The most common indication for male urethral catheterisation is to relieve urinary retention but it may also be used for investigations such as urodynamic studies and for instilling intravesical medication. The National Institute for Health and Care Excellence (NICE) has summarised the indications for catheter use (NICE, 2019). It is important to avoid use of catheters where possible, as around 60 per cent of healthcare-associated urinary tract infections are related to catheter insertion (DH, 2010). Nurses and other healthcare professionals carrying out this procedure should ensure that their employers accept this extended role as part of their workload. Competence should be assessed by other healthcare professionals who are deemed competent in this procedure and can provide supervision for those who are striving to achieve competence (Skills for Health, 2010; NMC, 2018).
The type of catheter used, called a Foley catheter, is designed to be retained in the bladder. It has a balloon for inflation with sterile water, which helps to anchor it in the bladder. See below for information on how long the different types of catheter can be left in place. Note that only standard-length catheters should be used in males. The National Patient Safety Agency (NPSA) received reports of more than 100 male patients who were catheterised with short-length (female-length) catheters over a 2-year period, causing pain, haematuria and penile swelling and sometimes more serious side-effects (NPSA, 2009).
You will also need to select an appropriate drainage appliance or catheter valve for the patient (see procedure on “Catheter care”).
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Silver-alloy-coated latex (short-term catheter—can be left in place for 4 weeks)
Short-term latex catheter coated with polytetrafluoroethylene (PTFE) (up to 4 weeks)
Silicone-coated long-term catheter (up to 12 weeks)
Hydrogel-coated long-term catheter (up to 12 weeks)
Pure 100% silicone long-term catheter (up to 12 weeks)
CatheterisationAdults
Male indwelling urethral catheterisationEdited by Rachel Leaver, Lecturer Practitioner—Urological Nursing,
Do not undertake or attempt any procedure unless you are, or have supervision from, a properly trained, experienced and competent person.Always first explain the procedure to the patient and obtain their consent, in line with the policies of your employer or educational institution.
Catheter selection (Note: colours of catheter materials vary between manufacturers)
Catheter length. Standard-length catheters are the only length acceptable for use in males. Duration. It is good practice to check the manufacturer’s information on the catheter packaging to confirm whether it is a long- or short-term catheter. Catheter diameter (Charrière size). For routine urine drainage in an adult, select the smallest Charrière size which will effectively drain the bladder—usually size 12 ch or 14 ch (4.0 mm or 4.7 mm diameter). Check the patient’s history for problems (e.g. an enlarged prostate gland or urethral stricture) that may influence the choice of diameter.Balloon size. It is important to follow the manufacturer’s guidelines. A catheter with a 10-mL balloon is used for routine bladder drainage in adults. Most catheters come with a 10-mL syringe of sterile water in the packaging, although there are some catheters that have a pre-filled balloon ready for inflation once the catheter has been inserted. Catheters designed for postoperative use following urological procedures have larger balloons with a larger Charrière size. They should not be used for routine bladder drainage as they may irritate the trigone area at the base of the bladder, causing spasm, pain and bypassing. Latex allergy. Check whether the patient is allergic to latex. Only catheters made of polyvinylchloride (PVC) and 100% silicone are free of latex.
Standard-length catheters range between40 and 45 centimetres
Select a standard-length catheter according to the criteria below
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02/2019
WOUNDCARE PACK BLUELATEX FREE POWDER FREE04/2021
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MAKE SURE YOU USE THE
CORRECT CATHETER
Female-only catheters can cause severetrauma and haemmorrage if used in males.
Queen Victoria HospitalBeckham NHS
Shorter catheters (20-26cm) are for females only
Standard catheters (40-45cm) can be used for males and females
This is a FEMALE urinary catheterUse for FEMALES ONLYIf used in males, this can cause severe trauma and life-threatening haemorrhage
Trauma will occur if a balloon catheter is inflated in the urethra, which is likely to happen if a short-length catheter is used in a male patient. The consequences can include severe haemorrhage which may have fatal consequences (NPSA, 2009).
The National Patient Safety Agency has produced posters and labels forcatheter packaging, to increase awareness of the dangers of using ashort-length catheter for a male patient (NPSA, 2009).
Consequences of selecting the wrong catheter Be aware of the risks
Select a suitable drainage bag or catheter valve Check packaging is intact; check expiry dates
Before embarking on catheterisation, assess the patient’s needs. Consider what type of drainage bag and sampling port would be best for the patient, and for his comfort and dignity (Loveday et al., 2014). (See also the procedure on “Catheter Care”.)
Catheterisation
Adults
Male indwelling urethral catheterisation Page 2
Page 2 of 6
Do not undertake or attempt any procedure unless you are, or have supervision from, a properly trained, experienced and competent person.Always first explain the procedure to the patient and obtain their consent, in line with the policies of your employer or educational institution.
