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Introduction

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Urinary catheter insertion is performed to drain urine from the bladder (Figure 47-1) in patients who are incontinent or have urinary obstruction or to frequently monitor urine output as a proxy for renal function. Long-term catheterization is associated with increased risk of urinary tract infection.

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Definitions and Terms

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  • ▪  French (Fr): The unit of measurement used in sizing urinary catheters—where 1 French equals 1/3 of a millimeter.
  • ▪  Intermittent straight catheterization: A technique used for intermittent bladder drainage wherein the catheter is inserted and removed periodically to decompress bladder.
  • ▪  Prostatic hypertrophy: A common cause of difficulty with spontaneous urinary drainage as well as catheter insertion.

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Techniques

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  • ▪  Indications:
    • —Perioperative urinary drainage
    • —Urinary tract outflow obstruction
    • —Urinary volume measurement in the intensive care unit (ICU)
  • ▪  Contraindications:
    • —Urethral disruption
  • ▪  Method:
    • —Prior to urinary catheterization, patient consent should be obtained, the urethra and surrounding areas prepped and draped (Figure 47-2), and the universal protocol performed as described in Section I.
    • —Prior to catheterization, the operator should wash hands and wear sterile gloves.
    • —According to Centers for Disease Control guidelines, Catheters should only be inserted by trained personnel.
      • • Catheters should only be inserted when necessary, rather than for the convenience of patient-care personnel, and should only be left in place as long as necessary.
      • • Alternative methods of urinary drainage should be entertained (ie, condom catheter, suprapubic drain).
    • —The smallest appropriate catheter should be selected for insertion, and the balloon checked for patency (Figure 47-3):
      • • Smaller catheters (12-14 Fr) are appropriate for use in patients with strictures.
      • • Medium catheters (16-18 Fr) are typically used in adult males.
      • • Larger catheters (20-24 Fr) may be used in patients with prostatic hypertrophy or hematuria.
    • —If the patient is uncircumcised, the foreskin should be retracted prior to skin preparation.
    • —The catheter should be lubricated and inserted into the urethra and advance to its full length, while the penis is held vertically with the nondominant hand (Figures 47-4 and 47-5).
    • —After urine has drained from the catheter, the balloon should be inflated.
    • —If the foreskin has been retracted, it should be reduced to anatomical position following successful catheterization.
    • —The catheter is attached to a closed drainage system (Figure 47-6) and the drainage bag is positioned below the level of the bladder to prevent urinary reflux into the bladder.
  • ▪  Complications:
    • —Urethral trauma
    • —Infection

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Figure 47-2.
Graphic Jump Location

Urinary drainage catheter and tested balloon.

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