This document provides information on urinary catheterization including the types, parts, indications, procedures, and complications of catheterization. It discusses the different types of catheters including intermittent, external, and indwelling catheters. It describes how to properly insert a transurethral catheter and notes key steps like explaining the procedure to the patient, gathering supplies, cleaning the area, lubricating the catheter, and inflating the balloon. Potential complications of catheterization like urinary tract infections are also reviewed.

1. PROF SHABNAM NAZ SHAIKH
OBGYN
CMC, SMBBMU Larkana

2. The process of
insertion of
catheter into
the bladder to
drain out urine.

3. Catheter is hollow flexible tube that
collects urine from bladder to
drainage bag.
It can be made up of:
1.Rubber
2.Plastic
3.Silicone

4. PARTS OF CATHETER

5.  The french scale (Fr) is used to denote
the size of catheter.
 1 Fr is equal to 0.33mm in diameter.
 The smaller the number the smaller the
diameter.
 No: 10 Fr is used for children.
 No: 14 & 16 used for female adults.
 No: 20 & 22 used for male adults.

6. 1.Unconscious or intubated pt:
2.Acute urinary retention
3.Neurogenic bladder
4.Obstruction (of urethra by anatomical condition that make it
difficult to urinate , large cystocele, narrowing of urethra ,
kidney or bladder stones and blood clots
5.3rd and 4th degree UV prolapse.
6.Bladder irrigation following surgery.

7. 1. Trauma
2.Chronic heart failure
3.Renal failure
4.Sepsis
5.Eclampsia
6.Aph
7.Obstructed labor
8.After any surgery.

8. 1.Residual volume measurements
2.Radiographic contrast
3.Renal function ( 24 hours urine sample)
4.Urodynamic flow rate studies
5.Instillation of drugs. (BOTOX )

9. • Pelvic fracture
• Urethral injury
• Bladder trauma
• Use of anticoagulants

10. 1. Intermittent
2. External--- condom catheter for
males
3. Indwelling

11. This type of catheter is used to drain the bladder for short period of
time like 5 to 10 minutes. It can be inserted or removed several
times a day. Purpose of this catheterization is to drain urine from
bladder that is not emptying adequately.
 INDICATIONS; Used to empty the bladder
• Just before normal vaginal delivery,
• Exploration,
• Evacuation.
• Manchester repair
• Prolapse surgery
• Before any perineal surgery

12. It is closed sterile system with catheter retention balloon that
is inserted through urethra or suprapubically for a period of
time defined as less than 30 days.
SITES FOR INDWELLING CATHETER
1.Transurethral
2.Suprapubic
TRANSURETHRAL:
Catheter inserted into the bladder via urethra. This is a typical
approach because process can be done by nurses.

13.  Two way foley’s;
 Three way foley’s;---Use to drain the bladder after
bladder or upper urinary tract surgeries to add continuous
irrigation capabilities.
 These helps to remove tissue chips ,blood clots and other
debris from bladder after surgery.
 Medications such as antibiotics can be introduce via
continuous drip method.
 If irrigation is discontinued irrigation lumen can be closed
by clamp or catheter plug.

14. Explain reason for catheterization to the
patient and family
Explain whole procedure to pt and answer
any question about procedure if pt asked.
Check all allergies to latex and iodine.
Maintain privacy and adequate lighting.

15. GATHER ALL
EQUIPMENTS:
1.Foley’s catheter
2.Sterile drainage bag with sample
port and tubing.
3.Water soluble lubricant jelly
4.10c.c syringe with sterile water for
foley’s balloon
5.Sterile drapes, gloves, cotton balls
6.Sterile specimen cup and
7.Iodine

16. Female position:
 Female urethra is shorter than male urethra.
 Insertion of catheter is facilated by having the
pt on her back, adequate exposure of urethra
is obtained by flexing her knees, separate
them and placing her feet flat on bed. (Frog
lagged position).
 Place the catheter set between the female pt’s
legs.

17.  Open the prepackaged foleys packet.
 Place drap under the pt’s hip plastic side down. Place
fenestrated drap over the pt expose only genital area.
 Put sterile gloves.
 open the packet of cleaning solution, saturate cotton balls
(use soap if Pt has allergy to iodine).
 Hold the labia apart and with dominant hand ,clean the
urethral meatus with iodine in downward towards the anus
using single stroke.
 Openlubricant,saturatedistalendofcatheterbutleaveitinsterile
packingtoreducetheriskofcontamination.

18.  Hold the labia open and hold the catheter in dominant
hand, introduce tip into the urethral orifice in slightly
upwards and backwards direction, feeding it out off
sterile packaging.
 insert catheter approximately 5-6 cm. If pt experience
any pain or discomfort stop procedure.
 Once the urine start to drain insert the catheter upto
bifercation point to ensure that balloon is in the bladder
because inflation of balloon in urethra is painful.
 Gently inflate the balloon with 10ml sterile water or
according to capacity of balloon. Inflation must be
painfree.
 Withdraw catheter slightly to ensure catheter is in
bladder and secure.
 Attached catheter to drainage bag.
 Make pt comfortable, ensure bed is clean and dry,
dispose off equipment's in clinical waste bag.
 Wash your hands.

