Haik Primary Hospital IPD Catheterization Protocol

Senie 2016 E.C

Updated on Senie 2017 EC
 Haik Primary Hospital

Table of content
1. Introduction ------------------------------------------------------------------------ 3
2. Indications catheterization ----------------------------------------------------- 3
3. Types of catheterization -------------------------------------------------------- 4
4. Choice of urinary catheter------------------------------------------------------ 4
5. Catheterization procedure------------------------------------------------------ 8
6. Complications---------------------------------------------------------------------- 9

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1. Introduction
Urinary catheterization is a procedure where a flexible tube (catheter) is inserted into
the bladder to drain urine. It's commonly performed by healthcare professionals and can
be done through the urethra (urethral catheter) or a small opening in the abdomen
(suprapubic catheter). The procedure is used for various reasons, including managing
urinary retention, monitoring urine output, and collecting urine samples.

The first balloon catheter was designed in the 1930s by Frederic Foley; the basic
catheter retains his name. Modern-day alternatives to indwelling urethral catheterization
include external catheters, suprapubic catheters, intermittent catheterization, and, in
some cases, supportive management with protective garments.

Principles of urinary bladder care:

 Catheterize when only absolutely needed.

 Keep the catheter if and only if the patient still needs it.
 Apply aseptic precautions and rigorous infection prevention practice.
 Provision of consent, ensuring privacy, dignity to the patient.

2. Indications for urinary catheterization

Urinary bladder catheterization is a common procedure done in both in-patient and out-
patient settings. Urinary catheters are used for urinary drainage, or as a means to
collect urine for measurement or access the bladder for treatment.

 Management of urinary retention with or without bladder outlet obstruction.

 Management of patients with urinary incontinence following failure of
conservative, behavioral, pharmacologic, and surgical therapy
 Accurate urine output monitoring in critically ill patients.
 During surgery to assess fluid status and prevent bladder over distention
 During and following specific surgeries of the genitourinary tract or adjacent
structures (ie, urologic, gynecologic, colorectal surgery).
 Bladder irrigation (management of hematuria associated with clots).
 Intravesical pharmacologic therapy (eg, bladder cancer).
 For patient safety, comfort, or continence:
o Management of immobilized patients (eg, stroke, pelvic fracture).
o Management of patients with neurogenic bladder from spinal cord injury.
o Improved patient comfort for end-of-life care.

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Unwarranted urinary catheters are placed in 21 to 50 percent of hospitalized patients.

The most common inappropriate indication for placing an indwelling urethral catheter is
management of urinary incontinence. Chronic urinary incontinence should not be
managed with an indwelling urethral catheter unless there is no other option. Others
include:

- Catheterizing older adults despite being continent

- Catheterizing for obtaining urine sample

Contraindications to indwelling urinary catheter:

The only absolute contraindication to insert a Foley catheter is urethral injury, commonly
associated with pelvic trauma. Gross hematuria or the presence of blood at the urethral
meatus in a patient with pelvic trauma should be considered as possible urethral
trauma. Relative contraindication includes systemic bleeding, and urethral surgery.

3. Types of catheterization
Indwelling (Foley) Catheter: A catheter that remains in the bladder for a period of time,
connected to a drainage bag.

Intermittent Catheter: A catheter that is inserted and removed multiple times a day to
drain the bladder.

Condom Catheter: A sheath-like device placed over the penis to collect urine.

4. Choice of urinary catheter

Catheters available for urinary drainage include:

1. External (eg, condom, pouch)

2. Urethral (indwelling, intermittent), and
3. Suprapubic

Indwelling urethral catheters are most commonly placed in the hospital setting for acute
indications. However, they are intended for short-term use (less than three weeks) and
should be changed to a suitable alternative when the indication for catheterization
becomes subacute or chronic, or the expected duration of catheterization exceeds three
weeks.

For patients requiring chronic catheterization without urinary retention, external

catheters are suggested over urethral catheters whenever possible.

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For patients requiring chronic catheterization for bladder emptying dysfunction,

intermittent catheterization is suggested over chronic indwelling catheters. Clean
technique is an acceptable and practical alternative to sterile technique.

External catheters are the least invasive means of collecting urine in patients who do
not have urinary retention or urinary obstruction. They are widely used in chronic care
facilities because they avoid urethral trauma and improve patient comfort and mobility
compared with indwelling catheters. The impact of external catheters on hospital-
acquired urinary tract infections is not known.

External catheters are available as penile sheath catheters (i.e., condom catheters) for
males or urinary pouches for both males and females. Contraindications to their use
include the presence of penile ulceration or perineal dermatitis. It is important to ensure
the patient has adequate manual dexterity if they are expected to place the device
themselves.

