INTERN SURVIVAL GUIDE

Male Catheterisation

Tutorial Overview• Equipment Selection

• Equipment and Patient Preparation

• Procedure Steps

• Catheter Selection

• Indications, Documentation and Complications

Equipment Selection1. Alcohol Wipes1. Alcohol Wipes1. Alcohol Wipes1. Alcohol Wipes 2. Catheterisation Pack2. Catheterisation Pack

2. Catheterisation Pack2. Catheterisation Pack

3. Sterile Gloves:3. Sterile Gloves:x 2 pairs in your size3. Sterile Gloves:3. Sterile Gloves:x 2 pairs in your size

Equipment Selection6. Cleaning Solution6. Cleaning Solution2 sachets of sterile water6. Cleaning Solution6. Cleaning Solution2 sachets of sterile water

8. Sterile Water &8. Sterile Water &10ml Syringe (if latex 10ml Syringe (if latex catheter)catheter)

8. Sterile Water &8. Sterile Water &10ml Syringe (if latex 10ml Syringe (if latex catheter)catheter)

7. Anaesthetic Gel7. Anaesthetic GelInstilligel x 27. Anaesthetic Gel7. Anaesthetic GelInstilligel x 2

9. Urinary Drainage /9. Urinary Drainage / Colletction BagColletction Bag9. Urinary Drainage /9. Urinary Drainage / Colletction BagColletction Bag

5. Incontinence Sheet5. Incontinence Sheet5. Incontinence Sheet5. Incontinence Sheet4. Disosable Apron4. Disosable Apron4. Disosable Apron4. Disosable Apron

Equipment Selection• 2 layers of packaging• Outer has information on size,

length and volume for balloon– Remove before placing onto

sterile field• Inner is sterile with vertical and

horizontal serration for no touch insertion

• Note Silastic catheters have a prefilled 10ml syringe for balloon

10. Select Catheter10. Select CatheterChoose silastic or latexUsually 14 Ch or 16 ChHave a few spare on trolley

10. Select Catheter10. Select CatheterChoose silastic or latexUsually 14 Ch or 16 ChHave a few spare on trolley

Equipment and Patient Preparation

1. Put all equipment on the bottom shelf of the cleaned trolley

2. At bedside – perform hand hygiene3. Discuss procedure with patient4. Put on apron5. Open catheter pack on top of trolley to

create a sterile field6. Attach yellow waste bag as shown7. Have urine collection bag close by8. Open necessary equipment

- Place on the sterile field9. Only then prepare the patient

- Positions patient- Underwear removed- Incontinence pad underneath

Procedure1. Wash hands (scrub) and put on sterile

gloves

2. Draw up sterile water if using latex catheter (with help)

3. Place fenestrated drape over penis

4. Cleaningi. Hold penis in left hand with gauzeii. Clean with right handiii. Hold soaked cotton balls with plastic

forcepsiv. Clean penis shaft and foreskinv. Retract foreskin and clean glansvi. Always clean distal to proximalvii. Dispose of cotton balls

Procedure5. Remove gloves and apply the second

sterile pair

6. Elevate the penis to c.90°

7. Slowly instil anaesthetic gel x 2- Allow 3 minutes to take effect

8. Open catheter cover vertically

9. Hold penis with gauze in left hand

10. Gently pull penis towards end of bed

Procedure11. Introduce catheter into urethral meatus

12. Advance catheter in the bag

13. Retract bag as catheter advances

14. On feeling resistance raise penis to c. 90°

15. Maintain gentle pressure to pass prostate

16. Once in the bladder- Resistance disappears- Urine appears in catheter bag- Pinch catheter with left hand to stop the flow

Procedure

17. Remove cover from catheter

18. Attach collection bag to catheter port- This is the port urine is coming out

19. Inflate catheter balloon with 10mls water- Through coloured port- Only when urine seen in collection bag

Procedure

20. Replace foreskin with left hand

21. Clean and dry patient

22. Ensure dry before replacing clothing (ask nurse for help)

23. Dispose of waste appropriately and wash hands

Catheter Selection- Type

• Short term– Can remain in situ for up to 4 weeks– Usually brown in colour– Made of Latex, Teflon of PVC

• Long term– Can remain in situ for up to 12 weeks– Clear or white in colour– Most often made from silicone– Designed to resist infection

Catheter Selection- Size

• Use the smallest size possible to maintain drainage

• Larger sizes used only when clots or debris present

• Measured in Chariers (Ch)– The outer circumference of the catheter– Usually a 14Ch or 16Ch catheter is ideal

Indications• To relieve urinary retention • To bypass urethral obstruction• Management of incontinence• Permit bladder irrigation– E.g. post prostatectomy or TURP

• Empty bladder prior to surgical procedure• To monitor urinary output• Permit instillation of medication– E.g. Cytotoxic agents in bladder carcinoma

• Required for certain investigations– E.g. micturating cystourethrogram

Essential Documentation• Date and time of procedure

• Verbal consent

• Indication for catheterisation

• Catheter– Type– Size– Balloon inflated with 10mls water

Essential Documentation• Catheterisation– Performed under sterile technique– Ease of insertion– Urine flow prior to balloon inflation

• Post Catheterisation– Foreskin replaced– Volume drained– Observation of urine: Clear, cloudy, bloody etc.– Request nurse to monitor urine output

Complications• Patient discomfort or pain: – Advise the patient procedure is uncomfortable – Use plenty of anaesthetic gel. Allow at least 3

minutes for the gel to work– Handle the patient gently

• Urinary tract infection: – Observe hand hygiene as per protocol– Clean the patient properly– Wear sterile gloves and ensure the field is sterile– Do not touch the catheter, keep it covered in the bag

during insertion

Complications• Damage to the urethra: – Avoid by handling the tissues gently - do not force the

catheter past the prostate– Ensure that the catheter is in the bladder before you

inflate the balloon (observe urine flow into the catheter bag)

– If you cannot pass the catheter easily, then get more senior help

• Blockage: – Avoid this by choosing the correct catheter type and size– Use a larger size with a 3rd port for irrigation if there is any

blood or clots or debris in the bladder

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