Purpose Back to Top Urinary catheters are used to drain the bladder.

Health care providers may recommend a catheter for short-term or long-term use because of the following reasons:

Urinary incontinence (leakage of urine or the inability to control when urinating) Urinary retention (being unable to empty the bladder when need to)
Surgery that made a catheter necessary, such as prostate or gynecological surgery Other medical conditions such as multiple sclerosis, spinal cord injury, or dementia

Indication Back to Top Diagnostic Collection of uncontaminated urine specimen Monitoring of urine output Imaging of the urinary tract Acute urinary retention (eg, benign prostatic hypertrophy, blood clots) Chronic obstruction that causes hydronephrosis Initiation of continuous bladder irrigation Intermittent decompression for neurogenic bladder Hygienic care of bedridden patients

Therapeutic

Contraindication Back to Top Urinary catheterization is contraindicated in the presence of traumatic injury to the lower urinary tract (eg, urethral tear). This condition may be suspected in male patients with a pelvic or straddle-type injury. Signs that increase suspicion for injury are a high-riding or boggy prostate, perineal hematoma, or blood at the meatus. When any of these findings are present in the setting of concerning trauma, a retrograde urethrogram should be performed to rule out a urethral tear prior to placing a catheter into the bladder. Types of Catheter Back to Top Catheters come in many sizes, materials (latex, silicone, Teflon), and types (Foley, straight, coude tip). A Foley catheter, for example, is a soft, plastic or rubber tube that is inserted into the bladder to drain the urine. In general, the smallest possible catheter will be used. Some people may need larger catheters to control urine leakage around the catheter or if the urine is thick and bloody or contains large amounts of sediment. There are three main types of catheters: Indwelling catheter Condom catheter Intermittent (short-term) catheter

Sex Differences Back to Top In males, the catheter tube is inserted into the urinary tract through the penis. A condom catheter can also be used. In

females, the catheter is inserted into the urethral meatus, after a cleansing using povidone-iodine. The procedure can be complicated in females due to varying layouts of the genitalia (due to age, obesity, Female genital cutting, childbirth, or other factors), but a good clinician should rely on anatomical landmarks and patience when dealing with such a patient. Equipment Back to Top Commercial single-use urethral catheterization tray Povidone iodine Sterile cotton balls Water-soluble lubrication gel Sterile drapes Sterile gloves Urethral catheter Prefilled 10-mL saline syringe Urinometer connected to a collection bag

Sterile anesthetic lubricant (eg, lidocaine gel 2%) with a blunt tip urethral applicator or a plastic syringe (5-10 mL) Anesthesia Back to Top Topical anesthesia is administered with lidocaine gel 2%. Many facilities have a preloaded syringe with an opening appropriate for insertion into the meatus available either separately or in the catheter kit. To instill, hold the penis firmly and extended, place the tip of the syringe in the meatus, and apply gentle but continuous pressure on the plunger. Pearls Back to Top Insertion of a Coud catheter: The Coud catheter, which has a stiffer and pointed tip, was designed to overcome urethral obstruction that a more flexible catheter cannot negotiate (eg, patients with benign prostatic hypertrophy). To place a Coud catheter, follow the procedure described above. The elbow on the tip of the catheter should face anteriorly to allow the small rounded ball on the tip of the catheter to negotiate the urogenital diaphragm. Perineal pressure assistance: The distal tip of the catheter might become caught in the posterior fold between the urethra and the urogenital diaphragm. An assistant can apply upward pressure to the perineum while the catheter is advanced to direct the catheter tip upward through the urogenital diaphragm. Open Section Back to Top Prophylactic antibiotics are recommended for patients with prosthetic heart valves, artificial urethral sphincters, or penile implants. Catheter types and sizes o Adults: Foley (16-18 F) o Adults with obstruction at the prostate: Coud (18 F) o Children: Foley (5-12 F) o Infants younger than 6 months: Feeding tube (5 F) with tape Positioning Back to Top Place the patient supine, in the frogleg position, with knees flexed.