Male and Female Urethral Catheterisation
What is it?
Catheterisation is the aseptic insertion of a sterile tube
(catheter) into the urinary bladder for the purpose of
instilling or draining fluid. Catheters are usually inserted
urethrally however if this is not possible due to blockage
or for reasons of patient choice the suprapubic route may
be used. In this case the catheter is inserted through the
abdomen and into the bladder.
Why are they used?
To empty the bladder prior to surgery.
To monitor renal function post-operatively.
To drain the bladder in urine retention.
To monitor renal function in critically ill patients.
To instill fluid, irrigation or cytotoxic drugs.
To perform bladder function tests.
As a last resort for incontinence if all other methods fail.
What are the main risks?
Insertion of a urinary catheter carries a high risk of
infection and should only be used if considered
to be clinically essential. Insertion can also cause
bruising and trauma to the urethral mucosa which
then acts as entry points for micro-organisms into
the blood and lymphatic system. Scar tissue is also
easily formed as a result of trauma.
Further Information
Further information is available from:
NHS Quality Improvement Scotland (2004) Best Practice Statement.
Urinary Catheterisation and Catheter Care. www.nhshealthquality.org
Pratt RJ et al (2007) epic2: National Evidence-Based Guidelines for Preventing
Healthcare-Associated Infections in NHS Hospitals in England. Journal of Hospital
Infection February 65S:S1-S64
Please ensure you refer to local policy before undertaking any procedure
Please ensure you refer to local policy before undertaking any procedure
Flow chart to aid assessment of patient need for catheterisation
Have all alternative methods of management been considered?
YES
NO – do not catheterise
Can you justify the reason for this clinically invasive procedure?
NO – do not catheterise
YES
Why does the patient require a catheter?
To empty the bladder prior to surgery or investigations
Doctor/MDT Specialist to document justification
To allow irrigation of the bladder
Doctor/MDT Specialist to document justification
To introduce cytotoxic drugs
Doctor/MDT Specialist to document justification
To enable bladder function tests to be performed
Doctor/MDT Specialist to document justification
To measure urinary output accurately e.g. patient in shock
Doctor/Outreach to document justification
Incontinence affecting wound healing
Doctor/Tissue Viability Specialist to document justification
To relieve incontinence
Refer to continence advisor for continence assessment
To determine residual urine
Use a bladder scanner (residual above 500ml - catheterise)
To bypass an obstruction flow e.g. constipation
Use a bladder scanner (residual above 500ml - catheterise)
To relieve retention of urine
Use a bladder scanner (residual above 500ml - catheterise)
Please ensure you refer to local policy before undertaking any procedure
Catheterised patients should be reviewed regularly and the catheter removed as soon as possible
Chart to aid choice of catheter
Patient preference should be considered and consent is essential
What is the catheter required for
1st choice = intermittent catheter
To empty the bladder once – intermittent catheter
Bladder emptying is incomplete but can store urine – intermittent catheter
Urethral strictures – intermittent catheter
Bladder substitution – intermittent catheter
Intermittent catheterisation unsuitable – urethral catheter
Continuous irrigation – urethral catheter
Continuous urine measurement – urethral catheter
Incontinence all alternatives explored – urethral catheter
Residual above 500ml due to retention or obstruction – urethral catheter
Urethral catheterisation not possible – supra-pubic catheter
Intractable bypassing of long term urethral catheter - supra-pubic catheter
How long is it needed for?
To empty the bladder once – intermittent catheter
1 day to 4 weeks – use PTFE
4 weeks to 12 weeks – use Hydrogel
Continuous irrigation – Silicone 3 way catheter
If the patient is allergic to latex use a silicone catheter
Alternatives to catheterisation for incontinence
Potential complications of catheterisation
Trauma
Continence assessment
Urinary tract infection
Pelvic floor exercises
Stricture formation
Regular toileting
Urethral perforation
ConvenePlease ensure you refer to local policy before undertaking any procedure Encrustation
Bladder calculi
Fluid intake advice
Neoplastic changes
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Types of Catheter
PTFE - 4 weeks
SILICONE - 12 weeks
HYDROGEL – 12 weeks
INTERMITTENT
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Catheter Care Bundle
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Ongoing Care
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Please ensure you refer to local policy before undertaking any procedure
Name……………………………………
WMS No………………………..
T- DOCS: Male Urethral Catheterisation
Please insert a urethral urinary catheter into this patient’s bladder.
Washes Hands
Understands indications & anatomy
Obtains informed consent
Explanation to patient, often
including complications
Communication skills
Appropriate preparation
Appropriate analgesia
Technical ability especially with any
special equipment and sharps
Aseptic technique
Seeks help as appropriate
Post procedure management
Professionalism
Overall ability to perform procedure
Hand wash with water and soap using the Ayliffe technique.
Urinary retention/ pre-op/ critically unwell
Aware of different positioning and angles that may be required to
pass catheter through urethra.
Aware of length of urethra and position of prostate
Introduce themselves.
Gains informed consent.
Clear explanation of procedure, e.g. “I am going to pass a tube
into your bladder, it will go into the bladder via the urethra which
is the tube in your penis that allows urine to drain from your
bladder”.
Chaperone
Assessment throughout the procedure and allows patient to ask
questions.
Cleans trolley correctly, places equipment on bottom shelf
Selection of equipment: trolley, appropriate catheter type and
size, instillagel 11mls, sterile gloves x 2 pairs, apron, alcohol rub,
10ml syringe, catheter bag, sterile water 10ml, Normasol, waste
bag, sterile gauze and catheterisation pack
Prepares patient and maintains privacy and dignity
Ensures use of 11ml instillagel for men, aware the gel may
cause stinging sensation on initial administration.
