Lesson 6.3: Urinary Catheterisation
Catheterisation requires strict aseptic technique throughout. Always obtain consent and offer a chaperone. Understand the key difference between male and female technique.
Equipment
Catheter tray: sterile gloves, sterile drapes, catheter (12–14Fr Foley for most adults), 10 mL sterile water for balloon inflation, drainage bag, anaesthetic lubricating gel (Instillagel), cleansing solution (0.9% saline), gauze, syringe.
Male Catheterisation — Step-by-Step
- Explain procedure fully. Consent. Offer chaperone. Position supine, legs slightly apart.
- Open catheter pack aseptically. Pour cleansing solution. Prepare equipment without contaminating the sterile field.
- Wash hands. Apply sterile gloves. Drape patient, exposing the penis.
- Retract foreskin if present. Clean glans and meatus with saline-soaked gauze — circular motion from meatus outward. New gauze each time.
- Apply Instillagel into the urethra. Wait 2 minutes for anaesthetic effect.
- Hold penis perpendicular (90 degrees) initially to straighten urethra, then angle downward at 45 degrees to pass the external sphincter.
- Advance catheter using a no-touch technique. Never force against resistance.
- Advance fully until the bifurcation is at the meatus. Urine should flow. If no urine, advance a little further before inflating balloon.
- Inflate balloon with 10 mL sterile water. Never inflate if there is any resistance or pain.
- Withdraw gently until resistance felt. Connect to drainage bag. Replace foreskin. Secure catheter to inner thigh.
- Document: date, catheter type/size/batch number, balloon volume, urine obtained, complications.
Female Catheterisation — Key Differences
- Position: knees flexed and hips abducted (frog-leg position). Good lighting is essential.
- Identify the urethral meatus — it lies between the clitoris and the vaginal opening.
- Cleanse front to back — labia minora, then meatus, always moving posteriorly.
- Female urethra is approximately 4 cm long — advance catheter only 5–6 cm before inflating balloon.
- Inadvertent vaginal insertion: leave the catheter as a landmark and attempt again above it with a new sterile catheter.
Indications and Contraindications
| Category | Detail |
|---|---|
| Indications | Urinary retention. Monitoring urine output (critical illness, perioperative care). Urinary incontinence management. Intravesical drug delivery. Irrigation. |
| Absolute contraindication | Suspected urethral trauma: blood at meatus, high-riding prostate on PR, perineal bruising after pelvic fracture. Do NOT catheterise, refer to urology. |
| Relative contraindications | Urethral stricture (use smaller catheter, consider urology). Recent urethral surgery. Severe coagulopathy. |
| Complications | UTI, catheter-associated UTI (CAUTI), urethral trauma, false passage, balloon inflation in urethra, bypassing, catheter blockage, haematuria. |