Urinary catheterization involves the placement of a flexible, hollow tube (an indwelling or Foley catheter) into the bladder through the urethra for continuous drainage and collection of urine. This procedure is typically performed to relieve acute or chronic urinary retention, to monitor precise urine output in critically ill patients, or to facilitate healing in individuals with severe perineal wounds. The male urethra measures approximately 20 centimeters and contains natural curves that require a specific technique to navigate successfully. This information provides a detailed overview for those assisting under medical direction, emphasizing the necessity of sterile practice to prevent catheter-associated urinary tract infections (CAUTIs).
Essential Supplies and Patient Preparation
The procedure requires a pre-packaged, sterile catheterization kit, which usually contains all necessary items to maintain an aseptic technique. Standard kits include sterile gloves, antiseptic solution, cotton balls or swabs, sterile drapes, forceps, and a syringe pre-filled with sterile water for balloon inflation. The catheter size is measured on the French (Fr) scale; 14 or 16 Fr is the most common size for routine adult male catheterization, balancing adequate drainage with minimal trauma to the urethral lining.
Patient comfort and privacy are the first steps, achieved by positioning the individual in a supine position with legs slightly abducted, and ensuring the bed height is appropriate for the caregiver. Before opening the sterile kit, strict hand hygiene must be performed, and the genital area should be cleansed with soap and water if a pre-procedural bath was not possible. Once the sterile kit is opened, sterile gloves are donned to establish a sterile field around the patient’s genitals. A syringe containing a water-soluble lubricating jelly, often containing lidocaine for comfort, is then prepared for instillation into the urethra.
Step-by-Step Catheter Insertion Procedure
The procedure begins by applying the sterile drapes around the penis, followed by cleaning the urethral meatus and glans using the antiseptic-soaked swabs held with sterile forceps. The cleaning motion should be circular, starting at the meatus and moving outward, using a fresh swab for each of the recommended three swipes to reduce the microbial load. Instill the lubricating jelly directly into the urethra, gently holding the meatus closed afterward to allow the gel to dwell for several minutes, which helps to anesthetize and dilate the passageway.
The catheter is then grasped with the sterile dominant hand, while the non-dominant hand grasps the penile shaft, lifting it to a position perpendicular (90 degrees) to the body. This maneuver is crucial for straightening the natural S-curve of the male urethra, allowing for a smoother passage of the catheter. The catheter is inserted slowly and steadily through the meatus. If resistance is felt, which often occurs at the external sphincter, the patient should be instructed to take a deep breath, cough, or “bear down” to help relax the muscle.
The catheter is advanced until urine flows freely into the drainage bag, indicating the tip has entered the bladder. Advance the catheter an additional 3 to 5 centimeters (about 1 to 2 inches) to ensure the retention balloon is fully within the bladder cavity and clear of the sensitive prostatic urethra. Inflating the balloon prematurely or in the urethra can cause significant pain and severe tissue damage. The non-dominant hand, which held the penis, is now considered non-sterile and should not touch the insertion equipment.
Securing and Drainage Setup
Once the catheter is correctly positioned, the retention balloon is inflated with the pre-filled syringe of sterile water, typically 10 milliliters, which stabilizes the catheter within the bladder. After inflation, a gentle tug is applied to the catheter until slight resistance is felt, confirming the balloon is resting against the bladder neck. The catheter must then be securely anchored to the patient’s thigh or lower abdomen using a manufactured catheter securement device, like a Stat-Lock.
Proper securement prevents accidental traction, which can lead to meatal erosion, tissue necrosis, and painful urethral trauma. The drainage bag is then connected to the catheter and positioned below the level of the bladder, ideally attached to the bed frame, never the side rail, to allow gravity to facilitate continuous drainage. Ensure there are no dependent loops or kinks in the tubing that could obstruct the flow of urine, maintaining a closed drainage system to minimize the risk of infection.
Identifying and Addressing Common Issues
Troubleshooting often centers on the inability to advance the catheter fully, which may be caused by a urethral stricture or benign prostatic enlargement (BPH). If firm resistance is met after instilling the lubricant, gentle, persistent pressure may be applied while having the patient breathe deeply, but the catheter should never be forced, as this risks creating a false passage or severe urethral injury. If the catheter cannot be advanced after two attempts with a smaller size, the procedure should be stopped, and further medical assistance must be sought immediately.
Pain or bladder spasms immediately following insertion can signal that the retention balloon is inflated within the prostatic urethra, rather than the bladder. In this scenario, the balloon must be immediately deflated, the catheter advanced further, and then re-inflated after urine flow is re-established. Post-procedure monitoring includes watching for hematuria, or blood in the urine, which is common if minor trauma occurred during insertion but should not be persistent or significant. Long-term safety involves monitoring for signs of a CAUTI, such as fever, chills, suprapubic pain, or new-onset confusion in older adults, which require prompt medical evaluation.