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1. Urinary Catheterization
By: Ahmad Thanin

2. Definition
Urinary Catheterization is a medical procedure of
insertion a catheter through Male or Female urethra's
opening direct to bladder
Urinary Catheterization is used either therapeutic or
diagnostic.
Urinary Catheterization is done when a person is unable
to urinate using a toilet, bedpan, urinal, or when accurate
urinary output is required

3. Other Medical Terms
Dysuria:
Painful or
difficult
urination.
Hematuria:
Blood in
urine.
Nocturia:
Frequent
urination at
night.
Polyuria:
Large
amount of
urine.
Urinary
Urgency:
Need to void
at once.
Urinary
Frequency:
Voiding
frequent
intervals.

4. Indication
Therapeutic Diagnostic
Acute & Chronic Urinary Retention.
Intractable urinary incontinence
Bladder Irrigation.
Post operative.
Post spinal injury.
Post Epidural Anesthesia.
Measure Residual Urine.
Bladder investigation.
Allow intravesical drug
instillation
Obtain uncontaminated
urine sample

5. Contraindications
Acute
Prostatitis.
Urethral injury
or trauma.
Agitated
patient.
Allergy to
latex.

6. Types of Catheterization
• consists of a soft
plastic or rubber
sheath, tubing, and a
collection bag for the
urine.
Condom catheter
• used when the
catheter is to be
inserted and removed
immediately
Straight Catheter
• known as Foley
catheter, is left inside
the bladder to
provide continuous
urine drainage.
Indwelling Catheter
• is a type of indwelling
catheter. It is inserted
to irrigate the bladder
to prevent
obstruction (i.e
bleeding)
3-Way Catheter for
continuous bladder
irrigation (CBI)
• inserted into the
bladder through a
surgical incision
made in the
abdominal wall, right
above the pubic bone.
Suprapubic
Catheter

7. Complications
• Urinary Tract Infection.
• Creation of false passages.
• Urethral strictures.
• Urethral perforation.
• Bleeding
Acute phase
• Prostatitis.
• Cystitis.
• Urethritis.
• Pyelonephritis.
• Sepsis
For long period use:

8. Symptoms of a CAUTI can
include
pain in the lower
abdomen or groin area
a high temperature
a burning sensation
during urination
more frequent
urination

9. A person can reduce their risk
of developing a CAUTI by:
washing their hands thoroughly with soap and warm water before and after
touching catheter equipment
keeping the skin around the catheter entrance clean by washing it with mild soap
and water twice per day
ensuring that urine collection bags are kept below the level of the bladder, as this
will help prevent blockages
not lying on the catheter, as this can prevent the flow of urine through the tube
ensuring that there are no twists or kinks in the tubing, as blockages can raise the
risk of infection
keeping hydrated by drinking one or two glasses of liquid every 2 hours

10. Catheter Insertion
Equipment – General
Sterile Gloves.
Suitable Antiseptic.
Swabs or cotton wool.
Sterile paper towel or sterile blanket.
Anesthetic lubricating gel (Lignocaine Gel)
Appropriate size of sterile catheters.
Urine bag.

11. How To Do Urethral
Catheterization in a Female
Equipment
• Sterile drapes and gloves
• Povidone iodine
• Applicator swabs, sterile gauze, or cotton balls
• Water-soluble lubricant
• Urethral catheter (size 16 French Foley catheter is
appropriate for most women)*
• 10-mL syringe with water (for catheter balloon inflation)
• Sterile collection device with tubing

12. • The female urethral meatus appears as an anterior-
posterior slit located anterior to the vaginal opening and
about 2.5 cm posterior to the glans clitoris. If the meatus
recedes superiorly into the vagina, as can happen in
older women, it can often be palpated in the midline as a
soft mound surrounded by a firm ring of periurethral
tissue.
Relevant Anatomy
• To expose the vulva, position the patient supine in either
lithotomy or frog position (hips and knees partially
flexed, heels on the bed, hips comfortably abducted).
Positioning

13. Step-by-Step Description of
Procedure
Place all equipment within easy reach on an uncontaminated sterile field on
a bedside tray. You may put the box containing the catheter and the drainage
system between the patient’s legs, so that it is easily accessible during the
procedure.
If not done already, attach the catheter to the collection system and do not
break the seal unless a different type or size of catheter is required.
Test the retention balloon for leaks by inflating it with water.
Apply lubricant to the tip of the catheter.
Saturate the applicator swabs, cotton balls or gauze with povidone iodine.

