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.
- ▪ 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.
- ▪ Prostatic hypertrophy: A common cause of difficulty with
spontaneous urinary drainage as well as catheter insertion.
- ▪ 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 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
- • 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- —If the foreskin has been retracted, it should be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
Urinary drainage catheter and tested balloon.
Hand positioning for catheter insertion.