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| HOW TO DO IT |
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| Year : 2023 | Volume
: 4
| Issue : 1 | Page : 77-78 |
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How to do it: Urethral catheterisation
Georgie Mathew1, KV Sanjeevan1, Pranati Sharma2
1 Department of Urology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Coimbatore, Tamil Nadu, India
2 Department of Neurosurgery, Amrita Hospital, Faridabad, Haryana, India
| Date of Submission | 23-Mar-2023 |
| Date of Acceptance | 25-Mar-2023 |
| Date of Web Publication | 26-Apr-2023 |
Correspondence Address:
Dr. Pranati Sharma
Department of Neurosurgery, Amrita Hospital, Faridabad - 121 002, Haryana
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/JME.JME_39_23
How to cite this article:
Mathew G, Sanjeevan K V, Sharma P. How to do it: Urethral catheterisation. J Med Evid 2023;4:77-8 |
Urethral catheterisation is one of the most commonly performed procedures worldwide. Unfortunately, it happens to be one that is taken for granted with dire consequences. Nosocomial urinary tract infection (UTI) (catheter-associated UTI) is one of the prime suspects of which faulty catheterisation technique is on the rise. One must also consider the fact that it is a very difficult condition to treat since the organisms involved are multidrug resistant on most occasions.
Urethral injuries can give rise to urethral strictures, which can cripple the life of a patient. Hence, while performing urethral catheterisation, the following guidelines should be adhered to.
| Sterile Precautions | |  |
The physician should wash his/her hands thoroughly with a povidone-iodine scrub solution. The patient's genitalia, lower abdomen and upper thigh should be cleaned with chlorhexidine. A sterile drape should be placed. Antibiotic prophylaxis is not required, provided that there is no established UTI or asymptomatic bacteriuria. Prepared tray is opened [Figure 1]
| Adequate Analgesia | | |
Intraurethral insertion of 2% lignocaine jelly results in significantly less discomfort in comparison with a lubricant alone. Following this, it is advisable to wait for 5–10 min for the drug to take effect[1]
| Choice of Catheter Size | | |
It is ideal to use the smallest size that allows adequate drainage. If the urine to be drained is clear, a 14F catheter should be considered. If the patient has haematuria associated with clots, larger-size catheters (18F to 20F) may be considered. Smaller-size catheters have the advantage of causing less urethral mucosal trauma and allowing periurethral gland secretions to drain out effectively. Silicone catheters can be considered if long-term catheterisation is planned.
| Special Considerations during Insertion | | |
It would be ideal not to have direct contact with the catheter. As it is being inserted, the covering sheath may be gently peeled away [[Figure 2] and [Figure 3] – male and female, respectively].
It would be a good practice to observe the patient to see if he/she is in any form of discomfort.
The bulb of the catheter should be inflated with sterile water, once catheter placement in the bladder is ensured by drainage of clear urine through the catheter [Figure 4]. The use of normal saline may result in difficulty in deflating the balloon if the catheter is left in situ for long.[2]
The catheter should then be connected to a closed drainage system and fixed to the anterior abdominal wall or thighs.
The retracted prepuce has to be pulled back into position to avoid paraphimosis.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Siderias J, Gaudio F, Singer AJ. Comparison of topical anesthetics and lubricants prior to urethral catheterization in males: A randomized controlled trial. Acad Emerg Med 2004;11:703-6.  |
| 2. | Sharpe SJ, Mann FA, Wiedmeyer CE, Wagner-Mann C, Thomovsky EJ. Optimal filling solution for silicone Foley catheter balloons. Can Vet J 2011;52:1111-4. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
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