In the name of god
Principle Of Urethral Catheterization

Dr. A Jabbari (MD)

Tabriz university of medical science

Urology department
‫‪ ‬اهداف درس‪:‬‬
‫‪ ‬آشنایی با انواع کاتترها‬
‫‪ ‬اندیکاسیون کاتتریزاسیون‬
‫‪ ‬نحوه صحیح کاتتریزاسیون‬
‫روش ارزیابی ‪:‬‬
‫‪ o‬تئوری بیشتر بصورت ‪MCQ‬‬
‫‪ o‬عملی بصورت استفاده از فرمهای ‪Logbook‬‬

The word "katheter" came from "kathiemai —
καθίεμαι" meaning "to sit". The ancient Greeks
inserted a hollow metal tube through the urethra
into the bladder to empty it and the tube came to
be known as a "katheter".
Historical Background

One of the earliest descriptions of a urinary catheter
can be found in the Hippocratic text On Diseases
(400 BC), in which bladder drainage was
considered a basic skill in the armamentarium of
Greek physicians

In Avicenna’s Canon of Medicine, mention is also
made of urethral catheterization as a means to
deliver intravesical therapy.
Indications
The most common indications for the use of a bladder
catheter can be broadly divided into two main
categories:

To allow the instillation of diagnostic or therapeutic
agents

To obtain drainage of bladder
Other indications..

To allow healing after lower urinary tract
surgery/trauma

To evacuate the bladder when the urine contains
particulate matter, especially in combination with
simultaneous irrigation (post transurethral resection,
clot/purulent material evacuation)

The collection of microbiologic clean urine
(uncooperative patients because of age or mental
status or comorbidities that prevent voluntary
voiding)

To provide access to the bladder for urinary tract
imaging studies such as cystography

To allow instillation of pharmacologic agents for
local therapy of some bladder pathologies
Catheter Selection

The size and type of urinary catheter used depends
on the indication for catheter insertion, age of the
patient, and type of fluid expected to be drained
Catheter size

Catheter size is measured in the French scale,
whereby one Fr is equal to 0.33 mm

As a general rule, catheter size should be the
smallest size that can accomplish the desired
drainage
Age in year
Catheter size in Fr
<5
5-8
5-10
8-10
10-14
10
>14
10-14
Material

Modern urinary catheters are most frequently made
of latex, rubber, silicone, and polyvinylchloride
(PVC)

Rubber and latex catheters are often chosen for
short-term drainage.

Silicone catheters are indicated for patients
requiring a longer period of indwelling time

Evidence suggests that the use of silicone catheters
is associated with a lower incidence of urinary tract
infections compared with those made of latex.
Number of Channels

The most basic catheters are constructed with a
single lumen to permit urinary drainage or
irrigation/instillation.

Additional lumens are added to permit addition of
a retention balloon (two way ) and for simultaneous
drainage and irrigation (three way )
Tip Shape
Straight without retainig
mechanism

One-time drainage, instillation or irrigation in
children, females, and most males

Robinson

Nelaton

Jaques
Straight with balloon

Foley: continuous drainage or irrigation in children,
females, and most males

Madduri: used for urethrography, allows proximal
and distal occlusion and contrast instillation in the
intermediate section
Straight with 2 or 4 wings

Malecot: continuous drainage or irrigation in
children, females, and most males
Straight with umbrella

Pezzer: continuous drainage or irrigation in children,
females, and most males
Malecot vs Pezzer
Curved with balloon

Coudé: continuous drainage or irrigation

Ease of insertion males with enlarged prostate
midlobe or high bladder neck
End hole catheters

Councill: continuous drainage or irrigation in
children, females, and most males
(end hole permits insertion or exchange over a
previously placed guidewire)
End hole catheter

Whistle tip: has a large diameter end hole
occupying half of its beveled tip
( for increased drainage/instillation capacity)
Technique of Catheter Insertion

The patient should be in the supine position at a
comfortable height for the physician performing
catheterization

In female patients a “frog-leg” position is most
suitable, and the use of stirrups can be considered,
especially in the obese

Catheterization should be carried out in a sterile
fashion with antiseptic preparation and draping of
the patient’s meatal and genital area

If topical anesthesia is to be used,evidence suggests
it requires a minimum of 10 minutes of exposure of
low temperature(< 4° C) anesthetic gel(depending
on the agent), sufficient volume of the agent (20 to
30 mL), and slow instillation time (>3 to 10 seconds)
to have the most effect.
Catheterization in male Patients

After sterile skin preparation and draping, grasp the
shaft of the penis with the nondominant hand
(which is now regarded as contaminated) and hold
the penis at a 90-degree angle or perpendicular to
the patient.

