Urinary catheterization involves inserting a flexible tube (catheter) into the bladder through the urethra to allow urine to drain for collection. This procedure is commonly performed when a patient experiences acute or chronic urinary retention, meaning they are unable to empty their bladder naturally due to an obstruction or weakened bladder muscles. Catheters are also used to accurately monitor urine output in critically ill patients, to aid in healing wounds compromised by incontinence, or during various surgical interventions. The two main types are intermittent catheters, which are inserted to drain the bladder and then immediately removed, and indwelling catheters, which remain in place for a continuous period. This guide will focus on the insertion of an indwelling catheter, often called a Foley catheter. This medical procedure should ideally be performed by a trained healthcare professional.
Essential Preparation and Supplies
A successful and safe catheter insertion procedure relies heavily on meticulous preparation and maintaining a sterile field to prevent infection. The necessary equipment is often provided in a pre-packaged catheterization kit, which typically includes sterile gloves, an antiseptic solution (such as povidone-iodine), sterile lubricating jelly, the catheter itself (often double-lumen), a syringe pre-filled with sterile water for balloon inflation, and a urine drainage bag.
Selecting the correct catheter size is important, with the diameter measured on the French (Fr) scale. For most adult male patients, a size between 14 Fr and 16 Fr is commonly recommended. The patient must be positioned supine, lying on their back with legs extended, for comfortable access to the genital area. Prior to opening the sterile kit, the caregiver must perform thorough hand hygiene, and privacy must always be ensured.
Step-by-Step Guide to Catheter Insertion
The process begins with establishing a sterile environment by opening the catheterization kit and carefully draping the patient with the sterile barriers provided, ensuring only the penis is exposed. The supplies are organized on the sterile field to allow for a smooth, uninterrupted procedure once sterile gloves are applied. Using the non-dominant hand, the caregiver gently grasps the penis just behind the glans, lifting it upward to a position nearly perpendicular to the patient’s body to straighten the natural curve of the male urethra. This hand is now considered contaminated and maintains traction on the penis until the catheter is fully inserted.
Next, the glans penis and the urethral meatus (the external opening) are cleaned thoroughly using the antiseptic solution and cotton swabs provided. The cleaning motion should move outward from the meatus in a circular pattern, discarding each swab after a single use. After cleaning, a generous amount of sterile lubricating jelly is applied directly into the urethral opening to minimize friction and patient discomfort during advancement. This lubrication is crucial for navigating the long and curved male urethra.
The catheter is then slowly and gently advanced through the meatus, maintaining the upward angle and gentle traction. If resistance is met, particularly at the external sphincter or prostate, the caregiver must not force the catheter forward. Instead, pause, maintain steady pressure, and ask the patient to take slow, deep breaths or cough, which can help relax the sphincter muscles and allow for continued advancement. The catheter is continually advanced until the distal end of the tube begins to drain urine, confirming the tip has successfully entered the bladder.
Once urine flow is observed, the catheter must be advanced an additional one to two inches to ensure the retention balloon is fully positioned within the bladder cavity. The syringe pre-filled with sterile water is then connected to the inflation port, and the specified volume (typically 5 to 10 milliliters) is slowly injected to inflate the balloon. If the patient reports any sudden pain during balloon inflation, immediately stop, aspirate the water, and advance the catheter slightly further before attempting inflation again. After the balloon is fully inflated, the catheter is gently pulled back until a slight resistance is felt, confirming the balloon has engaged the bladder neck and the catheter is securely in place.
Post-Insertion Care and Drainage System Management
Following successful catheter placement, the indwelling tube must be secured properly to prevent accidental traction, which can cause significant damage to the urethra and bladder neck. A dedicated securing device or tape should be used to anchor the catheter tubing to the patient’s inner thigh or lower abdomen, allowing for a small amount of slack to prevent pulling during movement.
The drainage bag is then connected to the catheter and positioned below the level of the bladder at all times. This ensures that gravity facilitates continuous urine flow and prevents the backflow of urine, which is a major risk factor for infection. The drainage bag should be routinely emptied when it is approximately half to two-thirds full to prevent excessive weight from pulling on the catheter. Caregivers should always use a separate clean container for collection and avoid letting the drainage spout touch any surface.
Daily hygiene is necessary to prevent bacterial migration up the catheter tube. This involves washing the area where the catheter exits the meatus and the surrounding tubing with mild soap and water.
Catheter Removal
When the indwelling catheter is ready for removal, the retention balloon must be fully deflated. Insert a syringe into the inflation port and allow the sterile water to be passively withdrawn. Confirm that the amount of fluid aspirated is equal to the amount originally instilled to ensure the balloon is completely flat before withdrawal. The catheter is then gently and slowly withdrawn from the urethra, and the patient’s voiding patterns are monitored afterward to confirm they can urinate naturally.
Recognizing and Responding to Procedure Complications
Despite careful technique, complications can sometimes arise during or after the catheterization procedure. If the caregiver is unable to advance the catheter after multiple gentle attempts, or if the patient experiences severe, persistent pain or bleeding (hematuria), the procedure should be stopped, and medical assistance must be sought immediately. Improper balloon inflation while the balloon is still in the urethra will cause intense pain and could lead to urethral trauma, necessitating prompt deflation and repositioning or removal.
Delayed complications often relate to catheter-associated urinary tract infections (CAUTI), the most common issue with indwelling catheters. Signs of a developing CAUTI include fever, chills, cloudy or foul-smelling urine, and bladder spasms or pain in the lower abdomen. If the patient develops these signs, or if the catheter stops draining urine despite adequate fluid intake, a healthcare professional must be contacted without delay. The inability to deflate the balloon during a planned removal is a serious issue that requires specialized medical intervention.