Urinary catheter insertion is performed to drain urine from the
bladder (Figure 48-1) 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.
- ▪ French (Fr): The unit of measurement used in sizing
urinary catheters—where 1 French equals 1/3 of
- ▪ Intermittent straight catheterization: A technique used
for intermittent bladder drainage wherein the catheter is inserted
and removed periodically to decompress bladder.
- ▪ Indications:
- —Perioperative urinary drainage
- —Urinary tract outflow obstruction
- —Urinary volume measurement in the intensive care
- ▪ Contraindications:
- ▪ Method:
- —Prior to urinary catheterization, patient
consent should be obtained, the urethra and surrounding areas prepped
and draped (Figure 48-2), and the universal protocol should be 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
- • 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.
- • Medium catheters (16-18 Fr) are typically
used in adult females.
- • Larger catheters (20-24 Fr) may be used in patients
- —The labia should be spread, the urethra identified,
and the catheter should be lubricated and inserted into the urethra
- —After urine has drained from the catheter, the
balloon should be inflated.
- —The catheter is attached to a closed drainage system
and the drainage bag is positioned below the level of the bladder
to prevent urinary reflux into the bladder.
- ▪ Complications:
- —Urethral trauma
Clinical Pearls and Pitfalls
- ▪ Urethral
identification may be difficult in obese patients, patients with
prior surgery, following childbirth or with prolapsed of vagina
- ▪ If no urine
drains from the catheter after insertion to an appropriate length,
the catheter may be irrigated with sterile saline—free
saline return suggests that the tip is in the right location.
Leone M. Garnier F. Avidan M. Martin C. Catheter-associated urinary
tract infections in intensive care units. Microbes Infect.