Insert the lubricated tip of the catheter into the
urethral meatus and gently but firmly continue to
advance the catheter for 7 to 10 cm, while
simultaneously bringing the shaft of the penis to the
horizontal plane or parallel to the patient

Once the entire length of the catheter has been
introduced (up to the juncture of the connector or to
the two-way bifurcation),wait for spontaneous urine
passage, confirming proper placement of the catheter

If spontaneous drainage of urine is not seen, gently
press on the patient’s suprapubic area

If despite this maneuver no drainage occurs, slowly
instill 20 mL of saline using a catheter-tipped syringe
into the drainage port of the catheter and then slowly
aspirate the fluid instilled

Only when the position of the catheter has been
verified should the retaining balloon be inflated

Sterile water is the preferred solution for balloon
inflation. Air is compressible and might leak, and
electrolyte or glucose-based solutions can
precipitate and occlude the tubing and valve
mechanism

The catheter should be attached to a sterile closed
bag system as soon as urine is draining

The drainage bag should be placed below the level
of the bladder to encourage one-way gravity flow
with the tubing as straight as possible and avoiding
kinks that might impair drainage.
ex vacuo hematuria

In patients with acute urinary retention with
significant bladder distension ,bladder drainage
might precipitate decompression-induced
hematuria.

In these patients the catheter should be
intermittently clamped and released to permit
gradual bladder decompression over 30 to 60
minutes
Catheterization in female Patients

After antiseptic preparation and sterile draping, use
the nondominant hand to spread the patient’s labia
(now considered contaminated) to reveal the
urethral meatus

After lubrication,insert the tip of the catheter and
gently advance using a slightly downward direction,
until about half the length of the catheter has been
inserted

In the obese patient, the use of one or more
assistants to provide labial retraction or the use of
stirrups can be helpful
postmenopausal vaginal atrophy or
conditions resulting in the urethral
meatus receding into the introitus:

Holding the index and middle fingers of the nondominant hand
together, slowly slide posterior along the introitus until the urethral
meatus is palpated and then proceed to slide the fingers just distal to
the inferior margin of the meatus. Using the dominant hand, pass the
catheter along the groove made by the fingers

A second maneuver is to use a vaginal speculum to aid in the
retraction and fixation of the introitus. Finally use a coudé tip catheter
angled upward and gently slide the tip along the anterior vaginal
wall in the midline, until it enters the meatus, and then advance into
the bladder.
Special Considerations in Children

Whenever possible the procedure should be
explained in clear and age-appropriate language
to the child

In female children the correct identification of the urethral meatus is
essential to avoid unnecessary catheter contact with the sensitive
introitus, leading to discomfort and possibly loss of cooperation by
the child.

The meatus is just above the superior margin of the introitus and
frequently hidden by the superior portion of the hymen. Gentle
downward pressure on the upper aspect of the hymen with a cotton
ball may allow visualization of the meatus.

Failing this maneuver, the catheter tip should be inserted just above
the hymen in the midline

In uncircumcised boys, retract the foreskin only until the meatus is
visible. In infants and children younger than 3 years of age, when the
normal foreskin adhesions have not yet involuted, simply align the
preputial opening with the meatus to assist catheter insertion.
Difficult Catheterization

Difficulty inserting a catheter into the bladder is most
commonly due to prostatic growth, urethral
stricture(s), bladder neck contracture, or false
passage from previous urethral instrumentation

After the catheter has been inserted using aseptic
technique, it should immediately be connected to
the sterile bag, because an aseptic closed
drainage system minimizes the risk of catheterassociated urinary tract infections
Complications of Urethral
Catheterization

UTIs account for 40% of all nosocomial infections

Inability to remove the catheter from the bladder

Hematuria

Urethral and meatal strictures

Urethral perforation

Allergic reactions

Malignant neoplasms

Stone formation

Bladder neck and urethral erosions