The document discusses urinary catheters, including their history, types, uses, and procedures for insertion and care. It was originally developed as an open drainage system in the 1920s and later evolved to include closed drainage systems. Catheters are used to drain and collect urine from the bladder for various indications such as urinary retention, monitoring output, drainage after surgery, and instilling medications. Complications include urinary tract infections and difficulties removing catheters due to encrustations or entrapped balloons.

1. DR. SWAPNIL S. TOPLE
DNB UROLOGY
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2. Dr. Frederick Foley
• Developed in the 1920s
by Dr. Frederick Foley
• The urinary catheter was
originally an open
system with the urethral
tube draining into an
open container.
• In the 1950s, a closed
system was developed in
which the urine flowed
through a catheter into a
closed bag.
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3. What is a urinary catheter
Urinary
catheter is any
tube placed in
the body to
drain and
collect urine
from the
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4. INDICATIONS FOR
CATHETERISATION
 broadly divided into two main categories:
1. to obtain drainage or
2. to allow the instillation of diagnostic or therapeutic
agents
 The relief of acute or chronic urinary retention due to
either bladder outlet obstruction or neurogenic
bladder dysfunction is the most common indication
for urethral catheterization
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5.  to monitor urinary output
 Urinary diversion by a catheter is used to allow healing
after lower urinary tract surgery/trauma
 to evacuate the bladder when the urine contains
particulate matter, especially in combination with
simultaneous irrigation (post transurethral resection,
clot/purulent material evacuation)
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6.  to collect of microbiologic clean urine (uncooperative
patients because of age or mental status or
comorbidities that prevent voluntary voiding)
 to measure postvoid residual urine volume samples for
diagnostic purposes
 to provide access to the bladder for urinary tract
imaging studies such as cystography, which requires
the instillation of radiographic contrast material
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7.  UC with a pressure monitoring catheter is used during
urodynamic testing for physiologic assessment of
voiding function
 to allow instillation of pharmacologic agents for local
therapy of some bladder pathologies such as
chemo/immunotherapy for transitional cell carcinoma
(mitomycin, BCG), interstitial cystitis (dimethyl
sulfoxide), and intractable hematuria (e.g., alum,
formalin instillation)
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8. Catheter types
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9. Documentation
 Details regarding
the catheterisation
should be recorded
in the patient’s
notes. For further
information please
refer to your
hospitals policy and
procedure manual.
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10. Matters to consider for Catheterization
• Time and date of catheterisation
• Type of catheter
• Amount of water in balloon
• Size of catheter
• Expiry date of product
• Any problems on insertion
• Description of urine, colour and volume drained
• Specimen collected
• Review date
(Marsden Manual 2001)
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11. What you Need for Catheterization
 1 Dressing trolley
 2. Catheterisation pack including penile
clamp
 3. Sterile gloves
 4. Appropriate size catheter
 5. Xylocaine jelly syringe
 6. Sterile water for the balloon
 7. Syringe
 8. Specimen jar
 9. Antiseptic solution
 10. Waterproof Sheet
 11. Extra Jug
 12. Light source
 13. Tape to secure the catheter to the leg
 14. Drainage bag
 15 Urine bag holder
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12. Catheter selection
 The size and type of urinary catheter used depends on
the indication for catheter insertion, age of the
patient, and type of fluid expected to be drained
 Catheter size is measured in the Charrière or French
scale, whereby one Fr or Ch is equal to 0.33 mm. This
measurement indicates the total circumference of the
catheter and not the lumen size.
 As a general rule, catheter size should be the smallest
size that can accomplish the desired drainage
 12 to 14 Fr for clear urine and 20 to 24 for thick pus or
blood-filled urine
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13. The use of feeding
tubes as urethral catheters should be discouraged because their
stiffness and length can be a source of complications (ischemic
ulcers, urethral strictures, and knotting in the bladder)
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14. MATERIAL
 Modern urinary catheters are most frequently made of
latex, rubber, silicone, and polyvinylchloride (PVC).
 Rubber and latex catheters are often chosen for short-term
drainage.
 Silicone catheters are indicated when there is
rubber/latex sensitivity or allergy and are particularly
suited for patients requiring a longer period of
indwelling time.
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15.  Silicone is relatively inert, causing less tissue reaction,
and is associated with less bacterial adherence than
other catheter materials (Roberts et al, 1990)
 Evidence suggests that the use of silicone catheters is
associated with a lower incidence of urinary tract
infections compared with those made of latex (Crnich
et al, 2007).
