OzEMedicine - Wiki for Australian Emergency Medicine Doctors

see also:

• urology
• suprapubic catheterisation
• acute urinary retention
• Vic. Better Health Channel Patient Information Sheet - urinary catheterisation
• Continence Foundation of Australia
• NWM Division of GP's - urinary catheter resources for Mx of Residential Aged Care patients
• YouTube video on male urinary catherisation procedure - basic nursing asepsis emphasis
• YouTube video male urinary catherisation procedure - brief video - no sound needed
• Emedicine.com - male catheterisation
• State Uni of NY Buffalo
• NSW GMCT Urology Network - bladder washout / irrigation guidelines (pdf)

• hand washing should be performed immediately before and after all catheter-related interventions.
• aseptic technique using sterile equipment is recommended for the insertion of indwelling or intermittent catheters.
  • however, sterile scrub and use of sterile gloves and gown is NOT necessary as there is no evidence this reduces rate of UTI.
• use catheters with 5-10ml balloons as larger balloons increase bladder irritation and may increase risk of stricture formation.
• use the smallest catheter size possible to reduce discomfort and possible pressure necrosis of urethra, however, larger, 3 way catheters may be needed in the short term to manage heavy bleeding with clots.

• presence of, or suspected urethral trauma
  • eg. straddle injuries, blood at meatus in multi-trauma patients, high-riding prostate on PR, scrotal haematoma, unstable pelvic fracture, inability to void.
  • consider retrograde urethrography prior to attempting catheterisation
• traumatic attempt at urethral catheterisation which may have produced a false passage
  • consider suprapubic catherisation as an alternative

• urinary catheters are sized according to the French units system
• 1 French = 0.33mm = 0.013“ = 1/77th of an inch
• thus the size in French units is roughly equal to the circumference of the catheter in millimeters.
• urinary catheters are commonly available in sizes from 10F to 28F

• invented by Boston medical student Frederic Foley in the 1930's.
• rubber for short term use, silastic for long term use (antibiotic-coated or silver impregnated ones may reduce UTI rate)
• self-retaining via inflatable balloon proximal to drainage hole
• usual size for adults 14 or 16F (children usually require 8-12F and may require an introducer to place)
• 3-way Foley catheter has an extra lumen to allow irrigation of blood clots and are usually 22F

• PVC catheter with tapered pointed end but not self-retaining
• useful in locating urinary passages through prostatic urethra altered by previous surgery
• 12-14F

• straight PVC catheter, not self-retaining

• firm PVC catheter with lumen at end but not self retaining
• used to evacuate clots from bladder using a 50ml Twoomey syringe
• 22F

• UTI
  • After 48 hours of catheterization, most catheters are colonized with bacteria, thus leading to possible bacteruria and its complications.
  • ~5% septic complication per day of IDC in hospitals
  • The risk of developing catheter-associated UTI ranges from 1-5% in individuals who have one intermittent catheterisation, to 20% of individuals with indwelling catheters with closed drainage systems.
  • Risk of infection following catheterisation depends on the technique used for catheter insertion, duration of catheterisation and the quality of catheter care.
  • risk is lower with suprapubic catheters or with intermittent catheterisation when compared to long term IDC.
• structural damage to the urinary tract
• bleeding
• false passage
• pressure necrosis of urethra due to excessively large catheters
  • catheter leakage
  • discomfort
  • stricture formation
• bladder erosions and bleeding after relief of retention
• paraphimosis if forget to return foreskin to its normal position after insertion of catheter

• chronic renal inflammation
• chronic pyelonephritis
• development of calculi (kidney stones)
• symptomatic UTI that may lead to bacteraemia, sepsis and death.

• Mx of acute urinary retention
• the unwell patient where accurate fluid balance or urinary output documentation is required and the benefits outweigh the risks of urosepsis.
• impaired conscious state or the intubated patient where there is inability to control voiding
• following urologic or gynaecologic surgery where retention or other issues are likely.
• where movement of the patient is contraindicated - eg spinal trauma, post-op hip replacements
• urinary incontinence where contamination of nearby wounds is a risk

• Urinary tract obstruction that is not correctable medically or surgically
• Extensive skin breakdown caused or exacerbated by incontinence
• Neurogenic bladder and retention
• Palliative care for terminally ill or severely incontinent residents for whom attendance of continence care and hygiene is uncomfortable
• Preference of a resident who has not responded to other incontinence interventions

• phimosis
  • may require a dorsal slit or dilatation of foreskin with artery forceps under dorsal nerve block
• meatal stricture
• urethral stricture
  • may require dilatation with urethral sounds by a urologist
• obstruction at prostatic urethra
  • may be due to external sphincter spasm:
    • try 2nd dose of lubricant and milk down urethra
    • try gentle sustained pressure with catheter
    • try 16F silastic
    • try 12-14F Tieman's
    • discuss with urology
      • consider 16F silastic on an introducer
      • consider dilatation with urethral sounds

• usually due to failure of the balloon to empty
  • check catheter for evidence of obstruction
  • consider injecting contrast into catheter to determine level of obstruction
  • discuss with urology to consider procedures to puncture the balloon
  • as a last resort, consider cutting the catheter:
    • clamp catheter with forceps to ensure it cannot recoil into patient when cut
    • first cut proxomal to balloon inflation valve
    • if this does not allow balloon to deflate, and obstruction seems to be in extracorporeal section, cut catheter on the patient side of the obstruction.