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A catheter is a medical device consisting of a long, thin tube which can be fitted with a variety of different tips to serve a range of functions. Catheters are inserted into the body as part of many different medical procedures; for example, they are utilized to diagnose genitourinary (GU) tract bleeding, to monitor intracranial pressure, and even administer certain medications. In common practice, 'inserting a catheter' typically denotes the routine insertion of a urinary catheter into the bladder through a patient's urethra for the purpose of draining urine. Like all medical procedures, including this commonplace one, appropriate medical training and strict adherence to safety and sanitation protocols are imperative.
Steps
Preparing for Insertion
Discuss the procedure with the patient beforehand. Most patients are not accustomed to inserting any object, particularly a lengthy tube, into their urethra. Although this is not always characterized as 'painful,' it is frequently described as 'uncomfortable,' sometimes intensely so. Out of consideration for the patient, explain the procedure's steps to them before commencing.
- Clarifying the steps and what to anticipate can also aid in relaxing the patient and alleviating anxiety.
Instruct the patient to lie flat on their back. Their legs should be apart, and feet should be together. This position aids in relaxing the bladder and urethra, making catheter insertion smoother. A tense urethra can squeeze the catheter, causing resistance during insertion, leading to discomfort and potentially damaging the urethral tissue. In severe cases, this may result in bleeding.
- Help the patient assume the supine position if needed.
Cleanse your hands and don sterile gloves. Gloves are vital components of Personal Protective Equipment (PPE) used by healthcare providers to safeguard themselves and patients during medical procedures. Sterile gloves, particularly in catheter insertion, help prevent the introduction of bacteria into the urethra and minimize the risk of contact between your hands and the patient's bodily fluids.
Unpack the catheter kit. Single-use catheters are typically packaged in sealed, sterile kits. Before opening, ensure you have the appropriate catheter size for the procedure. Select a catheter size suitable for the patient, typically measured in units called French (1 French = 1/3 mm) ranging from 12 (small) to 48 (large) French.
- Smaller catheters generally enhance patient comfort, but larger ones may be necessary for draining thick urine or securing the catheter in place.
- Some catheters feature specialized tips for various functions. For example, Foley catheters, commonly used for urine drainage, have a balloon attachment that can be inflated to hold the catheter behind the bladder neck.
- Gather necessary supplies such as medical-grade disinfectant, cotton swabs, surgical drapes, lubricant, water, tubing, drainage bag, and tape. Ensure all items are properly sanitized or sterilized.
Sanitize and prepare the patient's genital area. Cleanse the genital area with disinfectant-soaked cotton swabs, followed by rinsing or wiping with sterile water or alcohol to remove any debris. Repeat as necessary. Then, place surgical drapes around the genitals, leaving an opening for access to the penis or vagina.
- For female patients, ensure thorough cleaning of the labia and urethral meatus (opening above the vagina). For males, clean the urethral opening on the penis.
- Clean from inside to outside to prevent urethral contamination. Begin at the urethral opening and gently move outward in a circular motion.
Inserting the Catheter into the Bladder
Apply lubrication to the catheter's tip. Cover the distal end of the catheter (the 0.78-1.97 in (2-5 cm) segment at the tip) generously with lubricant. This is the end that will be inserted into the urethral opening. If using a balloon catheter, ensure to lubricate the balloon section at the tip as well.
For female patients, gently separate the labia and insert the catheter into the urethral opening. Hold the catheter in your dominant hand and use your non-dominant hand to spread the patient's labia, allowing clear visibility of the urethral opening. Carefully insert the catheter's tip into the urethra.
For male patients, support the penis and insert the catheter into the urethral opening. Grasp the penis with your non-dominant hand and gently elevate it perpendicular to the patient's body. Insert the catheter's tip into the patient's urethra using your dominant hand.
Continue advancing until the catheter reaches the bladder. Slowly guide the catheter through the urethra and into the bladder until urine is visible. Once urine starts to flow, push the catheter an additional 2 inches (5.08 cm) to ensure it reaches the bladder neck.
If employing a balloon catheter, inflate the balloon using sterile water. Employ a syringe filled with sterile water to inflate the balloon through sterile tubing connected to the catheter. The inflated balloon acts as an anchor to prevent catheter displacement during movement. After inflation, gently tug on the catheter to verify the balloon is snugly positioned against the bladder neck.
- The quantity of sterile water required for balloon inflation varies based on the balloon size. Typically, around 10 cc of water is necessary, but confirm the balloon size for accuracy.
Attach the catheter to the drainage bag. Utilize sterile medical tubing to enable urine drainage into a collection bag. Secure the catheter to the patient's thigh or abdomen using adhesive tape.
- Ensure the drainage bag is positioned lower than the patient's bladder. Catheters rely on gravity for drainage, and urine cannot flow against gravity.
- In medical settings, catheters may remain in place for up to 12 weeks before replacement, although they are often changed sooner. Certain catheters, such as straight or intermittent catheters, are removed immediately after urine ceases to flow.
Useful Tips
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Catheters are manufactured from various materials including latex, silicone, and Teflon. They may come with or without balloons, and with different balloon sizes.
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Empty the drainage bag every 8 hours.
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Most healthcare practitioners adhere to universal precautions, employing sterile techniques that involve wearing sterile gloves, facial and/or eye protection, sterile gowns, and working in a sterile environment during catheter insertion.
Cautions
- Some patients may have latex allergies. Monitor for any adverse reactions.
- Improper insertion of the catheter may result in leakage or inadequate urine drainage into the collection bag.
- Watch for potential complications such as strong odors, cloudy urine, fever, or bleeding.
- Foley catheters should only be inserted by trained medical professionals or under their supervision. Incorrect insertion can lead to severe urethral damage.
Essential Supplies
- Sterile gloves
- Sterile drapes
- Skin cleaning solution
- Cotton swabs
- Sterile water
- Lubricant
- Medical tubing
- Drainage bag
- Tape
- Sterile water
- Syringe
