A straight catheterization, also known as intermittent catheterization, is a temporary procedure used to drain urine directly from the bladder. It involves inserting a thin, flexible tube (the catheter) through the urethra into the bladder for immediate drainage. This guide provides information for patients or caregivers, but thorough, hands-on training from a qualified healthcare professional is necessary before attempting the procedure.
Indications and Required Equipment
Straight catheterization is most commonly prescribed to manage urinary retention, where the bladder cannot empty on its own due to nerve damage, a urinary tract issue, or weakened muscles. Emptying the bladder regularly helps prevent potential complications like kidney damage, uncontrolled leakage, and urinary tract infections. The procedure is also used to obtain a sterile urine sample for diagnostic testing or to manage conditions like neurogenic bladder.
The primary piece of equipment is the catheter itself, typically a straight-tipped tube made of plastic or rubber and sized using the French scale (14 to 16 French is common for adult males). A water-soluble lubricating gel is required to minimize friction and prevent urethral irritation; petroleum-based products must be avoided. The procedure also requires an antiseptic solution or wipes to clean the insertion site, sterile or clean gloves, and a container to collect the drained urine.
Preparing the Patient and Environment
Before beginning the procedure, meticulous hand hygiene by washing with soap and water is essential for infection prevention. The patient should be positioned comfortably, generally lying supine with their legs slightly extended or apart to provide easy access to the urethral opening. Ensuring the patient’s privacy and having all necessary supplies organized on a clean field helps maintain a smooth process.
If the patient is uncircumcised, the foreskin must be gently retracted to fully expose the meatus (the urethral opening). The glans penis is then thoroughly cleansed using the provided antiseptic solution, moving in a circular motion from the meatus outward to the base. Each antiseptic-soaked cotton ball or wipe should be used only once and discarded immediately.
Step-by-Step Catheter Insertion and Removal
The catheter’s tip and the first couple of inches must be generously coated with the water-soluble lubricating jelly to ensure smooth passage through the urethra. The penis should be held gently yet firmly with the non-dominant hand, lifting it slightly away from the body and positioning it straight up (perpendicular to the body). This positioning helps straighten the natural curves of the male urethra, minimizing kinking and facilitating advancement.
The lubricated catheter is then slowly and steadily inserted into the meatus with the dominant hand. As the catheter advances, resistance may be felt, typically at the external sphincter muscle about three-quarters of the way in. If resistance occurs, the patient should be instructed to take a deep breath, cough, or try to relax, which can help the muscle momentarily loosen. Gentle but firm, steady pressure should be maintained, but the catheter must never be forced, as this risks serious injury to the urethra.
Once the catheter reaches the bladder, urine will begin to flow out of the end of the tube, confirming correct placement. The catheter should then be advanced another one to two inches to ensure the eyelets, or drainage holes, are fully inside the bladder. The urine is allowed to drain completely into the collection container or toilet, and once the flow stops, the catheter is slowly and carefully withdrawn.
Post-Procedure Monitoring and Troubleshooting
After the catheter is removed, all used supplies should be immediately discarded to maintain hygiene. The patient’s genital area should be rinsed to remove any residual antiseptic solution or lubricant, and the hands should be washed again. Note the volume and appearance of the urine drained, as this monitors the patient’s bladder function and hydration status.
If the catheter cannot be inserted past the point of resistance, it should not be forced, and the patient may need to attempt the procedure again after a short break. If the bladder is full and the patient is experiencing significant discomfort or cannot pass any urine, this is a medical emergency. Immediate attention from a healthcare provider or emergency department is required in this situation.
Medical attention is necessary for signs of infection, such as fever, chills, pain during urination, or the presence of thick, cloudy, or foul-smelling urine. Persistent, significant bleeding (gross hematuria) or sustained pain following the procedure also requires contacting a urologist or emergency services. Regular follow-up with a healthcare team is part of managing any ongoing catheterization regimen.