19.  Insertion of catheter into the bladder via
anterior abdominal wall. Incision is made
above the pubic bone and below the
umbilicus.
 This process is done by urologist.
INDICATIONS:
 Urinary retention after urethral injury.
 Pt needs long term catheterization for bladder
dysfunction in neurological condition like
multiple sclerosis, spinal cord injury.

20. 1.1ST of all you will do x-ray or u/s to check any abnormality
around bladder area.
2.Prepare bladder area with pyodine or cleaning solution.
3.Locate bladder by gentlly feeling around the area.
4.Use local anesthesia to numb the area.
5.Insert catheter by using stamey device this helps to guide
catheter in with piece of metal called an obturator.
6.Remove obturator once the catheter is in the bladder.
7.Inflate balloon of catheter at the end with water to keep it
from falling out.
8.Clean the insertion area and stitches up the opening.

21. 1.Urine not draining properly.
2.Urine leaking out of catheter.
3.Small amount of blood in urine.

22.  must include daily cleansing of the urethral area and the
catheter itself with soap and water (some hospital policies
may vary in agent used)
 The area should also be thoroughly cleansed after all bowel
movements to prevent infection
 Antimicrobial ointments are no longer used

23.  UTI,
 septicemia,
 urethral injury,
 skin breakdown,
 bladder stones
 and hematuria
 Bacteriuria
 Chronic renal inflammation
 Pyelonephritis
 Nephrolithiasis
 Cystolithiasis
 Bladder cancer may also develop after many years of catheter use

24. Indwelling catheters are leading cause of catheter
associated UTI.
Bacteria or fungi may enter the urinary tract via catheter
where they multiply and cause the infection.
CAUSES :
1. Catheter may contaminated on insertion.
2. Bacteria from bowel movement may get on catheter.
3. Urine in drainage bag may flow back to catheter.
4. Catheter may not be regularly cleaned.

25. • Cloudy urine
• Blood in urine
• Strong urine odor
• Urine leaking around the catheter
• Pressure, pain or discomfort in lower back or
stomach
• Fever , chills , vomiting or unexplained fatigue

26. CAUTI is diagnosed by urine test
1.URINALYSIS :Can detect blood cells in the urine. The
presence may signals any infection.
2.URINE CULTURE: Can detect any bacteria or fungi in
urine.
TREATMENT
1.Increases fluidintake
2.Antibiotics
3.Other symptomatic treatment

27.  NURSING IMPLICATIONS/ MONITOR FOR COMPLICATIONS
 Foul smelling urine Thick, cloudy urine with or without sediment
 Painful urination (dysuria)Fever, chills Urethral swelling around
the catheter
 Bleeding into or around the catheter
 Catheter draining little or no urine despite adequate fluid intake
 Leakage of large amounts of urine around the catheter

28. Troubleshooting a leaking catheter
 May be caused by incorrect size of catheter (too small),
 improper balloon size, or bladder spasms
 If bladder spasms occur, check that the catheter is draining properly.
 If no urine is detected in the drainage bag, the catheter may be
obstructed by blood or thick sediment, or kinking of the catheter or
drainage tube.
 Irrigation or the catheter may be indicated
 Other caused of urine leakage around the catheter include
constipation or impaction of stool, or UTI

29. Including:
1.Date and time
2.Reason for insertion
3.Catheter type
4.Balloon size and volume of water
5.Date of removal or change of catheter
6.Name and signature of health professional.

30. VIVA Q
CONDITIONS WHERE INTERMITTENT CATHETERIZATION IS PREFERABLE?
• To empty bladder in case of atonia or during 2nd stage,
• Relief of AUR,
• checking PVR,
• CISC [temporarily measure in cases of OAB],
• to obtain a sterile urine sample.

31. ?
Intermittent doesn't have a balloon & isn’t connected
with a bag.
PVR intermittent catheters may be more flexible.
Otherwise insertion procedure is the same.
For how long can we keep it in before replacement?
It depends, but up to 12 wks

32.  How to reduce the risk of catheter related UTI?
Sterile technique, smaller effective size, closed drainage
system, early removal as possible, good hygiene [protocols].

NOT: antiseptic on urethral meatus [very irritable] or within
bag.
 What is “French”?
French [F] is a scale measure of the catheter’s lumen,
reflecting inner diameter. 1F = 1/3rd mm.
N.B: Urinary catheter involves both Foley's & intermittent.

33.  Cut the catheter above the bulb
 Pass the canula beside the catheter and prick the balloon
 Use urethral stylet to rupture the balloon
 Why not normal saline for inflation of balloon bcs it
crystalize and balloon can not deflate
 Why not air ---Bcs it is lighter and float not fix in neck of
bladder so cant drain properly


34. Q A urinary catheter is vigorously inflated in the urethra at the
time of caesarean section. Urine. leaks from the rupture into
which anatomical space?
 A Laterally to the femoral triangles
 B Into the vagina
 C Into the peritoneal cavity
 D Into the lesser pelvis
 E Into the anterior abdominal wall and mons pubis
The answer is into the anterior abdominal wall and mons pubis.
This is the only route possible due to the anatomy of the
urethra