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16. COATING
 The application of a viable bacterial coating onto
catheter surfaces as a method of reducing catheter-associated
urinary tract infection (CAUTI) by bacterial
interference is a novel approach that has shown
promise in a small pilot study involving the use of
Escherichia coli–coated catheters
 The rationale is based on natural competition by
nonpathogenic bacteria overpowering any pathogenic
bacteria that may enter the urinary tract (Trautneret
al, 2007). Further study is necessary to confirm if this
will be an effective strategy.
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17. NO OF CHANNELS  SINGLE LUMEN: simple
drainage or
irrigation/instillation
 DOUBLE LUMEN: to permit
addition of a retention
balloon
 TRIPLE LUMEN: for
simultaneous drainage and
irrigation(to drain thick
fluids like pus or blood)
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18.  It should be borne in mind, however, that the addition
of a multichannel catheter is accomplished by
decreasing the overall internal diameter or lumen of
the main drainage channel;
 a 24-Fr three-way catheter has a smaller internal
drainage diameter than a 24-Fr two-way, which has a
narrower lumen than a 24-Fr one-way catheter.
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19. TIP SHAPE
 BLUNT STRAIGHT TIP:
most common (foley)
 CURVED TIP (COUDE):
high bladder neck,
prominent median lobe
of prostate
 END HOLE
(COUNCILL): when
catheterization over
guide wire is required
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20. TECHNIQUE OF CATHETER
INSERTION
 POSITION OF PATIENT
Male: supine
Female: a “frog leg”
position is most suitable
Use of stirrups – in very
obese females
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21. ANESTHETIC
 If topical anesthesia is to be used, evidence suggests it
requires a minimum of 10 minutes of exposure
(depending on the agent), sufficient volume of the
agent (20 to 30 mL), and slow instillation time (>3 to
10 seconds)(Schede andThüroff, 2006; Tzortzis et al,
2009) to have the most effect.
 There is some evidence that cooling to 4° C diminished
the discomfort of lignocaine gel instillation, probably
due to a cryo-analgesic effect (Thompson et al, 1999;
Goel and Aron, 2003).
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22. ANATOMIC CONSIDERATIONS
MALE:
 18 to 20 cm in length
 its diameter variable, a
mere slit to 6 mm during
the passage of urine
 follows a sigmoid curse,
a proximal curve at the
peno-bulbar junction
and another at the
bulbo-membranous
junction
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23. FEMALE:
 LENGTH: 3.5 to 4 cm
long
 The meatus is usually in
an anterior location and
the bladder neck in a
posterior location in the
horizontal plane, giving
the urethra a slight
posterior inclination
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24. Structure of Foley Catheter
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25. PROCEDURE
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35. Gravity will help the Draining
of Bladder
Gravity is important for drainage and
the prevention of urine backflow.
Ensure that catheter bags are always
draining downwards, do not become
kinked and are secured and below
thigh level. Metal or plastic hangers
should be attached to the side of the
bed. Cloth bags tied to the bed to
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36. Rapid draining leads to Complications
 Rapid drainage of large
volumes of urine from
the bladder may result in
hypotension and/or
haemorrhage.(Upson
1995) Clamp catheter if
the volume drained is
1000mls or greater. After
20minutes release the
clamp and allow urine to
drain
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37. Collection of urine from catheterised
patients
 The process of obtaining a sample of urine from a
patient with an indwelling urinary catheter must be
obtained from a sampling port. The sample must be
obtained using an aseptic technique.
 This port is usually situated in the drainage tubing,
proximal to the collection bag which ensures the
freshest sample possible. The use of drainage systems
without a sampling port should be avoided (Gilbert,
2006).
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38. Specimens for Culturing Should
not be Cultured from Urine bags
 Specimens should not be
collected from the tap
from the main collecting
chamber of the catheter
bag as colonisation and
multiplication of
bacteria within the
stagnant urine or around
the drainage tap may
have occurred.
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39. Care of Inserted Catheters
 Every day , wash around the catheter and perineum
with soap and water; rinse and dry these areas well.
you may shower while wearing the catheter
 Sitting in the tub, however , is not recommended.
Good personal hygiene pre vents the accumulation of
bacteria, reduces the risk of infection, and prevents
odour
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40. DIFFICULT CATHETERIZATION
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41. COMPLICATIONS  UTIs account for 40% of all nosocomial infections. The
major risk factor is the use of urethral catheters, which are
responsible for up to (80%) of UTIs in the hospital setting
(Ha and Cho, 2006)
 Risk factors for CAUTIs:
 patients requiring more than 6 days of catheterization,
 female gender
 active nonurinary infection sites
 preexisting medical conditions
Malnutrition
 renal insufficiency
 catheter insertion other than in the operating room
 drainage tubing or a bag elevated above the level of the
bladder(Maki and Tambyah, 2001).
