Insertion of a urinary catheter
From WardWiki - Foundation Doctor Helper
Insertion of a urinary catheter is an important ward skill and makes for an ideal DOPs. This article takes the foundation doctor through the procedure. It pays no attention to the indications for it. The french catheter scale is used to sized catheters. As a rough rule, use 14F to 18F for men and 12F to 14F for women. The following technique is from the NHS Greater Glasgow & Clyde Control of Infection Committee Standard Operating Procedure.
Contents |
Preparation
The following equipment is required and should be prepared at the bedside, it is not good parctice to transport exposed sterile equipment around a ward.
Sterile catheter and catheter pack.
Smallest gauge catheter that will allow free urinary flow. (Choice of catheter will depend on patient assessment paediatric/ adult and anticipated duration of catheterisation).
Where long-term catheter use is required the patient/ parent/ guardian should be involved in the catheter choice. Choose also the most appropriate catheter length - standard length catheters or female catheter.
Sterile single-use anaesthetic lubricant, e.g. Instillagel® (Check patient is not allergic to the anaesthetic pre-use).
Urinary drainage bag.
Two pairs of sterile gloves.
10ml syringe filled with 5-10ml sterile water as per manufacturer’s instructions for Foley catheter balloon.
Normal saline.
Catheter stand for bed bound patients (acute settings), leg straps or sleeve for (non-acute) mobile patients. The patient’s preference should be considered.
A light source may be required.
Catheter balloon size to be no greater than 10mls. (Urological patients may need larger sizes).
Setting up / Sterile technique
Explain the procedure and the rationale for the catheterisation to the patient/ parent/ guardian.
Wash hands with liquid soap and water then alcohol gel.
Put on a plastic apron.
Prepare a trolley or appropriate surface area with the required equipment and take it to the patient’s bedside.
Explain the procedure and ensure privacy.
Prepare the patient. Ensure the patient is not unduly exposed.
Place protective sheeting below the patient’s buttocks.
Decontaminate hands with alcohol hand rub.
Open the packs.
Decontaminate hands with alcohol hand rub.
Don sterile gloves (both pairs).
Female Patients
Thoroughly cleanse the vulval area with either sterile saline/ sterile water or tap water swabbing from above downwards. Cleanse the labia minora vestibule in turn. Identify the urethral meatus and cleanse.
Male Patients
Cleanse the glans penis with either sterile saline /sterile water or tap water. In non-circumcised patients, retract the prepuce (foreskin) slightly to enable the glans penis to be cleansed and the urethral opening to be visible. NB Do not fully retract a phimotic foreskin. Remember to return the foreskin to its normal position once the procedure is completed.
Insertion
Arrange sterile drape beneath the patient.
Inform the patient that the local anaesthetic is cold and may sting.
Apply sterile single-use anaesthetic gel. If using anaesthetic gel anaesthetise urethra by applying for adults, 6mls female or 11mls male of local anaesthetic slowly and evenly into the urethra.
Allow a minimum of 5 minutes to elapse before passing the catheter.
Discard first pair of gloves.
Position sterile bowl to catch urine.
Open inner cover of the catheter.
Lubricate the tip of the catheter using a swab covered in anaesthetic gel.
Gently insert the catheter and monitor flow of urine.
(Female patients: Do not touch any part of the vulva with the catheter).
(Male patients: ensure that the glans penis is held at an angle away from the abdomen during catheterisation to allow the smooth passage of the catheter).
Post procedural care
Wipe the area
Cover the patient and preserve dignity
Record the residual volume
Obtain a urine dipstick if infection suspected
