In this section : Renal
Diagnosis, treatment and management of UTI in children (D&G)
Kidney Biopsy Complications
Parenteral Iron for Non-HD CKD Patients
Management of uncomplicated Henoch-Schonlein Purpura (HSP) in under 16s
Prescribing Advice on Admission – Insulin
Sodium Glucose Transporter 2 Inhibitors (SGLT2i)
Gentamicin in Renal Replacement Therapy
Vancomycin in Renal Replacement Therapy
Haemodialysis Medication Prescribing
Contrast Associated AKI
Low Molecular Weight Heparin
Fluid Replacement in AKI
Management of Urinary Symptoms
Acute Kidney Injury (AKI)
Urinary Tract Infection
Urethral Catheterisation
Kidney Transplantation
Ureteric Colic & Renal Stones
Intravascular Catheter Related Blood Stream Infection
Care of Vascular Access
Urinary Incontinence
Peritoneal Dialysis Related Peritonitis
Urethral Catheterisation
Last updated 30th March 2022
Introduction
- There is a substantial morbidity associated with urethral catheterisation.
- If 2 attempts at urethral catheterisation fail – contact the surgical middle grader who may need to consider suprapubic catheter
- Charge Nurse Ian Russell (32185) can be contacted to teach you catheterisation.
Catheter Selection
- Size – Male, use 14-18 FG (usually 16F); Female – use 12-14 FG
- Duration – if <4 weeks, use PTFE coated catheter; if >4 weeks, use hydrogel coated or all silicone catheter (long term)
- Balloon size – 10 ml for all except 3 way (30ml)
- Haematuria & clots – use 3 way catheter 20 or 22 FG
Irrigation Catheter (For Haematuria)
- 3 way catheter, 20 or 22 gauge, balloon filled with 30ml sterile water.
- Universal irrigation set for one or two bottles of Fresenius irrigation fluid (0.9% saline in Flowfusor container), connected up to a two litre drainage bag.
- Run fluid through, adjusting the rate to achieve rose coloured urine.
- Flow rates will vary: up to two litres per hour.
- If it blocks then kink or milk the tubing to drainage bag in hope that this will suck blood clot or debris into the tubing
- If remains blocked then consider bladder washout.
Suprapubic Catheter
- Indicated if fails to achieve urethral catheterisation in patient with retention or following suspected urethral injury.
- Contraindicated when history bladder tumour, undiagnosed haematuria or abnormal clotting with INR >1.5
- Caution with midline lower abdominal scar as increases risk of bowel perforation
- Size 14 Addacath catheter is preferred to the Bonano pigtail because it can be left in long term but the Addacath is bigger and therefore more tricky to insert
- Ensure bladder palpable, prep skin, identify position two fingerbreadths above pubic symphysis then infiltrate with local.
- Aspirate urine with needle and syringe to confirm in right place
- Make small incision with scalpel
- Insert trochar then pass catheter/pigtail through it
- Document clear urine draining
- Reexamine later to ensure abdomen is soft and non tender
Catheter Bypassing
- Can be caused by blocked catheter or bladder spasm
- Ensure catheter patent by flushing saline through lumen
- If clear most likely due to bladder spasm.
- Try taking 5ml out of the balloon to reduce irritation
- If that fails then try anticholinergic eg Trospium XL 60mg od which is better tolerated than Oxybutinin
Bladder Washout
- Used to dislodge blood clot in patient presenting with haematuria & urethral discomfort despite bladder irrigation.
- Occasionally used to prevent recurrence of infection in patient with long term catheter.
- Use 50 ml catheter tip syringe.
- Slowly inject and withdraw 25ml sterile saline solution – this comes ready prepared in a Urotainer bag.
- If this fails to dislodge the clot then try injecting rapidly (to fragment clot) but withdraw slowly as pulling hard may damage the bladder wall
Links
- Urethral Catheterisation – University of Ottowa
- Royal Marsden Manual – Search for “Urethral Catheterisation”
Content updated by Ian Russell