Why insert an indwelling urinary catheter

Urethral catheterisation is the insertion of a catheter into the urinary bladder via the urethra. Suprapubic catheterisation is the insertion of a catheter into the bladder via the anterior abdominal wall. Urinary catheters can be made of latex, polyvinylchloride PVC or silicone. For boys older than 3 years insert the Xylocaine gel into the urethra. Gently hold the urethra opening closed and wait 2 - 3 minutes to give the gel time to work.

For infants apply sterile lubricant to catheter before insertion. Post urology surgery consider using two syringes of xylocaine gel to increase lubrication of the urethra and decrease risk of trauma.

Remove the wire if using a 6Fr catheter Hold the penis with slight upward tension and perpendicular to the child's body. Insert the catheter. When the first sphincter is reached at level of pelvic floor muscles gently bring the penis down to face the child's toes, apply constant gentle pressure.

If resistance is felt the following strategies should be considered: Remove the catheter and utilise a 2nd tube of lubricant Increase traction on penis and apply gentle pressure on the catheter Ask the child to take a deep breath Ask the child to cough and bear down e.

Advance the catheter and gently insert it completely into the urethra until the connection portion. Including catheter type, length and size Amount of water instilled into balloon Document all procedures and cares involving IDC cares Ongoing nursing management Measure urine output as indicated 1 — 4 hourly, assessing the colour and concentration of urine output.

Report any variation from this to the treating medical team. Certain drugs will increase diuresis, such as diuretics and ACE inhibitors. If oliguric ensure catheter is not blocked see trouble shooting below. Record fluid balance. A fluid balance which keeps the urine dilute will lessen the risk of infection. This may not be possible due to the clinical condition of the child. The IDC insertion site and securement should be assessed at least once a shift, to ensure the IDC is not pulling on the genitals and not twisted.

IDC drainage bags should be emptied once a shift at a minimum. Position drainage bag to prevent backflow of urine or contact with the floor. Gravity is important for drainage and prevention of urine backflow.

Ensure the drainage bag is below the level of the bladder, is not kinked or twisted and is secured. Drainage system Adherence to a sterile continuously closed method of urinary drainage has been shown to markedly reduce the risk of acquiring a catheter associated infection. Always check the strapping of the catheter is secure after hygiene is performed.

Infection surveillance Consider daily the need for the IDC to remain in situ. Cloudy, offensive smelling or unexplained blood stained urine is not normal and needs further investigation. Specimen collection Urine for for urinalysis or culture should be collected fresh from the needleless sampling port of catheter tubing not drainage bag , this should be completed in line with the Aseptic Technique Procedure.

Clamp below the sampling point. Consider the need to perform a bladder scan to assess bladder volume. Escalate to medical team if concerned. The patency of a catheter can be checked via the sampling port or catheter tubing. A blocked catheter should be flushed via the catheter tubing, this is of particular importance in case of blood clots or mucus for example after a bladder augment. Checking catheter patency via Needleless Sampling Port Checking catheter patency and flushing via Catheter Tubing Clamp catheter below the sampling point.

If saline is not coming back on suction, gently reinject 10mls of normal saline and let urine drain by itself without sucking back on the syringe. It may be that the catheter tip is stuck to the bladder wall. So ensure the saline is flushing easily and urine is subsequently flowing back by itself, without any suction. Open additional equipment using ANTT. Leave the urinary catheter in its inner sterile plastic protective wrapping until the time of insertion, to protect it from potential physical and environmental contamination.

Wash your hands and put on sterile gloves. Using low-linting swabs, separate the labia with your non-dominant hand so you can see the urethral meatus. Hold the labia open and, with your dominant hand, clean the urethral meatus with 0. Squeeze the gel into the urethra, remove the nozzle and discard. Box 1 outlines further relevant information. If you are using a plain aqueous lubricating gel without anaesthetic you can continue with the procedure immediately. When the anaesthetic gel has taken effect, wipe away any excess, dispose of the gloves, wash and dry your hands and put on new sterile gloves.

Hold the labia open. Holding the catheter in your dominant hand, introduce the tip into the urethral orifice in a slightly upward and backward direction, feeding it out of the sterile packaging this adds a further layer of physical protection for the duration of the insertion procedure.

Insert the catheter approximately cm Fig 1e. The direction and length of catheter inserted relates to the anatomy of the female genitourinary tract Fig 2 Dougherty and Lister, If the patient experiences any pain or discomfort, stop the procedure and seek medical advice. Once urine starts to drain, insert the catheter up to the bifurcation point to ensure the balloon is in the bladder.

Inflation of the balloon in the urethra is painful. For pre-filled balloons remove the clip and gently squeeze the reservoir of sterile water. Observe the patient for any signs of discomfort as inflation should be pain-free.

Once the balloon is inflated, withdraw the catheter slightly to ensure the catheter is in the bladder and is secure Dougherty and Lister, If the catheter is not already attached to a drainage bag, attach it to either a drainage system or catheter valve as required see Parts 3 and 4 of this catheter series. Make the patient comfortable. Urologic procedures. Bradley and Daroff's Neurology in Clinical Practice. Sabharwal S. Spinal cord injury lumbosacral. Essentials of Physical Medicine and Rehabilitation.

Updated by: Kelly L. Editorial team. Urinary catheters. A urinary catheter is a tube placed in the body to drain and collect urine from the bladder. Your health care provider may recommend that you use a catheter if you have: Urinary incontinence leaking urine or being unable to control when you urinate Urinary retention being unable to empty your bladder when you need to Surgery on the prostate or genitals Other medical conditions such as multiple sclerosis , spinal cord injury, or dementia Catheters come in many sizes, materials latex, silicone, Teflon , and types straight or coude tip.

In most cases, your provider will use the smallest catheter that is appropriate. An indwelling catheter may be inserted into the bladder in 2 ways: Most often, the catheter is inserted through the urethra. This is the tube that carries urine from the bladder to the outside of the body. Sometimes, the provider will insert a catheter into your bladder through a small hole in your belly. This is done at a hospital or provider's office.