Special Operations Forces Medical Handbook

8-34

emptying of the bladder.

What You Need:

1. Catheter (options):
   a. Foley catheter: Has balloon at end of straight tip. Sizes generally used are 16 or 18 Fr. Balloon sizes
   are 5 and 30 cc. 5cc balloon is most commonly used.
   b. Red rubber Robinson: Red colored straight catheters without balloons.
   c. Short female straight catheters: 14 or 16 Fr.
   d. Coudé catheter: Has curved tip with or without balloon. If balloon is attached, check to see if the
   balloon port is on the same or opposite side as the curved tip. If no balloon, there is usually a small
   raised bump or ridge at the opposite end to orient to the tip.


2. Antiseptic solution. If none is available, use soap and water.


3. (Sterile) Water soluble lubricant or lidocaine gel. If none is available, use petroleum gel or even patient’s
   saliva. Can make lidocaine gel by mixing 10 cc of 1% lidocaine solution with 10 cc of lubricant.


4. 5-30 cc syringe to inflate Foley cuff.

When You Don’t Have Everything (options):

1. If no Foley or Coudé, use feeding tube, nasogastric tube, small diameter chest tube or IV tubing (try to
   round the edges). Standard catheter size is about 3/8 inch diameter.


2. If no sterile tube, can boil tube. A clean non-sterile tube can be safely used as long as the bladder is
   emptied regularly and there is no evidence of break in the mucosal lining (gross bleeding). Risk of
   infection is low with clean intermittent catheterization.


3. If no sterile lubricant, try to find water-soluble lubricant. Can use petroleum gel such as vaseline. If
   nothing available: either use water, passing the catheter very slowly; or use saliva (preferably patient’s).

What To Do:

1. Using sterile technique, wash the urethral meatus with antiseptic soap. Lubricate the catheter with water
   soluble lubricant and gently pass the catheter into the bladder. In males, it is necessary to pass the
   catheter until the hub or ange is in contact with the urethra.


2. In young males, the pain caused by the catheter may cause the patient to clamp down with his sphincter
   preventing passage of the catheter. In such cases, use 10-20 cc of lidocaine gel (1-2%) which can be
   made by mixing 10 cc of 1% lidocaine solution with water soluble lubricant to make a viscous solution.
   Squirt the lidocaine gel into the urethra and squeeze the meatus shut and hold for 1-2 minutes.


3. In older males, the prostate may make it difcult to pass a catheter. A Coudé catheter with the tip pointing
   up toward the patient’s head may be easier to pass. Also a larger, stiffer Coudé in the 20-22 Fr size may
   also be easier. If only a small catheter can be passed, a urethral stricture may be present.


4. In females, the meatus may be tucked under a fold in the vaginal opening or obscured by the labia. “Frog
   leg” the patient as much as possible and elevate the buttocks. This is best accomplished with the patient
   in stirrups at the end of an exam table. An assistant may be required to spread the labia apart. A strong
   light is also very useful.


5. Have patient empty the bladder. Measure the residual, dipstick the urine and send for a culture if possible.
   Record the amount emptied from the bladder and the results of the testing. Normal post-void residuals
   should be generally under 100 ml. In patients with large bladder capacities, a residual representing
   20-25% of the total initial bladder volume is considered normal. Example: patient voids 450cc and has
   150 cc left. The initial bladder volume was 600 cc with 25% remaining. This is acceptable.


6. If the bladder is palpable, place a Foley catheter. Empty the bladder as much as possible. Patients that
   have very large volumes (>1000 ml) when suddenly emptied may experience a profound vasovagal
   reaction. It would be prudent to empty the bladder with the patient lying down. To avoid a vasovagal
   reaction, one can empty the bladder by letting out 400 ml every few minutes. Extremely large bladders,
   when drained often will cause rupture of bladder mucosal veins that had been compressed by the urine.
   Do not be surprised if the urine turns bloody. Irrigate out clots, as needed using sterile saline or water
   with a catheter tip syringe.


7. If the catheter is to be left more than a day, daily cleaning of the meatus with antiseptic soap can
   decrease infections. Prophylactic antibiotics are not necessary; however, if the catheter is left in place