urinary Catheterisation nursing procedure

Catheterisation is the process of introduction of a fine rubber, plastic, or metallic tube through the urethra into the urinary bladder in order to remove urine, monitor output, keep the bladder empty, or to keep the ureter open

Urinary catheterisation nursing procedure is done in schools and hospitals for learning and helping the patients

Types of Catheter

Non-retaining catheter

This catheter is also called an “in and out” catheter. It is only inserted to remove urine from the bladder and is removed immediately after the bladder is empty. They do not have balloons.

Self-retaining catheter

This is a catheter that, when passed, stays for some days. It has a balloon that helps to hold it in place. The most common are the Foley catheter and Malecot catheter. We have one-way and two-way types; they both have different functions. Self-retaining catheters are used to drain urine from the bladder for a long time—for example, in continuous bladder drainage, bladder irrigation, and urine output vs. fluid intake monitoring.

Metallic and non-metallic

These are catheters used in conditions where flexible non-metallic catheters cannot work.

Sizes of Catheter

Catheters are of various sizes according to the French scale. All age categories have their specific catheter size, from children to adults, women, and men

• Size 8 to 10 are for children
• Size 12 to 14 are for adult females
• Size 18 to 24 are for adult males
• Generally, the size ranges from 6 to 24

Indications / Importance of Catheterisation

These are the conditions where catheterisation is clinically accepted

• Collecting a urine sample for investigation like urinalysis, urine culture, and sensitivity.
• Pre-operative, post-operative, and intra-operatively to ensure the bladder is empty.
• In pelvic or abdominal surgeries to prevent injury or trauma.
• To measure the amount of residual urine after urinating.
• Splinting the urethra following urethral surgery or trauma.
• Urine incontinence to prevent pressure sores.
• Urine retention to empty the bladder when other nursing interventions fail.
• For accurate monitoring of urine in case of unconscious patients, patients with kidney failure, or patients in the ICU.
• To relieve bladder obstructions.
• Chronic urine incontinence.
• To empty the bladder for irrigation or instillation.
• Before bladder contrast X-rays for examination in case of fistula suspicion.
• To empty the bladder during labor to prevent obstruction and assist labor progress.

Contraindications of Catheterisation

Conditions where catheterisation should be avoided or done with caution:

• Infections of the urinary tract
• Suspected injuries to the urethra
• Allergy to catheter products like latex
• Surgery on the bladder

Causes of Catheterisation Failure

1. Urethral stricture: The urethra is reduced and becomes narrow or small so that it cannot allow a catheter to pass. Could be due to inflammation, trauma, or infection.
2. Enlarged prostate: Compresses the urethra, making catheter passage difficult (men only).
3. Tumours: Obstructing the urethra can prevent the catheter from entering the bladder.
4. Stones: Obstructing the urethral orifices.
5. Urethral spasm: Involuntary tightening of the urethral muscles resisting catheter insertion.
6. Congenital urinary tract abnormalities: Birth defects such as CAKUT prevent smooth catheter insertion.
7. Inadequate lubrication: Causes friction, pain, and difficulty advancing the catheter.
8. Wrong size catheter: Too large causes pain/injury; too small may coil or fail to drain urine.
9. Wrong catheter type: Inappropriate design for patient anatomy (e.g., straight vs. Coudé).

Setting a Trolley for Catheterisation

It is a sterile trolley, so setting starts from the bottom to the top. Wash hands first.

Bottom Shelf

• Catheter of an appropriate size
• K-Y Jelly for lubrication
• Antiseptic solution
• Receiver for used hand towels
• Receiver for used gloves
• Receiver for used swabs and gauze
• Drainage bag or spigot
• Two pairs of sterile gloves
• 20 ml syringe for ballooning
• Specimen bottle
• Laboratory form (if needed)
• Mackintosh and towel
• Water for ballooning
• Fluid balance chart
• Strapping for securing
• Scissors

Top Shelf

• Two sterile towels for covering the trolley
• One drape for providing a sterile field
• Receiver for receiving urine
• Gallipot for gauze
• Gallipot for cotton swabs
• Gallipot for antiseptic
• Sterile hand towel
• Towel clips for holding the drape

Bedside

• Screens for privacy
• Handwashing equipment
• Spotlight for lighting

Procedure for Catheterisation of a Female Patient

The method for passing a catheter to a female is different from males due to anatomy

Procedure for female catheterisation

1. Explain the procedure to gain cooperation and prevent embarrassment.
2. Provide privacy with screens and close the windows.
3. Ask for an assistant.
4. Position the trolley next to the bed.
5. Wear aprons to protect uniforms.
6. Position the patient dorsally with knees flexed and abducted.
7. Protect bedding with Mackintosh.
8. Wash hands surgically.
9. The assistant prepares items (cotton, gauze, lotion, gloves).
10. Wear sterile gloves.
11. Perform vulvar swabbing.
12. Drape the patient for a sterile field.
13. Place a receiver for urine.
14. Lubricate the catheter with K-Y Jelly.
15. Spread the labia and locate the urethral orifice.
16. Pass a catheter into the bladder, collect a urine sample if needed.
17. Balloon catheter with sterile water.
18. Connect the urinary bag or spigot.
19. Lift receiver and measure urine.
20. Remove the drape and Mackintosh.
21. Place a drainage bag for gravity drainage.
22. Thank the patient and leave her comfortable.
23. Clear the trolley and document the procedure.

Procedure for Catheterisation of a male Patient

setting is the same as for female catherisation

Procedure

1. Explain the procedure and gain cooperation.
2. Provide privacy with screens.
3. Ask for assistance.
4. Position the trolley and the patient.
5. Wear aprons.
6. Protect bedding with Mackintosh.
7. Wash hands surgically.
8. The assistant prepares items.
9. Wear sterile gloves.
10. Drape the penis and retract the glans if uncircumcised.
11. Clean the glans penis with an antiseptic.
12. Hold the shaft upright.
13. Place the receiver and lubricate the catheter.
14. Pass a catheter and collect a urine sample if needed.
15. Balloon catheter with sterile water.
16. Connect the urinary bag or spigot.
17. Measure urine, remove the drape, and place the drainage bag.
18. Thank the patient and clear the trolley.
19. Document procedure and findings.

Emptying a Urinary Bag/Drainage Bag

Follow standard procedure. Empty as per patient condition (hourly in ICU or every 24 hours).

Complications of Catheterisation

• UTI
• Urethral trauma or injury
• Bleeding or haematuria
• Pain and discomfort
• Urethral stricture
• Bladder spasm
• Catheter blockage
• Catheter leakage
• Paraphimosis (uncircumcised males)
• Sepsis
• Loss of bladder tone
• Psychological distress or anxiety

Care for Urinary Catheter

• Wash your hands before and after handling the catheter or the bag.
• Clean the perineal area daily.
• Keep the bag below the bladder level.
• An empty bag is half-full.
• Ensure tubing is free from twists.
• Clean the drainage outlet before and after emptying.
• Replace a dirty or damaged bag.
• Assess the insertion site for infection.
• Monitor urine flow, colour, smell, and sediment.
• Report and document findings.