflate the distal balloon by injecting the
appropriate volume of sterile water through the cuff inflation port.
• Gently withdraw the catheter from the urethra until resistance is met.
Secure the catheter to the patient’s thigh with a wide tape. If the
patient is uncircumcised, make sure to reduce the foreskin, as failure
to do so can cause paraphimosis.
• Connect to a drainage bag
• Take note of vol, colour,

29. Perineal Pressure Assistance
The distal tip of the catheter might become caught in the posterior fold
between the urethra and the urogenital diaphragm. An assistant can
apply upward pressure to the perineum while the catheter is advanced
to direct the catheter tip upward through the urogenital diaphragm.

30. Catheterization in females
• Put a fenestrated drape over the pelvis so that the vulva is exposed.
• Gently spread the labia and expose the urethral meatus, using your
nondominant hand.
• This hand is now contaminated and must not be removed from the
labia or touch any of the equipment during the rest of the procedure.
• Cleanse the area around the meatus with each cotton ball saturated
in povidone iodine.
• Use a circular motion, beginning at the meatus and working your way
outward.

31. • Discard or set aside the newly contaminated gauze or cotton balls.
• Hold the lubricated catheter and gently pass it through the urethra,
using your free hand. Urine should flow freely into the collection
tubing.
• If the catheter accidentally passes into the vagina, it should be
discarded and a new catheter used

32. Urethral Catheter Removal
Use a syringe to empty the balloon, and then apply gentle traction.
Pain, severe discomfort, resistance to withdrawal of the catheter, or
failure to aspirate normal saline through the inflation valve should alert
the practitioner to the possibility of a nondeflating urethral catheter

33. Complications
Early
• Trauma to urinary tract
• Creation of false passage
• Pericatheter urine leakage
• Genitourinary tract infection ( urethritis, cystitis, pyelonephritis,
epididymoorchitis, prostatitis)
• Urosepsis
• Catheter blockage: clot, debris
• Catheter dislodgement
• Urethral perforation. Bleeding

34. Late
• Urethral stricture
• Calculi( vesical, ureteric, renal)
• Atony of bladder with decreased bladder capacity
• Paraphimosis due to failure of reduced foreskin after catheterization
• Fragmentation of balloon
• Retained catheter ( non deflating balloon).
• Squamous metaplasia, uroepithelial dysplasia and may be carcinoma
• Hypospadias

35. Retained catheter
• This is a condition of a nondeflating urethral catheter that arises from
obstruction of the inflation channel, caused by a failed inflation valve
mechanism or crystallization of the inflation fluid.
• Also arises from encrustations
• The first step in managing the nondeflating Foley balloon is to
advance the catheter to ensure that it is actually in the bladder.
• If this does not work, cut the balloon port proximal to the inflation
valve. This removes the valve and should allow the water to
spontaneously drain.

36. • If this does not work, run a lubricated fine-gauge guidewire through
the inflation channel. The guidewire or stylet should allow fluid to
drain along the wire itself.
• If this does not work, a 22-gauge central venous catheter can be
passed over the guidewire. When the catheter tip is in the balloon,
the wire can be removed, and the balloon should drain.
• If the above techniques are unsuccessful, 10 mL of mineral oil may be
injected through the inflation port and will dissolve the balloon within
15 minutes. If this does not occur, an additional 10 mL can be instilled

37. • If none of the above techniques are successful, a urologist should be
consulted to rupture the Foley balloon with a sharp instrument under
ultrasound guidance.
• Danger of balloon fragments left in bladder if hyperinflation is done
Catheter blockage
• By clots, debris, calculi, thickened pus,
• Use of bladder syringe to flush and irrigate.

38. Pericatheter leakage
Caused by occlusion of drainage lumen by debris.
It can also be caused by bladder spasms triggered by UTI
• If from blocked lumen, flush and irrigate. Change catheter if occlusion
persists
• For bladder spasms: treat UTI, reduce the volume water in inflatable
balloon, anticholinergic use e.g roliten
• Improper catheter positioning, or drainage tube kinking.

39. Spontaneous catheter expulsion
• Catheter expulsion or inadvertent dislodgment, defined as
unintentional catheter removal, usually with the retention balloon
inflated.
• Arises from faulty valve mechanism
• Bladder stones with spikes that rupture balloon
• Straining.

40. • Catheter associated UTI (CAUTI)
• Infections are common because urethral catheters inoculate
organisms into the bladder and promote colonization by providing a
surface for bacterial adhesion and causing mucosal irritation.
• The presence of a urinary catheter is the most important risk factor
for bacteriuria.
• Most bacteria causing CAUTI gain access to the urinary tract either
extraluminally or intraluminally

42. • At least 66% of CAUTIs result from extraluminal contamination,
whereas 34% are a result of the intraluminal route.
There are three catheter-associated entry points for bacteria:
1) the urethral meatus, with the introduction of bacteria occurring on
insertion of the catheter,
2) the junction of the catheter-bag connection, especially when a break
in the closed catheter system occurs, or
3) the drainage port of the collection bag

43. • microorganism can migrate up the catheter into the bladder within 1-
3 days.

44. Conclusion
• Strict asepsis should be followed to avoid CAUTI.
• It’s a simple procedure that contributes to the care of patient but in
inexperienced hands can lead to great morbidity for the patient.

45. •
• Thank you