14. Place the sterile 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. 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.

15. Inflate the balloon with the
recommended volume of water, usually
10 mL. Resistance or pain may indicate
that the balloon is in the urethra and
not the bladder. If so, deflate the
balloon, then insert it all the way
before reinflation.
Pull the balloon up snug against
the bladder neck, after the balloon
has been inflated, by slowly
withdrawing the catheter until
resistance is felt.

16. • Remove the drapes.
• Secure the catheter to the thigh with an adhesive
bandage or tape.
• Hang the bag on the bed rails, so that urine can drain
via gravity.
Aftercare
• Be sure to maintain strict sterile technique during the
procedure to avoid urinary tract infection.
Warnings and Common Errors

17. How To Do Urethral
Catheterization in a Male
Equipment
• Sterile drapes and gloves
• Povidone iodine with application swabs, cotton balls, or gauze
• Water-soluble lubricant
• Urethral catheter* (size 16 French Foley catheter is appropriate for
most men; in the setting of prostatic hypertrophy or urethral
stricture, an alternate size or style of catheter may be required†)
• 10-mL syringe with sterile water (for catheter balloon inflation)
• Local anesthetic (eg, 5 to 10 mL of 2% lidocaine jelly in a syringe
[with no needle]) for distention and anesthesia of the male urethra
• Sterile collection device with tubing

18. Relevant Anatomy
• The male urethra bends acutely at the pubis.
Always hold the penis straight and upright, to
smooth out the curve, when passing a catheter
through the urethra.
Positioning
• Position the patient supine with hips
comfortably abducted.

19. Step-by-Step Description of
Procedure
Place all equipment within easy reach on an uncontaminated sterile field on a
bedside tray. You may put the box containing the catheter and the drainage
system between the patient’s legs, so that it is easily accessible during the
procedure.
If not done already, attach the catheter to the collecting system and do not
break the seal unless a different type or size of catheter or irrigation of the
catheter is required.
Test the retention balloon for integrity by inflating it with water, and apply
lubricant to the catheter tip.
Saturate the applicator swabs, cotton balls, or gauze with povidone iodine.
Place the sterile fenestrated drape over the pelvis so that the penis remains
exposed.

20. Grasp the shaft of the penis using your nondominant hand,
and retract the foreskin if the patient is uncircumcised. This
hand is now nonsterile and must not be removed from the
penis or touch any of the equipment during the rest of the
procedure.
Cleanse the glans penis with applicator swabs, gauze, or
cotton balls saturated in povidone iodine. Use a circular
motion, beginning at the meatus, and work your way
outward. Discard or set aside the newly contaminated
items.
Inject viscous lidocaine into the urethra. Insert the hub of
the lidocaine-containing syringe into the penile meatus and
inject about 5 mL. Pinch the meatus closed, to retain the
lidocaine within the urethra, for at least 1 minute. The
lidocaine distends the urethra, as well as provides some
anesthesia, thereby easing catheter passage.

21. Hold the catheter in your free hand. If a coudé catheter is being used, the tip
should point upward, so as to track the superior urethral wall during
insertion.
Advance the catheter slowly through the urethra and into the urinary bladder.
Patient discomfort is common. Ask the patient to relax and take slow deep
breaths as you continue to apply steady pressure on the catheter until it is
fully advanced to the level of the side port. Urine should flow freely into the
collection tubing.
Slowly inflate the balloon with 5 to 10 mL of water. Obvious resistance or
patient discomfort suggests incorrect placement. If this happens, deflate the
balloon, withdraw the catheter slightly, and then reinsert the catheter all the
way before trying to reinflate the balloon.
Position the balloon at the bladder neck, after successful balloon inflation, by
slowly withdrawing the catheter until you feel resistance.
To prevent paraphimosis, reduce the foreskin after the procedure.

22. • Remove the drapes.
• Secure the catheter to the thigh with an adhesive bandage, tape, or
strap. Some advocate taping the catheter to the lower abdominal wall to
minimize pressure on the posterior urethra.
• Place the bag below the level of the patient to ensure that urine can
drain via gravity.
Aftercare
• Be sure to maintain strict sterile technique during the procedure to
avoid urinary tract infection.
• Be sure to reduce the foreskin after the procedure.
• Be careful not to use excessive force during insertion, which could
potentially cause urethral injury.
Warnings and Common Errors