5. Catheterization procedure
Urinary catheterization should be performed up on the order of a clinician.

Pre-procedure:

- Consent: Verbal consent should be received. During consent adequate explanation

on the need to catheterize, about the insertion procedure, expected duration, the
potential discomfort, and possible complications.
- Privacy and dignity: The procedure should be done in private procedure rooms or
using appropriate shield. The procedure should be done in a dignifying manner.
- Catheter size: should be individualized to the needs of the patient. In adults, a 14 to
16 Fr (Female) or 16 to 18 Fr (Male) catheter is typically chosen. Smaller sizes (12-
14 Fr) may be needed for patients with urethral strictures and 6-10 Fr used for
pediatric patients. Larger catheters (20-24 Fr) are used to provide an adequate bore
for the drainage of hematuria or clots and in patients with BPH.
- Balloon size: A 5cm balloon size should be used for routine catheterization.

The procedure:

- Needed materials: appropriate size catheter, 2 pairs of sterile gloves, cleansing

agent (normal saline), lubricating gel (sterile, closed), syringe filled with water for
injection, drainage bag, bed protection (disposable pad), and alcohol-based hand
rub.

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Important Considerations:

 Keep the urine collecting bag below the level of the bladder at all times.
 Do not rest the bag on the floor.
 Empty the urine bag regularly. Do not keep it until it is full, empty when it about two-
third fill.
 Avoid contact of the drainage plug with the collecting container.
 Unless obstruction is anticipated as in bleeding after prostatic or bladder surgery
irrigation should be avoided.
 Do not clean the periurethral area with antiseptics in an attempt to prevent infection
(CAUTI). Routine hygiene such as cleansing the meatus area during bathing is
appropriate.
 Do not use topical or systemic antibiotics in an attempt to prevent CAUTI.
 Following aseptic placement of indwelling catheters, the standard is to use a closed
drainage system. Breaks in the integrity of the closed system should prompt
replacement of the drainage system.
 Indwelling urethral catheters and drainage systems are changed only for a specific
clinical indication such as infection, obstruction, or compromise of closed system
integrity.
 Indwelling urinary catheters should be removed as soon as it is no longer needed.
Following surgery not in the urinary tract, catheters should be removed as soon as
possible (ideally in the recovery room) to reduce the incidence of urinary tract
infection. If a catheter was inserted for surgery on the urinary tract, it should only be
removed by, or with prior approval of, the surgeon.
 To removing an indwelling urethral catheter aspirating the balloon port with an empty
syringe, which deflates the balloon; the catheter should then slip out.
 If an indwelling urinary catheter is accidentally removed (often by the patient), it can
be gently replaced if there is no blood at the meatus. However, if there is blood at
the meatus or if there is resistance upon reinserting the catheter, the reinsertion
attempt should be aborted and surgical consultation requested.
 Indwelling urinary catheters should generally be changed every 4 to 12 weeks to
minimize the risk of infections and complications. However, the specific frequency
can vary based on individual needs and factors like the type of catheter and the
presence of any complications. Some manufacturers provide specific guidelines for
catheter replacement, which should be followed.
 Documentation: On completion of the procedure, record information in the relevant
documents. This should include: Date and time of catheterization; the indication for
catheterization (or change of catheter); catheter type, length and size; amount of
water instilled into the balloon and any problems during the procedure.

6. Complications
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General complications:

- The most common complication of urinary bladder catheters is catheter-associated

urinary tract infection. In males, urinary infection can lead to epididymitis or orchitis.
- Other rare complications of indwelling catheters include urinary tract obstruction
from retained balloon fragments, bladder fistula, bladder perforation, or bladder
stone formation.

Catheter-specific complications:

- External catheters: Improper or prolonged application of condom catheters can

cause pressure-related complications including skin depigmentation, ulceration, or
penile necrosis.
- Urethral catheters: The traumatic insertion of urethral catheters can create a false
passage, which, if infected, may lead to periurethral abscess. Long-term
complications associated with chronic urethral catheters (indwelling or intermittent)
include patient discomfort, urethral stricture and incontinence.
- Suprapubic catheters: When properly placed, complications from the placement of
suprapubic catheters are uncommon. Inadvertent bowel injury can occur during
percutaneous suprapubic catheter placement.

Prevention of complications:

- The most effective strategy to reduce complications of urinary bladder catheters is

the avoidance of unnecessary catheterization.
- When urinary bladder catheters are required, adequate training of the patient,
hospital personnel, and caregivers is essential to avoid complications related to
placement, to ensure proper care, and to promptly recognize and treat complications
expeditiously when they do occur.

7. References
 STG 2021

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 UpToDate 2025

Amending team members

1. Dr Andinet Azaje (Internist, CCO) Sign ____________

2. Jemal Ahmed (Surgical nurse, IPD head) Sign ____________
3. Adefa Seid (BSC nurse, Matron) Sign ____________

Amendment ------------------------------------------------------------ every year