A catheter is a medical device consisting of a long, thin tube that can be attached with a variety of different ends to fulfill a variety of functions. Catheters are inserted into the body as part of various medical procedures; for example, it is used to diagnose genitourinary (GU) bleeding in the ducts, to monitor intracranial pressure, and even to administer certain medications. For common practice, "inserting a catheter" usually involves inserting a urinary catheter into the bladder through the patient's urethra for the purpose of draining urine. As with most medical procedures, even common ones, proper medical training and adherence to safety and sanitation procedures is mandatory. See Step 1 below to get started.
Step
Method 1 of 2: Preparing for Installation
Step 1. Explain the process of this method to the patient before running it
Most patients are not used to this method, let alone having a long tube inserted into their urethra. Although this method is not always described as "painful", it is often even generally said to cause quite a bit of "inconvenience". Out of respect for the patient, explain in detail the steps of the procedure before starting this method.
Explaining the steps and what will happen can also calm the patient and reduce anxiety
Step 2. Ask the patient to lie supine
The patient's feet should be in a straddle position. Lying in the supine position will relax the bladder and urethra, making catheter insertion easier. The tense urethra will put pressure on the catheter, creating resistance during insertion. This condition can trigger pain and sometimes even damage to the main tissue of the urethra. In severe cases it can even cause bleeding.
Assist patient in supine position if necessary
Step 3. Wash hands and put on sterile gloves
Gloves are an important part of the PPE (Personal Protective Equipment) that healthcare workers use to protect themselves and patients during medical procedures. In the case of catheter insertion, sterile gloves prevent bacteria from entering the urethra and prevent the patient's body fluids from coming into contact with your hands.
Step 4. Open the catheter kit
Disposable catheters are packaged in a seal and contain sterile instruments. Before opening the equipment, make sure the catheter provided is suitable for its intended use. You will need a catheter of the correct size for the patient. Catheters are measured in units called French (1 French = 1/3 mm) and are available in sizes from 12 (small) to 48 (large) French. Smaller catheters are usually better suited for patient comfort, but larger catheters may be needed to drain thick urine or ensure that the catheter remains in position.
- Some catheters also have a special tip that allows them to serve different functions. For example, a type of catheter called a Foley catheter is usually used to drain urine because a balloon is attached and can be inflated to secure the catheter position behind the bladder neck.
- Also prepare medical grade disinfectants, such as cotton swabs, surgical drapes, lubricants, water, tubes, drainage bags and plasters. All must be properly cleaned and/or sterilized.
Step 5. Sterilize and prepare the patient's genital area
Wipe the patient's genital area with a cotton swab that has been soaked in disinfectant. Rinse or wipe the area with sterile water or alcohol to remove dirt. Repeat as needed. When finished, place a surgical drape around the genitals, leaving room for access to the penis or vagina.
- For female patients, be sure to clean the labia and urethral meatus (the outer part of the urethral opening that lies above the vagina). For men, clean the urethral opening on the penis.
- Cleaning must be done from the inside out so as not to contaminate the urethra. In other words, start at the urethral opening and slowly work your way outward in a circular motion.
Method 2 of 2: Inserting the Catheter into the Bladder
Step 1. Lubricate the tip of the catheter with lubricant
Grease the distal part of the catheter (2-5 cm section at the tip) with a sufficient amount of lubricant. This is the tip that will be inserted into the urethral opening. If using a balloon catheter, be sure to lubricate the tip of the balloon as well.
Step 2. If the patient is female, hold the labia open and then insert the catheter into the urethral meatus
Hold the catheter with your dominant hand and use your non-dominant hand to open the patient's labia to reveal the urethral opening. Insert the tip of the catheter into the urethra gently and slowly.
Step 3. If the patient is male, grasp the penis and insert the catheter into the urethral opening
Hold the penis with your non-dominant hand and gently pull it up, perpendicular to the patient's body. Insert the tip of the catheter into the patient's urethra with your dominant hand.
Step 4. Continue pushing until the catheter reaches the bladder
The long catheter should be slowly inserted through the urethra and into the bladder until urine can be observed. Once the urine has started to flow, continue to push the catheter into the bladder 5 cm to make sure the catheter is touching the bladder neck.
Step 5. If using a balloon catheter, inflate the balloon with sterile water
Use a syringe filled with water to inflate the balloon through a sterile tube connected to the catheter. The inflated balloon acts as an anchor to prevent the catheter from shifting position as it moves. Once inflated, gently pull on the catheter to ensure that the balloon adheres to the bladder neck.
The amount of sterile water used to inflate the balloon depends on the size of the balloon on the catheter. Usually, about 10 cc of water is required, but to be sure check the available balloon sizes
Step 6. Connect the catheter to the drainage bag
Use a sterile medical tube to drain the urine into a drainage bag. Attach the catheter to the patient's thigh or abdomen with a tape.
- Make sure you place the drainage bag lower than the patient's bladder. The catheter works by gravity - urine cannot flow down the "incline".
- In a medical setting, catheters can be left in place for 12 weeks before being replaced, although they are often removed more quickly. Some catheters, for example, are removed immediately after urine stops flowing.
Tips
- Catheters are available in a variety of materials including latex, silicone and Teflon. This tool is also available without balloons or balloons of different sizes.
- Most health care workers follow universal precautions, which include wearing gloves, face and/or eye protection, and a gown when inserting a catheter.
- Empty the drainage bag every 8 hours.
- Evaluate the amount, color and odor of urine collected in the drainage bag.
Warning
- Some patients may be allergic to latex. Watch for allergic reactions.
- Monitor for the following complications: strong odor, cloudy urine, fever or bleeding.
- Cathetering may be incorrect if there is leakage, very little urine or almost no urine in the drainage bag.
