INDWELLING URETHRAL CATHETER INSERTIONPractical Procedures 485(ii) Measurement of urine output (e.g. volume resuscitation, shock
therapy, fluid balance).
(iii) Short term (e.g. post-operatively) or long term (e.g. when
transurethral resection of the prostate [TURP] is medically
contraindicated).2 Intermittent
(i) Obtaining uncontaminated urine for microscopy and culture
(especially in females or young children).
(ii) Facilitating adequate bladder emptying (e.g. in conditions
associated with atonic bladder).
(iii) Intravesical installation of contrast or drugs (e.g. in suspected
bladder trauma).
CONTRAINDICATIONS1 Traumatic urethral rupture suggested by penile, scrotal or perineal haema-
toma, blood at the urethral meatus and a high-riding prostate on rectal
examination.
2 Postoperative urological patient or patient with known urethral stricture.
(i) Consult the urologist first if the patient has had bladder neck or
prostate surgery.
TECHNIQUE1 Perform thorough aseptic hand wash and put on sterile gloves. Draw up
sterile water for balloon inf lation and place fenestrated drape over the
patient’s perineum.
2 Open the catheter wrapping at the distal (tip) end and, holding the proximal
portion (still in the wrapping), lubricate the catheter tip with lignocaine
(lidocaine) gel 2%.
(i) Male catheterization
(a) retract the patient’s foreskin and swab the urethral meatus
and glans with sterile gauze soaked in saline. Hold the penis
firmly and in an upright position and instil lignocaine
(lidocaine) gel 2% into the urethra
(b) gently squeeze the tip of the glans to close off the urethra to
retain the gel for 90 s to allow the anaesthetic time to work
(c) insert the catheter gently and slowly into the urethra,
withdrawing the plastic covering in stages
(d) advance catheter to the hilt and wait for urine to flow
(e) replace the foreskin.
(ii) Female catheterization
(a) position the patient as for a vaginal examination, supine with
knees and hips flexed and ankles together. Allow the legs to
rest gently in full abduction