Understanding the lower urinary tract is essential before attempting any catheterisation procedure. Urine flows from the kidneys through the ureters into the bladder, where it is stored until micturition occurs. The bladder acts as a muscular reservoir, lined with transitional epithelium and controlled by the detrusor muscle.
Urinary catheterisation involves the introduction of a hollow tube through the urethra into the bladder to drain urine. Clinical indications include acute urinary retention, monitoring precise urine output in critically ill patients, managing urological surgeries, and delivering local medication.
Catheters vary by material, lumen count, and design:
Preparation minimizes patient anxiety and reduces the risk of introduction of pathogens into the urinary tract. Nurses must first verify the clinical order, assess the patient's allergy history—particularly regarding latex and chlorhexidine—and check for previous urological surgeries or urethral strictures.
Explain the procedure clearly to secure informed consent and cooperation. Gather all required sterile equipment at the bedside, ensuring adequate lighting and proper positioning. For female patients, the dorsal recumbent or Sims position is standard, while male patients lie supine with legs extended slightly apart.
Strict aseptic technique prevents catheter-associated urinary tract infections. Perform hand hygiene, set up the sterile field, and don sterile gloves. Cleanse the meatus using antiseptic swabs, wiping from the center outward for females or in a circular motion from the meatus down the shaft for males.
Lubricate the catheter tip generously—using a local anesthetic gel for male patients to ease discomfort and relax the sphincter. Gently advance the catheter until urine flow is observed, then advance it an additional few centimeters further before inflating the retention balloon. Pull back gently until resistance is felt to ensure secure placement in the bladder neck.
Maintaining a closed drainage system is the single most effective intervention for preventing catheter-associated urinary tract infections. Secure the catheter tubing to the patient's thigh or lower abdomen to prevent urethral traction and micro-tearing of the mucosal lining.
Empty the collection bag regularly using a clean measuring container for each patient, ensuring the spigot never touches the contaminated container surface. Keep the drainage bag positioned below the level of bladder height at all times to prevent the backflow of urine into the bladder.
Catheterisation carries inherent risks that require vigilant monitoring by nursing staff. The most common complication is catheter-associated urinary tract infection, presenting with fever, cloudy urine, or suprapubic tenderness.
Removing an indwelling catheter requires a medical order and should occur as soon as clinical indications resolve to minimize infection risks. Gather a syringe, perform hand hygiene, and explain the procedure to the patient. Insert the syringe into the inflation port and allow the sterile water to withdraw completely by passive recoil or gentle aspiration.
Instruct the patient to take a deep breath and exhale slowly, then smoothly withdraw the catheter. Monitor the patient for the first spontaneous voiding post-removal, noting volume and time. Report urinary retention if the patient is unable to void within six to eight hours.