Use aseptic technique throughout.
Applies sterile gloves retracts the foreskin and cleans shaft,
glans and urethral meatus using Normasol solution.
Arranges sterile drape, administers instillagel 11mls, maintain
penile position upright and meatus closed for 3 to 5 minutes to
allow instillagel to take effect.
Washes hands and applies new pair of gloves, opens catheter,
slowly inserts catheter smoothly until urine begins to drain and
then passes catheter up to bifurcation point.
Attaches bag and inflates balloon.
Repositions foreskin
Cleaning of trolley, placing of equipment on bottom shelf,
opening packets correctly and aseptic technique throughout.
Reasons for failure to catheterise: e.g. stricture, spasm
Discusses complications e.g. haematuria, paraphimosis
Discusses what to do if no urine drains
Waste disposal
Explain that instillagel will take an hour to wear off
Documents time, date, clinical reason, aseptic technique,
instillagel, catheter size, type and expiry date, any problems,
amount of urine drained and colour.
Communicate to team members
Thanks staff
Thanks patient and ensures they are dry and comfortable.
Assess globally, would you be happy for this student to be
supervised to insert a catheter on a real patient?
Overall Grade
BE
B
S
AE
Please ensure you refer to local policy before undertaking any procedure
T-DOCS:
For Medical Students
Clinical Skill ………………………………..
Name of Student
Areas of good practice
1.
2.
3.
Areas for improvement
1.
2.
3.
Below Expectation
Skills labs
Supervised
Global assessment:
Borderline
Satisfactory
Skills labs
Unsupervised
Job Title
Name
Please print:
Patient Safe
Supervised
Assessor signature:
Date
Above Expectation
Teaching Potential
Signature
How suitable do you think this assessment is for undergraduate medical students?
Not Suitable
Highly Suitable
1
□ □ □ □ □ □ □ □ □ □
2
3
4
5
6
7
8
9
Any other Comments: Free text please use!
10
Please ensure you refer to local policy before undertaking any procedure
Name……………………………………………………….WMS No………………………..
T-DOCS: Female Urethral Catheterisation
Please insert a urethral urinary catheter into this patient’s bladder.
Washes Hands
Understands indications & anatomy
Obtains informed consent
Explanation to patient, often
including complications
Communication skills
Appropriate preparation
Appropriate analgesia
Technical ability especially with any
special equipment and sharps
Aseptic technique
Seeks help as appropriate
Post procedure management
Professionalism
Overall ability to perform procedure
Hand wash with water and soap, alcohol gel alone not sufficient
for aseptic technique.
Urinary retention/ pre-op/ critically unwell
Aware of different positioning and angles that may be required to
pass catheter through urethra.
Aware of length of urethra
Introduces themselves.
Gains informed consent.
Clear explanation of procedure, e.g. “I am going to pass a tube
into your bladder, it will go into the bladder via the urethra to
allow the urine to drain out”.
Chaperone
Assessment throughout the procedure and allows patient to ask
questions.
Cleans trolley correctly, places equipment on bottom shelf
Selection of equipment: trolley, appropriate catheter type and
size, instillagel 6mls, sterile gloves x 2 pairs, apron, alcohol rub,
10ml syringe, catheter bag, sterile water 10ml, Normasol, waste
bag, sterile gauze and catheterisation pack
Prepares patient and maintains privacy and dignity
Ensures use of 6ml instillagel for women, aware the gel may
cause stinging sensation on initial administration.
Use aseptic technique throughout.
Applies sterile gloves separates labia and cleans urethral orifice
using Normasol solution. Arranges sterile drape, administers
instillagel 6mls, waits for 3 to 5 minutes to allow instillagel to take
effect.
Washes hands and applies new pair of gloves, opens catheter,
slowly inserts catheter smoothly until urine begins to drain and
then passes catheter up to bifurcation point.
Attaches bag and inflates balloon.
Cleaning of trolley, placing of equipment on bottom shelf,
opening packets correctly and aseptic technique throughout.
Reasons for failure to catheterise: e.g. stricture, spasm
Discusses complications e.g. haematuria
Discusses what to do if no urine drains
Waste disposal
Explain that instillagel will take an hour to wear off
Documents time, date, clinical reason, aseptic technique,
instillagel, catheter size, type and expiry date, any problems,
amount of urine drained and colour.
Communicate to team members
Thanks staff
Thanks patient and ensures they are dry and comfortable.
Assess globally, would you be happy for this student to be
supervised to insert a catheter on a real patient?
Overall Grade
BE
B
S
AE
Please ensure you refer to local policy before undertaking any procedure
T-DOCS:
For Medical Students
Clinical Skill ………………………………..
Name of Student
Areas of good practice
1.
2.
3.
Areas for improvement
1.
2.
3.
Below Expectation
Skills labs
Supervised
Global assessment:
Borderline
Satisfactory
Skills labs
Unsupervised
Job Title
Name
Please print:
Patient Safe
Supervised
Assessor signature:
Date
Above Expectation
Teaching Potential
Signature
How suitable do you think this assessment is for undergraduate medical students?
Not Suitable
Highly Suitable
1
□ □ □ □ □ □ □ □ □ □
2
3
4
5
6
7
8
9
Any other Comments: Free text please use!
10
Please ensure you refer to local policy before undertaking any procedure