The document provides guidelines for urinary catheterization including preparing the patient, performing the procedure aseptically, inserting the catheter into the bladder, securing it, and documenting the process. It describes indications for catheterization as well as contraindications. Potential complications are outlined and care of indwelling catheters is discussed.

1. URINARY CATHETERIZATION
Department of Urology
Brawijaya Medical Faculty-SaifulAnwar Hospital
Malang

2. Learning outcome
 In combination with supervised accredited
training, the successful student should be
able to safely place a urinary catheter into the
urinary bladder of a male adult patient.

4. Background
 Urinary catheterisation is an important
procedure skill for many health care
professionals, especially foundation scheme
doctors.
 It is an invasive procedure which has the
potential to cause patients harm.
 should only be carried out by trained health
care providers.

5. Type of catheter

8. Foley catheter
(2-way and 3-way)

9. Tieman tip catheter

10. Catheter diameter

11. Indication
Therapeutic:
 Relief of acute or chronic
urinary retention
 To allow urinary bladder
irrigation
 During certain surgical
procedures (e.g. abdomino-
pelvic surgery)
 In certain patients with
intractable urinary
incontinence (e.g. bed bound
patients with urinary
incontinence and were all
other interventions have
failed)
Diagnostic:
 Monitor urinary output in
critically ill patients
 To measure residual urine
 To obtain an uncontaminated
sample of urine for
microbiological examination

13. Contraindication
 Actual or suspected urethral trauma (e.g.
pelvic trauma)
 Urethral stricture or obstruction

14. Contra indication

15.  Introduce your self to the patient and identify
their correct details
 Prior to any procedure it is important to
perform a full clinical assessment (including a
drug and allergy history).
 It is important to ascertain the indication and
any potential contraindication.
 If at any stage you are unsure whether or not
to perform the procedure - always seek
expert advice

16. Patient information
 Obtain informed consent from the patient.
 Make sure that the patient understands the reasons for
doing the procedure
 Inform them of what they will experience
 Understands the information given to them
 Understands the potential benefits and risks of a decision
 Understands the consequences of refusal of treatment
 Believes the information given to them
 Can retain the information for long enough to make an
effective decision
 Can weigh up the information and make a balanced
decision
 Can make a free choice

17. Patient position
Place the patient in the supine position, with
a protective disposable pad underneath
them. Cover the patient with a sheet to
preserve dignity. Generally you will need an
assistant to help you carry out this procedure

18. Infection control
 Done a disposable
apron and thoroughly
wash your hands

19. Equipment
 Prepare your equipment, while preserving the aseptic nature of
this procedure. Don two pairs of sterile gloves.
 Two pairs of sterile gloves
 Drapes
 Sterile cleansing fluid
 Cotton gauze and balls
 Disposable forceps
 Anaesthetic gel
 Urinary drainage bag
 Appropriate syringe
(always refer to the catheters manufactures instructions)
 Appropriate urinary catheter
 Appropriate fluid to inflate urinary catheter balloon
(Again always refer to the catheters manufactures instructions)

20.  Check that the urinary
catheter balloon
inflates and connect
the urinary drainage
bag to the catheter.
Make sure to check
expiry dates of all
equipment

21.  In an uncircumcised patient retract the
foreskin
 Place a piece of gauze around the shaft of the
patient’s penis.
 Soak the cotton balls in sterile cleansing fluid.
With the disposable forceps cleanse the
urethral meatus and glans in a circular motion
moving out from the centre.

23.  With prior warning,
slowly instill the patient’s
urethra with the local
anaesthetic gel. Apart
from anaesthetising the
urethra, this also helps to
dilate the urethra and act
as a lubricant.
 Over 2-3 mins apply
gentle pressure to the
end of the penis to
prevent any gel escaping

24.  Cover the patient in
sterile drapes

25.  With your dominant
hand gently advance
the urinary catheter.
Never force the
catheter. Asking the
patient to breath
deeply can help over
come urethral spasm

27.  Fully insert the catheter.
 It is important to observe
urine flow into the
catheter. If this does not
occur, despite the catheter
being full inserted, ask the
patient to cough or gently
press on their bladder area.
 Incase some of the
anaesthetic gel has
blocked the catheter tip –
you may consider gently
flushing the catheter with
sterile fluid

28. Push catheter gently

29.  Once you have ensured
that urine is flowing into
the catheter, gently inflate
the balloon as per the
manufactures instructions.
Ensure to inform the
patient to report any
discomfort and observe
closely for signs of distress.
The concern here is that
you may accidentally dilate
the catheter balloon while
it is in the patients urethra.

30. Balloon catheter fixation

31. Catheter fixation

33.  Gently pull the catheter back
 If you have retracted the patients foreskin,
ensure to replace in the normal position
 Secure the tubing and drainage bag.
 Appropriately dispose of all waste
 Wash your hands

34. Catheter urethra in the bladder

35. Difficult catheterization
 Inability to pass S-shaped bulbar urethra
 Tightening of external urethral sphincter
 Organic obstruction

36. Complication
 Urinary tract infections
 Urethral trauma
 Bladder trauma
 Urethral / bladder spasm
 Paraphimosis
 Pressure necrosis of the urethra

37. Document the procedure in the
patients chart.
 It is important to document the duration of
the catheter use and when it needs to be
replaced or removed. Long term indwelling
catheters should be regularly changed as per
the manufactures instructions, but also in the
clinical context of the individual patient
needs. Generally a change of catheter should
be done under antibiotic cover

38. Document the procedure
in the patients chart
 20/4/078
 Tn Kampret
TTL: malang, 12 Januari 1935
Time 14:00
 Procedure:
Urinary catheterization
 Indication:
Acute urinary retention
 Procedure:
Consent obtained
Aseptic technique
10mls of lidocaine gel
Size 16fg foley catheter (male)
10mls of sterile water in balloon
700mls of clear urine drained
No procedural problems
Trial removal of catheter in 1 weeks time

39. Care of indwelling catheter
 Drink much
 Meatal hygiene
 Put urine bag lower than bladder position
 Keep catheter in good fixation
 Always use a urine bag