THE FAQs
WHAT IS IT?
HOW DOES IT PRESENT?
QUICK EXPERT
1. Urinary Catheterisation refers to the insertion of a
catheter into the bladder to
drain urine otherwise unable
to be passed through normal
voiding processes.
2. It is indicated for various
pathologies, some of the most
common being urinary
retention (not responsive to
other interventions), urinary
incontinence, post/pre-surgery
and neurological conditions
that affect the function of the
bladder.
3. There are different types of
catheters that are
manufactured for specific
aetiologies. For example,
suprapubic catheters (mainly
used for neurological
conditions), intermittent
catheters, indwelling and so
on.
4. While it may be a commonly
practised procedure in
hospitals and aged care
homes, it is associated with
various risk factors that
can have disastrous
outcomes!
WHY CATHETERISE?
Urinary Catheterisation can be
indicated for a wide range of
aetiologies and disease conditions.
These aetiologies can also be further
classified as acute or chronic. Within
the aged care setting, nurses and care
workers are more likely to encounter
chronic urinary issues that require
continuous care, maintenance and
vigilance. The most common reasons
for catheterisation in the elderly are
urinary retention and incontinence,
which have proven untreatable by
others methods. Other reasons may
be around neurological conditions
which impact the normal function of
the bladder (i.e. multiple sclerosis),
inability to mobilise (or bed bound) or
post-surgical procedure (such as hip
replacement.
.
POINTS TO REMEMBER
Involve the carers in the
procedure of catheterisation
and educate them around
catheter care, hygiene and
maintenance
Urinary Catheterisation is a
procedure that is associated
with a host of serious risk
factors and should not be
taken lightly. UTIs (which can
lead to bacteruria and sepsis)
are almost guaranteed to
occur with an indwelling long-
term catheter.
Know the Care Plan and
indications for
catheterisation well and
follow the guidelines set by
your organisation.
Share information.
Collaborate with the team.
Urinary Catheterisation
There are 4 MAIN TYPES of urinary
catheters, classified by location and
attachment to urinary system:
1. URETHRAL – indwelling
2. SUPRAPUBIC - indwelling
3. INTERMITTENT – indwelling
4. URIDOME – external
Understand the difference!
URINARY INCONTINENCE URINARY RETENTION Urinary retention refers to a condition
in which urine remains within the
bladder and it is either not voided at all
(no urine is expelled during urination) or
it is expelled in small quantities, still
leaving a majority of urine remaining in
the bladder. Any condition (i.e. BPH,
urethral stricture, urethral trauma)
which prevents the normal voiding
process from occurring can lead to
urinary retention.
Urinary incontinence is defined as the
uncontrollable continuous leakage of
urine. The prevalence of UI increases
with age, and it is much more prevalent
in older women then in older men (30-
50% in older women and 9-35% in adult
men). It is however, not a normal part of
ageing
CHOOSING THE RIGHT CATHETER
SIZE
Catheters measure in Fg or French.
Anything from 5-10 is paediatric, from
12-14 is female, 14-18 is male, 14-20 is
also suprapubic catheters and finally 18-
22 is usually for residents that may have
haematuria, requiring a larger gauge to
drain the clots and blood.
CHOOSING THE RIGHT CATHETER
TYPE
Selection of catheter type is a little bit
more complex, as catheters can be
created from different materials, such as
silver oxide (which prevents the
formation of biofilm), silicone (which
can act to resist encrustation) and so on.
Normally however, catheters are only
designed in a limited number of styles,
either internal or external The most
common indwelling are:
1. One-WAY: used for intermittent
catheterisation.
2. Two-WAY (Foley): the most
common cathter you may see. Used
for both short/long term indwelling
catheterisation.
3. Three-WAY (Foley): used for
bladder irrigation (haematuria) and
for medications.
CONTINUED…
Ensure that you document every
aspect of the urinary catheterisation
procedure. This is one for the most
important roles for the RN and care
worker. It can help with:
Establishing a diagnosis
Maintains a legal record
For communication
Indications for catheterisation
Need for ongoing
catheterisation
A focused nursing assessment is also
required both before, during and
following the catheterisation procedure.
Nurses and carers have the responsibility
to ensure the catheter is working as it
should, that the patient is improving or
the desired therapeutic goal is reached,
and most importantly, to advocate for
the timely removal of the catheter when
deemed of no more use.
WHO DOES IT AFFECT
Urinary issues, especially those that are
associated with urinary retention (UR)
and incontinence (UI), can strike at any
age and gender. It is however, more
prominent in the ageing population.
Males however are at increased
risk for UR as they age due to
enlargement of the prostate.
Females on the other hand can
have increased rates of urinary
incontinence due to a reduction
in oestrogen
INDWELLING URINARY CATHETERISATION
The above figure shows the processes involved in the
catheterisation of a female resident. The nurse is
using a 2-Way Foley catheter which has a drainage
bag attached on one end, and a lure lock opening for
the inflation of the catheter balloon. Females can be
at greater risk of infection from flora moving from
the perennial area onto the catheter and also from
placing the catheter into the incorrect location.
The above figure represents the catheterisation of a
male resident. Males can be at greater risk of
urethral trauma due to the length of the urethra and
also present difficulty in those suffering from BPH.
MALE AND FEMALE DIFFERENCES
The differences in males and
females in relation to catheterisation
can be mainly related to the
anatomical differences. The main
concern is the length of the female
urethra which is much shorter than
that of the male. For example, when
applying lubricant upon a catheter
ready for insertion for a female, we
would only lubricate the first 5-7cm.
While in males, we would lubricate
as far as 15-20cm (note also that not
all catheters need lubrication, some
are hydrophilic and lubricate when
in contact with water).
CATHETER CARE AND
MAINTENANCE
Catheter care is a continuous and
sometimes complicated process.
However, it can be broken down
into two simple overarching
principles:
1. Infection Control
2. Unbroken Catheter Drainage
Maintaining a clean environment
forms the basis of all catheter
management. UTI’s are a major and
common complication of
catheterisation and we need to stay
forever vigilant to ensure their
incidence is reduced. Unbroken and
adequate catheter drainage also
ensures that the risk of infection is
minimised and that the catheter is
not causing more harm than good.
GET TO KNOW ME…
Viktor Burcevski Viktor had dual degrees in both
nursing and health science, with a
focus on population health and
ageing within Australia and has an
interest in those issues which
govern how we perform our roles
as nurses from the macro to the
individual level. Viktor also has
extensive experience in the
compilation of best practise
guidelines for nurses and carers.
References: Godfrey, H. & Evans, A. ( 2000).
Management of long-term urethral catheters: Minimizing complications. British Journal of Nursing, 9, 74-81.
Stickler, D. J. (2014). Clinical complications of urinary catheters caused by crystalline biofilms. Journal of Internal Medicine, 276, 120-129. Doi: 10.1111/joim.12220
Urological Nurses Society Inc. (2013). ANZUNS - Catheterisation Clinical Guidelines 2013.
Winder, A. (2012). Good practise in catheter care. Journal of Community Nursing, 26, 15-20.