Introduction
Aim
Definition of Terms
Indications
Preparation
Catheter size
Procedure for insertion of urinary catheter
Special precautions
Documentation
Ongoing nursing management
Troubleshooting
Removal of urinary catheter
Complications
Discharge information
Companion documents
References
Introduction
Insertion of an indwelling urethral catheter [IDC] is an invasive procedure that should only be carried out using aseptic technique, Insertion of an indwelling urethral catheter [IDC] is an invasive procedure that should only be carried using aseptic technique, either by a nurse, or doctor if complications or difficulties with insertion are anticipated. Catheterisation of the urinary tract should only be done when there is a specific and adequate clinical indication, as it carries a risk of infection.
Aim
To ensure the insertion and care of the urinary catheter is carried out in a safe manner that minimises trauma and infection risks.
Definition of terms
- Indwelling Urinary Catheter
[IDC]: A catheter which is inserted into the bladder, via the urethra and remains in situ to drain urine.
- Oliguric: a reduction in urine output.
- Paraphimosis: occurs when the foreskin is left in a retracted position. The pain and swelling may make it difficult to return the foreskin to the non-retracted position, this may reduce blood flow to the tip of the penis which if left untreated could lead to necrosis of the glans penis.
Indications
- To drain the bladder prior to, during, or after surgery
- For investigations
- To accurately measure the urine output
- To relieve retention of urine
- To relieve urinary incontinence when no other means is practical
Preparation
Preparation of the child and family
- Gain patient/primary care givers consent for procedure
- Families/primary care givers should be given a thorough explanation of the procedure. Involve the parents where possible when providing an age appropriate explanation of the procedure to the patient.
- Consider the need for a referral to play therapy to assist in explaining and preparing the patient for the procedure. Play therapists are also able to empower the child to identify distraction techniques, as well as provide support and distraction throughout the procedure.
- Nursing staff should discuss and plan procedural pain management with the child and family prior to the procedure. This may include non pharmalogical [including distraction techniques] and pharmalogical considerations including Nitrous Oxide or sedation if necessary. For more information regarding this please see the Procedural Pain Management guideline.
Preparation of Environment and Equipment
Ensure the patient’s privacy is maintained throughout the procedure and that they are kept warm. Ensure there is adequate light to perform the procedure.
Prepare the following equipment:
- Dressing trolley
- Catheterization pack and drapes
- Sterile gloves
- Appropriate size catheter [see catheter size guideline below]
- Sterile Lubricant and/or Xylocaine jelly syringe [plain sterile lubricant for infants]
- Sterile water to inflate balloon
[normal saline can crystallise and render the balloon porous, causing its deflation and the risk of catheter loss]
- 5ml/10ml Syringe – as stated on catheter packaging
- Specimen jar
- Sterile normal saline
- Straps/tape to secure catheter to leg
- Drainage bag
- Waterproof sheet
Catheter size
Use an appropriate size catheter
depending on the age of the child. Catheters that are too big or small are at risk of urethral trauma or leakage. The rational for IDC insertion should also be considered when selecting catheter, for example a patient requiring an IDC post kidney trauma may require a larger size to provide adequate drainage of potential blood clots. Consider silicone catheter if for long term use.
| Age | Weight | Foley |
| Neonate |
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