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Harvard Commentaries
35320
Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School


Urinary Catheterization


January 29, 2013

Diseases and Conditions
9339
catheterization
Urinary Catheterization
Urinary Catheterization
htmUrinaryCatheterization
In urinary catheterization, a catheter (hollow tube) is inserted into the bladder to drain or collect urine.
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InteliHealth
2011-01-24
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InteliHealth Medical Content
2012-01-22

What Is It?

In urinary catheterization, a catheter (hollow tube) is inserted into the bladder to drain or collect urine. There are two main types of urinary catheterization: indwelling catheterization and clean intermittent catheterization (CIC).

Indwelling catheterization
In this type of catheterization, one end of the catheter remains inside the bladder. A small, inflated balloon at the tip of the catheter inside the bladder keeps the end of the catheter from slipping out. Urine flows from the bladder through the catheter and collects in a drainage bag. If the patient is not bedridden, this drainage bag can be worn on the leg, where it can be hidden under a skirt or slacks. If the patient is bedridden, the drainage bag usually is attached to the lower portion of the hospital bed (near the floor). This position allows gravity to help the urine drain.

An indwelling catheter can be used for short-term or long-term care.

CIC
In CIC, the urinary catheter does not remain inside the bladder. It is inserted into the bladder only long enough to allow the bladder to drain. Then, it is removed. CIC can be done by the patient or by the patient's caregiver.

For short-term catheterization after surgery, and in certain paralyzed patients, CIC often is better than an indwelling catheter. This is because CIC is less likely to cause a urinary tract infection in these situations.

What It's Used For

Urinary catheters are used to remove urine from the bladder in the following situations:

  • To relieve a physical obstruction to urine flow, such as a urinary tract stone, a bladder tumor or an enlarged prostate.
  • To drain urine when the bladder's muscles or nerves are not working properly. This can be caused by a spinal cord injury, multiple sclerosis or some other nerve problem. Also, certain medications can interfere with the bladder's normal emptying.
  • To treat incontinence (difficulty holding in urine until you reach the toilet) when other methods have failed.
  • To drain urine in patients who are unconscious. This includes patients who are in a coma or under general anesthesia.
  • To measure urine output in infants and children who are not toilet trained.
  • To measure urine output in adults who are incapacitated because of critical illness or surgery.
  • To obtain a clean urine sample for tests to detect bacteria infections in the urine. A clean urine sample is one that is not contaminated by bacteria from the patient's hands, genitals or rectum. With a catheter, a clean urine sample can be obtained directly from inside the bladder.
  • To collect urine during diagnostic studies of the urinary tract.

Preparation

Indwelling catheterization
Health care personnel will open the kit that contains the sterile supplies and gloves beforehand, taking care to not touch the inside of the kit to avoid bacterial contamination.

CIC
All equipment (catheter, lubricant, urine receptacle) should be assembled beforehand. Caregivers should wear clean, disposable gloves when performing CIC on a patient. For self-catheterization, you should wash your hands thoroughly prior to inserting the catheter; gloves are not mandatory for self-catheterization.

How It's Done

Urinary catheters come in different diameters. For adult patients, catheters generally are less than one-quarter of an inch in diameter.

Indwelling catheter
The clothing will be removed from the lower portion of your body, and you will lie on your back. If you are a woman, your knees will be bent and your legs spread apart. This will allow the caregiver access to your urethra. If you are a man, your knees can be either straight or bent.

A health care professional (often a nurse) will clean the opening of your urethra with an antiseptic solution. Then, he or she will inject a lubricating jelly into your urethra. This injection will be done with a special syringe that has a smooth plastic tip instead of a needle. Once your urethra is lubricated, the tip of the urinary catheter will be inserted gently into the urethra's opening. Slowly, the catheter will be advanced up the urethra into your bladder. When the catheter tip reaches the bladder, urine will begin to flow down through the catheter tube. At this point, the health care professional advances the catheter a bit farther.

Just below the catheter tip, there is a balloon that has its own connecting tube. The balloon is inflated with a small amount of sterile water or saline (salt solution). The inflated balloon keeps the catheter from falling out of the bladder.

