A urinary catheter is a flexible tube inserted into the bladder to drain and collect urine. This technique becomes necessary when a person cannot empty their bladder naturally, a condition that can lead to infection, bladder stones, or kidney damage if left untreated. Because it is an invasive medical process, the procedure requires a trained professional or an individual who has received explicit instruction. The primary focus during catheter insertion is to maintain sterility to prevent infection and ensure patient safety.
Understanding Catheter Types and Indications
The choice of catheter depends on the reason for its use and the expected duration of placement. Intermittent catheters, often called “in-and-out” catheters, are single-use tubes inserted only long enough to empty the bladder completely, and then immediately removed. They are recommended for individuals managing chronic urinary retention or those who perform self-catheterization multiple times daily.
Indwelling catheters, commonly known as Foley catheters, remain in the bladder for extended periods, secured internally by a small balloon inflated with sterile water. A third type, the suprapubic catheter, is inserted directly into the bladder through a small abdominal incision, bypassing the urethra. Catheterization is indicated for acute or chronic urinary retention, monitoring urine output in critically ill patients, or short-term drainage following surgery. Utilizing the smallest effective catheter size is standard practice, as larger diameters can increase the risk of urethral trauma.
Essential Preparation and Safety Protocols
Thorough preparation is necessary before catheter insertion, as it directly impacts the risk of developing a Catheter-Associated Urinary Tract Infection (CAUTI). The procedure must always be performed using an aseptic, or sterile, technique. This begins with meticulous hand hygiene, followed by donning sterile gloves to create a barrier against microorganisms.
A sterile catheterization kit contains the necessary supplies, including the catheter, sterile lubricant, antiseptic cleansing solution, sterile drapes, and a collection bag for indwelling types. The patient is positioned comfortably, usually lying on their back, with adjustments made to expose the urethral opening. Female patients often have their legs bent with feet together, while male patients typically lie flat.
The insertion area must be cleaned meticulously with the antiseptic solution, wiping from the meatus outward to prevent contamination. For male patients, the penis tip is cleaned, and the foreskin is retracted if uncircumcised. For female patients, the labia are separated and held apart throughout the cleaning and insertion process. After cleaning, sterile drapes are placed around the genitals, creating a sterile field to minimize the risk of introducing bacteria.
Step-by-Step Insertion Technique
The initial step involves applying sterile lubricant liberally to the catheter tip and the meatus, which reduces friction and discomfort. For male patients, lubricant is often instilled directly into the urethra using a pre-filled syringe. If the lubricant contains a local anesthetic, a waiting period allows the medication to take effect before insertion begins.
Male Insertion
To begin insertion, the penis is held upright at an angle close to 90 degrees to straighten the urethra’s natural curve. The lubricated catheter is gently advanced into the meatus until urine begins to flow. Once urine is observed, the catheter must be advanced further, typically to the bifurcation or “Y” junction of the tubing. This full insertion ensures the balloon is entirely within the bladder, as the male urethra is long and urine return alone is insufficient confirmation.
Female Insertion
The technique for female patients differs due to the shorter urethral length, usually around 1.5 to 2 inches. The person inserting the catheter must keep the labia separated to clearly visualize the meatus, which is located above the vaginal opening. The catheter is inserted gently until urine flow is established, which usually occurs after advancing the catheter about 2 to 3 inches.
Securing the Indwelling Catheter
For indwelling catheters, once urine flows, the catheter is advanced an additional inch or two to ensure the retention balloon is safely positioned inside the bladder. Sterile water is then slowly injected into the balloon port to inflate the retention balloon, typically using 5 to 10 milliliters. A gentle pull confirms the inflated balloon is resting against the bladder neck. The final step involves connecting the catheter to a sterile drainage system, which must be positioned below the bladder level to allow continuous gravity drainage.
Post-Insertion Care and Troubleshooting
Effective long-term management of an indwelling catheter focuses on maintaining cleanliness and ensuring the drainage system functions correctly. The catheter must be secured to the body, typically the thigh or abdomen, using a securement device to prevent tension and minimize urethral trauma. The drainage bag must always remain below the level of the bladder to prevent urine backflow, a major risk factor for infection.
Daily hygiene involves cleaning the area where the catheter enters the body with mild soap and water at least once daily. The drainage bag should be emptied regularly, ideally when it is one-half to two-thirds full, to avoid excessive weight. Maintaining a high fluid intake is recommended to keep urine diluted and prevent sediment or clots that can block the catheter.
If urine flow stops, check the tubing for kinks or twists that might be obstructing the drainage path. Changing body position can sometimes relieve pressure points blocking the flow.
It is necessary to seek medical attention if signs of complications arise, indicating a developing infection or device problem.
When to Seek Medical Attention
Prompt evaluation is required for symptoms such as:
- Fever.
- Cloudy or foul-smelling urine.
- Pain in the lower abdomen.
- Urine leakage around the catheter site.
Additionally, if the catheter feels displaced or if the balloon fails to deflate during removal, a healthcare provider should be contacted immediately.