Urinary catheterization

What is Urinary Catheterization?

Insertion of a hollow tube (catheter) through the urethra into the bladder to drain urine.
It is a sterile (aseptic) procedure, must be done under strict sterile conditions to prevent infection.

Indications of Urinary Catheterization

A) Diagnostic purposes B) Theraputic purposes
1. Acute urinary retention
1. To obtain a sterile urine sample
• To immediately relieve bladder distension.
• Especially when the patient cannot void or when
2. Bladder outlet obstruction
contamination must be avoided (Female) .
• E.g., enlarged prostate (BPH), urethral stricture.
2. To measure post-void residual urine (PVR)
3. Before, during and after surgery
• To check how much urine remains in the bladder after
• To keep bladder empty and monitor urine output.
voiding.
4. Neurogenic bladder (Clean Intermittent Catheterization)
3. To monitor accurate urine output
• In spinal cord injury, multiple sclerosis, diabetic neuropathy.
• Important in critically ill patients, ICU, shock,fluid
5. Continuous bladder drainage
resuscitation , or acute kidney injury (AKI).
• In unconscious, immobilized, or incontinent
4. Pressure measurement
patients with skin breakdown.
• To measure intravesical (bladder) pressure or
6. Bladder irrigation
intra-abdominal pressure.
• To wash out blood clots (e.g., after TURP or bladder surgery).
5. Before imaging studies
7. Instillation of drugs into the bladder
• Such as cystourethrogram or contrast studies.
• e.g., chemotherapy, antibiotics.
8. Relief of obstructive uropathy
🚫 • Prevents back pressure on kidneys.
Contraindications of Urinary Catheterization
⚠ ➡
Absolute Contraindications (Do NOT catheterize) Relative Contraindications (Use with caution)
1. Suspected urethral injury 1. Urethral stricture
Signs include: 2. Recent urethral or prostate surgery
• Blood at the urethral meatus [Link] prostatomegaly (very enlarged prostate)
• Perineal bruising (butterfly hematoma) [Link] prostatitis (risk of bacteremia & severe pain )
• Inability to pass urine after pelvic trauma (fracture) 5. Congenital urethral abnormalities
• High-riding prostate on rectal exam
Inserting a catheter worsen the injury or create false passage.
In this case, a suprapubic catheter is preferred.
Rule out urethra injury by retrograde urethrogram
Complications of Urinary Catheterization
1. Pain
2. Urinary Tract Infection (UTI) (major risk)
3. Bleeding : mucosal injury
4. Urethral Trauma / Injury : forceful insertion,false passage
5. Catheter Blockage : Catheter Encrustations
6. Bladder Spasms : (‫ )العيان حاسس انه دايما مزنوق‬due irritation caused by the ballon
7. Urinary Leakage : Leakage around the catheter (bypassing)
Caused by : Blocked catheter , Bladder spasms

Catheter Sizes (French Scale – Fr)

Catheters are measured using the French (Fr) scale: Common sizes:
• 1 Fr ≈ 0.33 mm in diameter • Children: 8–10 Fr
Example: • Adult females: 14–16 Fr
• 18 Fr catheter = 6 mm diameter (18 × 0.33) • Adult males: 20–22 Fr

Males usually need larger catheters because: • The smaller the number the smaller the catheter
• The male urethra is longer
• The larger the number the larger and stiffer the catheter
• A stiffer catheter is easier to advance

Types of Urinary Catheters

1. Intermittent Catheter (Nelaton)

• Used for short-term drainage (about 5–10 minutes).
• Inserted, bladder drained, then removed immediately.
• Can be self-inserted by the patient.
• No balloon as no need for fixation
• Used when temporary urine drainage is needed or Instillation of drugs into the bladder
Balloon port
2. Indwelling (Retention / Foley) Catheter Urinary drainage bag

• Stays inside the bladder for a long period ( one week). Irrigation site

• Not Transparent (‫صفراء معتمة)مش شفافة‬

• Has a balloon at the tip that is inflated with sterile water to keep it in place.
• Connected to a urine drainage bag.
• Used for continuous drainage.
3. Silicone Catheter
• Stays inside the bladder for a long period ( month). Urinary drainage bag
Balloon port
• Transparent , harder than Foley catheter
‫أصفر شفاف أو أبيض شفاف‬
• Has a balloon at the tip that is inflated with sterile water to keep it in place.
• Connected to a urine drainage bag.
• Used for continuous drainage.
4. Suprapubic Catheter
• Inserted into the bladder through a small surgical incision above the pubic bone.
• Does not pass through the urethra.
• Used for long-term continuous drainage.
• Used when urethral catheterization is not possible.
Types of indwelling catheters
• 2-way Foley catheter
The two lumens are used for:
1. Urine drainage drains urine from the bladder
[Link] inflation to inflate the balloon and keep the catheter in place
• 3-way Foley catheter (for bladder irrigation)
The three lumens are used for:
1. Urine drainage
2. Balloon inflation
3. Continuous bladder irrigation (CBI) – to wash out the bladder
When is it used?
• In cases of blood clots in the bladder
• For hematuria (blood in urine)

