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CDHB

Urethral Catheterization

Indications for Urethral Catheterization

• Acute retention.
• Unconscious or sedated patients unable to void.
• In the operative and perioperative setting.
• Patients with prolonged epidural anaesthesia e.g., in labour.
• Chronic retention if associated with impaired renal function or infection.
• Incontinence.

  Note: Urethral catheterization for incontinence needs to be carefully assessed in light of social situation.

Male Urethral Catheterization

Algorithm for Male Urethral Catheterization

Notes

1. Straddle injury (fall, kick, cycle) or fractured pelvis (car accident, fall, crush) accompanied by penile tip blood, lower abdominal pain and inability to pass urine, or perineal haematoma.
2. If history of:
   • Urethroplasty or radical prostatectomy <6 weeks

     This surgery indicates the presence of a urethral graft or anastomosis. Catheterization should therefore be performed by a Urology Registrar if available. If unavailable, medical staff to insert a suprapubic catheter.

   • Urethroplasty or radical prostatectomy >6 weeks

     Proceed with urethral catheterization with care using 14 Fr catheter. If unsuccessful, insert a suprapubic catheter.

3. Potential risks for urethral catheterizations:
   • Other prostate or urethral surgery in the last four weeks (e.g. TURP, urethrotomy, bladder neck incision)
   • Urethral trauma in the last four weeks
   • Known prostate enlargement
   • Known urethral stricture
   • History of long term difficulty in passing urine (e.g., urinary retention, poor urinary flow)
   • History of difficult urethral catheterization previously
4. Bacterial endocarditis prophylaxis: for full details, refer to Infective Endocarditis Prophylaxis. For other situations, seek Consultant advice.

Insertion of Urinary Catheter

• Explain the procedure to the patient and gain informed consent.
• Select appropriate catheter (bigger is usually better, e.g., 18-20 Fr).
• Set up equipment following recommended best practice.
• Infection prevention: Catheter associated infections are the most common hospital-acquired infection. Risks can be reduced by adhering to standard precautions, including the 5 moments of hand hygiene and using an Aseptic Non-Touch Technique (ANTT).
• Choose catheter size and type according to reason for catheterization. Choose the catheter that will suit the purpose of the catheterization:
  • Use catheter size 16 - 18:
    • For uncomplicated urinary retention.
    • To facilitate accurate urine measurements.
    • For urinary incontinence.
  • Use catheter size 20 - 24, 3 way:
    • For moderate to heavy haematuria with potential for clots e.g., post urological surgery, bladder and/or prostate cancer, renal trauma.
  • Recommended best practice:
    • If catheter does not pass along the length of the urethra and into the bladder with ease, do not proceed. Seek advice.
    • If catheter is being inserted for retention, ensure volume of urine drained is measured and documented in patient's notes.
    • If catheter enters the bladder and urine begins to drain, advance the catheter until the Y-connection reaches the meatus before inflating the balloon. This ensures the balloon is clear of the urethra and within the bladder, preventing trauma on inflation.
    • If the patient has not been circumcized, return the foreskin to its natural position after catheterization.
• Clearly document in clinical notes:
  • Date/consent given.
  • Reason for catheterization.
  • Catheter type, length and size.
  • Amount of water in balloon.
  • Any problems with procedure.
  • Description of urinary drainage on insertion.
  • If specimen sent for further investigations.
  • Review date/catheter change or removal.
• Indications for Suprapubic Catheterization:
  • Failed urethral catheterization
  • Long term management of patients with neuropathic bladders

    Note: If contemplating this always discuss with the Urology Registrar or Consultant.

  Beware of lower abdominal scars from previous surgery: loops of bowel may be under the scar between skin and bladder.

Subsequent Management

Urinary catheters should be removed as soon as possible, but this will vary according to the circumstances. Seek advice - if the catheter is removed prematurely, it may have to be reinserted.

Topic Code: 3727