Once the catheter is in place, the drainage bag will be attached. The drainage bag should remain below the level of the bladder to ensure that urine drains properly with no backflow.

CIC
CIC catheters can be made of red rubber (latex) or plastic. Some are reusable, while others are disposable, single-use models.

People who do CIC catheterization on themselves will want to be next to a toilet or have a urine-collection receptacle ready. Wash your hands and the catheter with warm, soapy water. Clean the opening of your urethra, and spread lubricant on one end of the catheter. Insert the lubricated catheter tip into your urethra, and advance the catheter gently until urine begins to flow. Allow urine to drain completely into a toilet or urine receptacle. Once urine stops flowing, gently withdraw the catheter. If the catheter is reusable, wash it in soapy water and allow it to air dry in a ventilated container. Then wash your hands again before resuming your normal activities.

If you are a caregiver who is doing CIC on a patient, the steps are basically the same. However, you should wear clean, disposable gloves during the procedure.

Follow-Up

Indwelling catheters Each day, your caregiver will clean the area around your urethra. In female patients, this area also must be cleaned after every bowel movement. Your caregiver probably will empty the urine drainage bag about once every eight hours (sooner, if the bag is full). The catheter itself will be changed periodically, according to a schedule developed by your nurse or doctor.

Sometimes, the catheter becomes obstructed with debris, such as mucus, protein deposits or tiny mineral crystals. When this happens, urine flow may stop temporarily. To deal with this problem, your caregiver will flush the catheter with a special solution. To help prevent repeated obstructions of the catheter, your doctor may prescribe medication to make your urine more acidic. You also will be asked to drink more fluids to help flush your urinary tract.

If you have had an indwelling catheter for a long period of time, your bladder muscles may go into spasm. These bladder spasms can force urine to leak around the catheter. If this happens, your doctor can prescribe antispasmodic medication.

CIC
The process needs to be repeated every six to eight hours, or as directed by your doctor. Reusable catheters need to be sterilized periodically according to the manufacturer's directions.

Risks

When the catheter is inserted
Insertion of a urinary catheter carries a risk of the following problems:

  • The urethra or bladder can be damaged. Very rarely, the bladder wall is punctured.
  • The catheter can be inserted into the vagina by mistake. This happens most often in infant girls.
  • When indwelling catheters are inserted, the catheter balloon can be inflated inside the urethra, instead of the bladder, injuring the urethra's wall. This complication happens more often in males than in females, because the urethra is longer in men.

After the catheter is inserted
Whenever a catheter enters the bladder, there is a risk that bacteria will get into the urinary tract. In many cases, the bacteria grow in the urine without causing any symptoms of a urinary tract infection. Sometimes, however, the bacteria cause symptoms of a urinary tract infection, including a fever and changes in the urine's smell and appearance.

After long-term use of an indwelling catheter
In people who need an indwelling catheter for long-term care, the following complications can occur:

  • The urethra can be damaged or scarred.
  • A long-term inflammation or infection of the kidneys can develop.
  • "Stones" made of mineral deposits can form inside the kidneys or bladder, or on the catheter tip or balloon.
  • The scrotum, prostate or nearby structures can become infected.

When to Call a Professional

In someone with a urinary catheter, the following symptoms can be signs of infection or other complications. Contact your doctor or home-care nurse if you have any of these symptoms:

  • Fever, with or without chills
  • Pain in the abdomen, flank or lower back
  • Urine that smells foul or unusually strong
  • Urine that is thick, cloudy or tinged with blood
  • (Indwelling catheter) Little or no output of urine into the drainage bag, in spite of attempts to irrigate the catheter
  • (Indwelling catheter) Leakage of urine past the catheter

Additional Info

National Kidney and Urologic Diseases Information Clearinghouse
3 Information Way
Bethesda, MD 20892-3580
Phone: 301-654-4415
Toll-Free: 1-800-891-5390
Fax: 301-907-8906
http://kidney.niddk.nih.gov/

American Urological Association
1000 Corporate Blvd.
Suite 410
Linthicum, MD 21090
Phone: 410-689-3700
Fax: 410-689-3800
Toll-Free: 1-866-746-4282

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