Urinary Catheterization - Male

Cognitive Content

Skill Title :

Urinary Catheterisation in Male.   Status :  D

Learning Objectives :

  1. Indications for urinary catheterisation (K)
  2. Anatomy of Male Urethral Tract
  3. Equipment required for female/male urinary catheterization:
  4. Choosing appropriate catheter type/size depending upon Age/ Sex / Site Anomalies(SH)
  5. Complications / Risks associated with catheterization (K):
  6. Explanation to Patient of entire procedure
  7. Aseptic precautions during procedure and their impact
  8. Demonstrate correct method of urinary catheterization with strict aseptic technique in mannequin (Male )

Indications for urinary catheterisation (K): Short term / Long Term

  1. Perioperative use in selected surgeries (Pre Op/ Intra Op/ Post Op )
  2. Pelvic Trauma
  3. Chronic Retention of Urine
  4. Neurological disorders with lack of Sphincter Control
  5. Acute urinary retention or obstruction
  6. Terminally ill / palliative care
  7. Accurate measurement of urinary output in critically ill patients
  8. Required strict immobilization for trauma or surgery
  9. Assistance in healing of severe perineal and sacral wounds in incontinent patients

Anatomy of Male Urethral Tract (Picture):

Equipment Required :

  1. Catheterization tray consists of disposable sterile gloves, one fenestrated drape, lubricant, cotton balls with container, artery forceps (2), prefilled 10cc syringe with sterile water to inflate the balloon, sterile specimen container for urine sample collection; (Picture)
  2. Sterile catheter, latex (rubber) or silicone: 2 way or 3 way (where possible, select the non-latex 37 catheter),
  3. chlorhexidine 2% aqueous solution, Sterile water, catheter-secure device or adhesive tape,
  4. urinary drainage bag. (Picture)

Choosing appropriate catheter type/size depending upon Age/ Sex / Site Anomalies(SH) : Factors  considered :

   Add Pictures of Catheters

  • Patient sex
  • The size of the patient’s urethral canal
  • The expected duration of catheterization (e.g. intermittent or indwelling)
  • Knowledge of any allergies to latex or plastic and cleansing solutions.

What is French Scale / English Scale ?

Commonly used range is from 12 to 16 Fr The higher the number the larger the diameter of the catheter. 3Fr. = 1mm (i.e. a 24fr. catheter is 8mm in diameter)

Simulation Equipment for demonstration :

    • Picture

         

  • Equipment details
  • Technical specs
  • Operational Demo.

Complications /  Risks associated with catheterization (K):

Pain / Infection / False passage /  Rupture/Trauma and bleeding

Explanation to Patient of entire procedure

Aseptic precautions during procedure and their impact

Demonstrate correct method of urinary catheterization with strict aseptic technique in mannequin  (Male )

Place the patient in the supine position with legs extended and flat on the bed

Prepare the catheterization tray and catheter and drape the patient appropriately using the sterile drapes provided. Place the fenestrated (drape with hole) drape over the penis.

Apply water-soluble lubricant jelly , commonly Xylocain 2 percent gel.to the catheter tip.

With your non-dominant hand, grasp the penis just below the glans and hold upright. If the patient is not circumcised, retract the foreskin.

Do not forget to replace the foreskin at the end of the procedure.

With your dominant hand, cleanse the glans using chlorhexidine soaked cotton balls.

Place the drainage basin containing the catheter on or next to the thighs.

With your non-dominant hand, gently straighten and stretch the penis. Lift it to an angle of 60-90 degrees.

At this time, you may use the gel to anesthetize the urinary canal, which will minimize the discomfort.

With your dominant hand, insert the lubricated tip of the catheter into the urinary meatus.

Continue to advance the catheter completely to the bifurcation i.e. until only the inflation and drainage ports are exposed and urine flows (this is to ensure proper placement of the catheter in the bladder and prevent urethral injuries and hematuria that result when the Foley catheter balloon is inflated in the urethra).

If resistance is met during advancement of the catheter, pause for 10-20 seconds. Instruct the patient to breathe deeply and evenly. Apply gentle pressure as the patient exhales. If you still meet resistance, stop the procedure and repeat above steps with a smaller size.

Attach the syringe with the sterile water and inflate the balloon. It is recommended to inflate the 5cc balloon with 7-10cc of sterile water, and to inflate the 30cc balloon with 35cc of sterile water. Improperly inflated balloons can cause drainage and leakage difficulties.

Gently pull back on the catheter until the balloon engages the bladder neck.

Attach the urinary drainage bag and position it below the bladder level. Secure the catheter to the thigh. Avoid applying tension to the catheter.

Note: Never inflate a balloon before establishing that the catheter is in the bladder and not just in the urethra. If the patient reports discomfort, withdraw the fluid from the balloon and advance the catheter a little further, then re-inflate the balloon.

Care of the Catheter post insertion.

  • Strapping
  • Catheter dressing
  • Prevent spillage / Stretch

Assessment parameters :

  • Anatomy
  • Indications
  • Aseptic precautions,
  • Risks and complications
  • Actual procedure
  • Catheter care

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