Chapter 48

### Introduction

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.

###### Figure 48-1.

Female urinary anatomy.

### Definitions and Terms

• ▪  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.

### Techniques

• ▪  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 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 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.
• • Medium catheters (16-18 Fr) are typically used in adult females.
• • Larger catheters (20-24 Fr) may be used in patients with hematuria.
• —The labia should be spread, the urethra identified, and the catheter should be lubricated and inserted into the urethra (Figure 48-3).
• —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
• —Infection

###### Figure 48-2.

Patient preparation.

###### Figure 48-3.

Catheter insertion.

### Clinical Pearls and Pitfalls

• ▪  Urethral identification may be difficult in obese patients, patients with prior surgery, following childbirth or with prolapsed of vagina and/or urethra.
• ▪  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. 2004;6:1026–1032.  ...

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