When assembling equipment, check that the expiry date on the packets has not passed, and that the packets are sealed (Infection Prevention Society, 2017). Decontaminate your hands before patient contact.
Urethral lubricant gel without lidocaine as an alternative, from a sterile single-use container. KY gel or Aquagel are not licensed for urethral use (due to a high uptake within the urethral lining)
Lubricant gel containing 2% lidocaine hydrochloride (11 mL for males) from a sterile single-use container
Syringe and water for non-filled catheters
Alternatively, prefilled syringe of sterile water
Procedure pad to protect bed or couch
Sterile pack suitable for catheterisation (typical contents: bowl, gauze swabs, forceps, foil or cardboard tray, small gallipot, paper towels and paper sheet, waste bag)
Two pairs of sterile gloves Apron
White blunt fill needle
Sterile water
Cleansing fluid, as in local policy
Place sterile towels on the patient
Instillagel 6ml
Sterile lubricant local anaesthetic and disinfectant for
mucosa in disposable syringes for instillation
Prepare the anaesthetic gel
Catheterisation
Adults
Male indwelling urethral catheterisation Page 3
Page 3 of 6
Do not undertake or attempt any procedure unless you are, or have supervision from, a properly trained, experienced and competent person.Always first explain the procedure to the patient and obtain their consent, in line with the policies of your employer or educational institution.
Create a sterile field Arrange equipment and put on sterile gloves
Review the patient’s history. Explain the procedure to the patient, including provision of written information. Offer the patient a chaperone and obtain consent before beginning. Depending on the setting, you may need to check that the lidocaine local anaesthetic has been prescribed.
Ensure privacy by closing curtains and/or the door. Use a procedure pad to protect the bed or couch. Ask the patient to remove or loosen clothing and to lie in a supine position with legs extended. If the genital area is not socially clean, wash with soap and water and dry thoroughly before beginning the procedure.
Explain the procedure to the patient Patient position
please create new picture based on inset - see caption below
Following local policy at all times, decontaminate your hands and clean a trolley. Put on an apron and decontaminate your hands again, then prepare a sterile field. Use an aseptic technique throughout (see “Aseptic technique: key principles”).
Place the catheter, in the intact sterile inner wrapper, on the sterile field. Retain the batch number (place the outer packet on the trolley’s lower shelf). Add other sterile equipment without contaminating the sterile field, such as additional sterile gloves, sterile gauze and clinical waste bag. If you consider that there is a risk of splashing with urine, you should put on eye/face protection (DH, 2007). Uncover the patient, wash your hands again and dry with a sterile paper towel. Put on sterile gloves (Loveday et al., 2014).
Prepare the anaesthetic by taking the syringe containing local anaesthetic gel (2% lidocaine hydrochloride), placing your finger over the end of the syringe and pushing the plunger to break the seal. Remove the cap from the syringe.
Maintain a sterile field during the procedure by placing sterile towels over the patient’s thighs and lower abdomen. Alternatively cut a hole in the centre of a large sterile towel and place over the genital area so that you can access the penis but the thighs and lower abdomen are covered.
While maintaining a sterile field, place a bowl beneath the penis to receive urine. Tear along the perforated edge of the inner packaging of the catheter to expose a few centimetres of the catheter. Using the packaging to protect the catheter, pull back the packaging as you insert the catheter.
Catheterisation
Adults
Male indwelling urethral catheterisation Page 4
Put on new sterile gloves Open the catheter ready for insertion
Page 4 of 6
Do not undertake or attempt any procedure unless you are, or have supervision from, a properly trained, experienced and competent person.Always first explain the procedure to the patient and obtain their consent, in line with the policies of your employer or educational institution.
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Use the gauze to retract the foreskin, if it is present, to visualise the urethral opening before cleaning. It is important not to fully retract the foreskin, as it may be difficult to reduce. Clean the top of the meatus, passing over the glans towards the retracted foreskin in one sweeping movement and discard the ‘dirty’ swab. Take a second swab and repeat to clean the underside of the meatus, again passing over the glans towards the retracted foreskin. Discard the swab.
Please note, the gauze surrounding the penis during cleansing stays in place but is not shown in the remaining pictures for illustrative purposes. Before instilling the local anaesthetic gel into the urethra, place a few drops on the urethral meatus, then insert the nozzle of the syringe into the meatal opening. Instil the contents of the 11-mL syringe of gel into the urethra to bring about surface anaesthesia.
Once the local anaesthetic gel has been instilled into the urethra, you can remove the syringe. To prevent the gel from leaking out of the urethra, you will need to hold the glans penis closed. Wait 3–5 minutes for the anaesthetic gel to take effect.
Dispose of gloves. Wash and dry your hands. Put on a new pair of sterile gloves or follow local policy.
