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  1. Understanding PLAB 2: The Foundation Course
  2. /
  3. Module 6: Procedures, Emergencies, and Prescribing

Understanding PLAB 2: The Foundation Course

Course Progress
0 of 45 lessons completed (0%)
Module 1: Understanding PLAB 2
4
Module 2: The Consultation Toolkit
9
Module 3: Difficult Conversations
6
Module 4: Ethics and Professionalism
9
Module 5: Examination Stations
8
Module 6: Procedures, Emergencies, and Prescribing
9
Module 6 Introduction
Lesson 6.1 : Venepuncture
Lesson 6.2 : IV Cannulation
Lesson 6.3 : Urinary Catheterisation
Lesson 6.4: Basic Life Support, AED, and Choking
Lesson 6.5 : ABCDE: Emergency Assessment and the SimMan Station
Lesson 6.6: Prescribing Skills
Lesson 6.7: Inhaler Teaching, Spacers, and Wound Care
Lesson 6.8: The Foundation Is Complete: Ready for Cases

Lesson 6.3 : Urinary Catheterisation

Module 6: Procedures, Emergencies, and Prescribing

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

  1. Explain procedure fully. Consent. Offer chaperone. Position supine, legs slightly apart.
  2. Open catheter pack aseptically. Pour cleansing solution. Prepare equipment without contaminating the sterile field.
  3. Wash hands. Apply sterile gloves. Drape patient, exposing the penis.
  4. Retract foreskin if present. Clean glans and meatus with saline-soaked gauze — circular motion from meatus outward. New gauze each time.
  5. Apply Instillagel into the urethra. Wait 2 minutes for anaesthetic effect.
  6. Hold penis perpendicular (90 degrees) initially to straighten urethra, then angle downward at 45 degrees to pass the external sphincter.
  7. Advance catheter using a no-touch technique. Never force against resistance.
  8. Advance fully until the bifurcation is at the meatus. Urine should flow. If no urine, advance a little further before inflating balloon.
  9. Inflate balloon with 10 mL sterile water. Never inflate if there is any resistance or pain.
  10. Withdraw gently until resistance felt. Connect to drainage bag. Replace foreskin. Secure catheter to inner thigh.
  11. 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

CategoryDetail
IndicationsUrinary retention. Monitoring urine output (critical illness, perioperative care). Urinary incontinence management. Intravesical drug delivery. Irrigation.
Absolute contraindicationSuspected urethral trauma: blood at meatus, high-riding prostate on PR, perineal bruising after pelvic fracture. Do NOT catheterise, refer to urology.
Relative contraindicationsUrethral stricture (use smaller catheter, consider urology). Recent urethral surgery. Severe coagulopathy.
ComplicationsUTI, catheter-associated UTI (CAUTI), urethral trauma, false passage, balloon inflation in urethra, bypassing, catheter blockage, haematuria.