Preparation Before Catheterization

Required equipment:
• Sterile catheter
• Syringe with sterile water (10 ml)
• Cotton balls with antiseptic (betadine)
• Lubricant
• Sterile gloves
• Light source
• Urine drainage bag
• Tape or leg strap

Urinary catheterization checklist

1 Informing the patient (explain procedure & obtain consent)

2 Sterilization: • Genitalia cleaning & Wearing sterile gloves
3 Opening catheter pack & applying sterile lubricant
4 Introduction of catheter (Insertion)
5 Check for proper position of catheter (urine flow seen)
6 Fixation of catheter & check urine collection in bag
♀ Female Urinary Catheterization
1. Preparation
• Explain the procedure to the patient & Obtain consent
• Provide privacy & good lighting
• Wash hands & Put on sterile gloves
2. Positioning
• Place patient in dorsal recumbent position + Knees flexed, legs apart
3. Cleaning the Area
• Separate the labia place the thumb and forefinger with non-dominant hand
between the labia minora, spread and separate upward
• Clean urethral area by antiseptic from front to back (above the meatus downward toward the rectum)
• Use one cotton ball per swipe
4. Lubrication
• Open sterile catheter pack
• Apply sterile lubricant to catheter tip (5–6 inches)
5. Catheter Insertion
• Hold labia apart
• Gently insert catheter upward into urethral meatus
• Ask patient to breathe slowly if resistance occurs ( This may relax the sphincter muscle)
• Do not force the catheter
6. Confirm Position
• When urine flows, advance catheter about 1 inch further
7. Balloon Inflation ⚠
Important safety rule
• Inflate balloon with 10 mL sterile water Never inflate the balloon unless you are confident
the catheter tip is inside the bladder.

• Gently pull catheter until balloon rests at bladder neck

8. Fixation & Drainage
• Connect catheter to urine drainage bag
• Secure catheter to inner thigh
• Keep bag below bladder level
9. Aftercare
• Check urine (amount, color, odor)
• Remove gloves and wash hands
• Document procedure
❌
✅
How do you confirm correct catheter placement when no urine appears? ‫بحكقينةسراتيلجمنيحعقانلبومكلان‬
‫ونسحب لو طلع بسهولة‬

Saline flush test

bladder ‫يبقى في ال‬
‫لو في مقاومة يبقى لسه‬
Using ryle syringe inject sterile saline: urethra ‫في ال‬

• If it flows in easily and comes back freely catheter is inside the bladder.
• If there is resistance or pain not in correct position.
♂ Male Urinary Catheterization
1. Preparation
• Explain procedure & Obtain consent
• Provide privacy
• Wash hand & Put on sterile gloves
2. Positioning
• Place patient in supine position
• Expose only genital area
3. Cleaning the Area
• Retract foreskin (if uncircumcised)
• Hold penis with non-dominant hand
• Clean meatus in circular motion from center outward (tip to root )
• Use new cotton ball each time
4. Lubrication
• Open sterile catheter pack
• Apply lubricant to 5–6 inches of catheter
5. Catheter Insertion
• Hold penis at 90° angle
• Gently insert catheter into urethra
• If resistance is felt: ( resistance at the external urethral sphincter & internal urethral sphincter )
• Ask patient to take deep breaths , Lower the penis and continue to advance the catheter
• Never force the catheter
6. Confirm Position
• When urine starts to flow, insert catheter 1–2 inches further (to the bifurcation)
7. Balloon Inflation ⚠
• Inflate balloon with 10 mL sterile water Important safety rule
Never inflate the balloon unless you are confident

• Gently pull catheter until balloon rests at bladder neck the catheter tip is inside the bladder.

8. Fixation & Drainage

• Connect catheter to urine drainage bag
• Fix catheter to lower abdomen or thigh
• Keep bag below bladder level
9. Aftercare
• Observe urine (color, amount, clarity, odor)
• Remove gloves & wash hands
• Document
Removal of an Indwelling Catheter
Care of an Indwelling (Foley) Catheter Steps include:
• Hand hygiene before and after care • Deflating the balloon with syringe
• Clean perineal area twice daily • Gentle catheter removal
• Encourage fluid intake (2.5–3 liters/day) • Inspect catheter for integrity
• Keep drainage bag below bladder level • Monitor urine after removal
• Document all findings