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42.  hematuria,
 urethral and meatal strictures
 urethral perforation
 Allergic reactions including anaphylaxis (Thomas et al,
2009; Wyndaele,2002).
Especially at risk are patients with long-term indwelling
Catheters
 Malignant neoplasms (2.3% to 10%)
 stone formation (46% to 53%),
 bladder neck and urethral erosions (Igawa et al, 2008).
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43.  A unique complication: Inability to remove catheter
from the bladder, reasons being
Due to encrustations,
Entrapment by sutures, or
Inability to disengage/deflate the retaining balloon
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44. HOW TO MANAGE THIS
CONDITION?
 Encrustations:
Mild encrustations-gentle traction will solve the
problem
Significant encrustations-a semirigid ureteroscope and
the holmium:YAG laser to remove the stone fragments
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45.  Entrapment by suture(recent bladder or prostate
surgery)
 semirigid ureteroscopy along the catheter and using
the holmium:YAG to release the suture have also been
described (Bagley et al, 1998; Nagarajan et al,2005).
Because the suture materials used in bladder and
prostate surgery are often absorbable, waiting for
suture dissolution is another option.
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46.  Inability to deflate a foley balloon: a stepwise approach
is followed
One should first attempt to place another 1 to 2 mL of
fluid in the balloon to ensure normal balloon contour,
which may be important with the large-volume
balloons
the next step is to cut the inflation port
insert a surgical steel wire (24 or 28 gauge; often
included as an obturator for small-caliber ureteral
catheters) or the stiff end of a 0.035-inch hydrophilic-coated
guidewire through the valve inflation lumen
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47. ultrasound-guided needle puncture can be conducted
with a lon spinal needle (22 gauge) using either a
transrectal, transvaginal, or suprapubic surface probe
(Daneshmand et al, 2002)
open surgery
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48.  Overinflation of the balloon not recommended-painful
to the patient and may cause bladder injury
and fragmentation and retention of the balloon
fragments (Gülmez et al,1996)
 Use of chemical instillations such as ether or toluene
to induce balloon rupture should be discouraged
because these agents can cause chemical cystitis
(Patterson et al,2006)
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49. REFERENCES
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 Chung C, Chu M, Paoloni R, et al.: Comparison of lignocaine and water-based lubricating gels for female urethral
catheterization: a randomized controlled trial. Emerg Med Australas. 19 (4):315-319 2007 17655633
 Crnich CJ, Drinka PJ: Does the composition of urinary catheters influence clinical outcomes and the results of research
studies?. Infect Control Hosp Epidemiol. 28 (1):102-103 2007 17301937
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not deflate. Urology. 59 (1):127-129 2002 11796297
 Davenport K, Keeley FX: Evidence for the use of silver-alloy-coated urethral catheters. J Hosp Infect. 60 (4):298-303
2005 15936115
 De Ridder DJ, Everaert K, Fernández LG, et al.: Intermittent catheterisation with hydrophilic-coated catheters
(SpeediCath) reduces the risk of clinical urinary tract infection in spinal cord injured patients: a prospective
randomised parallel comparative trial. Eur Urol. 48 (6):991-995 2005 16137822
 Ellis H: The Foley catheter. J Perioper Pract. 16 (4):210-211 2006 16669367
 Garbutt RB, McD Taylor D, Lee V, Augello MR: Delayed versus immediate urethral catheterization following
instillation of local anaesthetic gel in men: a randomized, controlled clinical trial. Emerg Med Australas. 20 (4):328-332
2008 18782206
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50.  Gülmez I, Ekmekcioglu O, Karacagil M: A comparison of various methods to burst Foley catheter
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 Ho KJ, Thompson TJ, O’Brien A, et al.: Lignocaine gel: does it cause urethral pain rather than prevent
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treatment. Int J Urol. 15 (6):481-485 2008 18430150
 Jahn P, Preuss M, Kernig A, et al. Types of indwelling urinary catheters for long-term bladder drainage
in adults. Cochrane Database Syst Rev 2007;(3):CD004997.
 Johnson JR, Kuskowski MA, Wilt TJ: Systematic review: antimicrobial urinary catheters to prevent
catheter-associated urinary tract infection in hospitalized patients. Ann Intern Med. 144 (2):116-126
2006 16418411
 Lee SJ, Kim SW, Cho YH, et al.: A comparative multicentre study on the incidence of catheter-associated
urinary tract infection between nitrofurazone-coated and silicone catheters. Int J
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 Maki DG, Tambyah PA: Engineering out the risk for infection with urinary catheters. Emerg Infect
Dis. 7 (2):342-347 2001
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51. Thank you
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