(b)
Instil the anaesthetic gel (a)
Cleansing (a)
Show use of sterile gauze to hold penis (in left hand). See new caption text in red below. (already shown in Cleansing (b) Select the cleansing agent for cleaning the urethral meatus according to local
policy. Use sterile gauze to wrap around the penis when you hold it. Use your non-dominant hand to do this. Take care not to contaminate your dominant hand as you clean the area.
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Slowly inflate the balloon with 10 mL of sterile water, according to the manufacturers’ instructions. The patient should not feel any pain at this stage, but if he does, the balloon might still be in the urethra (see page 2). If the patient does experience pain, follow local policy and manufacturer’s instructions. You may be required to deflate the balloon, remove the catheter and start again with a new catheter. Or you may be able to deflate the balloon, advance the catheter further and reinflate the balloon. Once the balloon has been successfully inflated in the bladder, gently pull the catheter out until you meet some resistance; this allows you to check that the balloon was inflated in the bladder and is now in the correct position.
Catheterisation
Adults
Male indwelling urethral catheterisation Page 5
Inflate the balloon
Page 5 of 6
Do not undertake or attempt any procedure unless you are, or have supervision from, a properly trained, experienced and competent person.Always first explain the procedure to the patient and obtain their consent, in line with the policies of your employer or educational institution.
Pass the catheter into the urethral meatus Pass the catheter into the bladder
Stop the procedure at any sign of resistance Ensure balloon is in the bladder
To straighten the first curve of the urethra, hold the penis upright and extend it as shown in the illustration. Maintain this position until the catheter has been inserted.
With a smooth, slow action, pass the catheter through the urethra and into the bladder. As you reach the external sphincter, there is usually a feeling of resistance; at this point, ask the patient to cough or bear down as if he wanted to pass urine, while continuing to pass the catheter into the bladder.
If the patient complains of undue pain or discomfort; if you notice bleeding other than that which might be experienced in minor trauma; or if you continue to feel resistance to passage of the catheter and cannot pass this into the bladder, stop the procedure and seek medical advice.
Insert 20–25 cm of the catheter (the male urethra is about 18 cm long) and discard the wrapper. When urine starts to flow out of the catheter, insert it almost to its bifurcation (Dougherty & Lister, 2015). This ensures that the balloon will inflate in the bladder and not within the bladder neck or prostatic urethra.
Catheter valve
Catheterisation
Adults
Male indwelling urethral catheterisation Page 6
Technique for prefilled balloons Attach catheter to drainage system
For pre-filled balloons, remove the clip. Gently squeeze the reservoir of sterile water. Check that this does not cause the patient any pain or discomfort.
Page 6 of 6
Do not undertake or attempt any procedure unless you are, or have supervision from, a properly trained, experienced and competent person.Always first explain the procedure to the patient and obtain their consent, in line with the policies of your employer or educational institution.
Monitor volume of urine draining Make the patient comfortable
Make the patient comfortable; older patients may need to rest for 30 minutes, particularly if they had urinary retention, as rapid drainage of large volumes of urine from the bladder may result in hypotension and/or haemorrhage. Dispose of equipment according to local policy. Remove gloves then apron (Loveday et al., 2014); wash and dry your hands.
Date
Catheter type
Size
Batch number
Expiry date
Antibiotic given?
Reason for catheter change
Problems
Name
Date of next planned change
REF 165816UK
14Ch 43cm 10ml
LOT 87DO8324 2 2021 07 STERILE EO..........................................
Plan the care of the catheter with the patient. Note the date when the catheter should be changed or removed in the care plan. Short-term indwelling urethral catheters should be changed when clinically indicated and in line with the manufacturer's recommendations (Loveday et al., 2014). Document the date, the type and size of catheter, and the amount of water in the balloon. Most catheter packaging comes with sticky labels which contain all the necessary information (catheter material, size, lot number, expiry date and balloon size), which can be stuck in the patient’s notes and/or the catheter passport.
Many organisations use a urinary catheter passport—a document that the patient receives at the time of insertion of the catheter, which records what type of catheter they have and how long it has been in place (Codd, 2014). The passport allows other healthcare professionals (in the community, for example) to find out these details if the patient’s notes are not available to them. If the patient is going home, make sure you include all relevant information in the discharge summary.
Note the amount of urine draining and the rate. If more than 1 litre drains do not clamp the catheter but stay with the patient, as rapid decompression may lead to bleeding (Boettcher et al., 2013). If the patient has a chronic obstruction he may experience a post-obstructive diuresis following catheter insertion. In some cases the excessive loss may result in shock and severe dehydration so the patient may need fluid replacement (Halbgewachs & Domes, 2015).
Once the catheter is in place, attach an appropriate drainage appliance or catheter valve (see “Catheter care”). Check that the meatus and glans are clean and reposition the foreskin. Ensure the catheter is secured comfortably to minimise patient discomfort (Loveday et al., 2014).
