Urinary Catheterization

What is Urinary Catheterization?

A thin, flexible tube is inserted into the bladder to drain urine when normal flow is obstructed or when you need accurate output measurement.

Indications

1. Acute or chronic urinary retention from obstruction, neurological conditions, or weak bladder muscles.
2. Monitoring urine output in the ICU or during major surgery.
3. Collecting a sterile urine sample.
4. Perioperative use, especially urinary tract or prolonged surgery.
5. Severe incontinence when other treatments fail, especially with mobility or neurological impairment.
6. Facilitating healing of open sacral pressure ulcers or perineal wounds by keeping the area dry.
7. Bladder irrigation to manage clots or debris, especially postoperatively.

Contraindications

1. Known or suspected bladder carcinoma (trauma or bleeding risk).
2. Anticoagulation or antiplatelet therapy (bleeding risk).
3. Acute prostatitis (catheterization worsens it).
4. Recent urethral surgery (disrupts the surgical site or stricture).
5. Severe urethral stricture (insertion causes trauma).

Types of Catheter

1. Single-lumen (straight). One channel, for short-term use like surgery or a sample.
2. Double-lumen (indwelling). One lumen drains, one inflates the retention balloon.
3. Triple-lumen. Drainage, balloon, and irrigation or medication delivery, for continuous bladder irrigation.

Supplies and Equipment

• Sterile catheters. Males typically 12 to 16 French (Fr), females 10 to 14 French (Fr), chosen by anatomy and clinical need.
• Sterile gloves
• Antiseptic solution for periurethral cleaning
• Sterile water-based lubricant
• 10 mL syringes prefilled with sterile water to inflate the catheter balloon
• Urine drainage bag connected to the catheter
• Adhesive securement device or tape
• Urine receptacle
• Specimen container (if for culture)
• Bath blanket or sheet for draping
• Standing lamp or flashlight

Inserting an Indwelling Foley Catheter

1. Explain the procedure so the patient stays calm and still.
2. Position supine. Females: knees bent, thighs externally rotated. Males: knees and hips extended, legs gently separated.
3. Hand hygiene and sterile gloves to prevent pathogens entering the urinary tract and causing CAUTI. Perform hand hygiene immediately before and after insertion or any manipulation of the catheter (CDC).
4. Open all supplies onto the sterile field (catheter kit, gloves, antiseptic, sterile drapes, lubricant, drainage bag).
5. Drape the lower abdomen, exposing only the genital area (males) or urethral opening (females).
6. Place the catheter kit on the sterile field, between the legs (female) or on the thighs or between the legs (male).
7. Cleanse the meatus:

• Females: with the nondominant hand, spread the labia. With forceps, wipe front to back (pubis to rectum) along the far labia with an antiseptic-soaked cotton ball and discard, then the near labia, then down the middle, a new cotton ball each time.
• Males: hold the penis at the shaft below the glans; clean the meatus in circular motions from the center outward.

8. Lubricate the catheter: 2.5 to 5 cm (1 to 2 in.) for females, 15 to 17.5 cm (6 to 7 in.) for males, because the male urethra is longer and more convoluted.
9. Hold the catheter 7.5 to 10 cm (3 to 4 inches) from the tip, coiling the rest loosely in your palm, with the drainage bag attached.
10. Insert:

• Females: have the client take a slow breath and insert through the meatus as they exhale; advance another 5 to 7.5 cm (2 to 3 inches) until urine flows, then release the labia and hold the catheter with the nondominant hand.
• Males: hold the penis upward, insert 7.5 to 10 cm (3 to 4 inches), and advance 17 to 22.5 cm (7 to 9 inches) until urine flows. Do not force against resistance. Lower the penis once urine flows, and replace the foreskin in uncircumcised patients. A brief burning sensation is normal.

11. Inflate the balloon with the prefilled syringe, attach the drainage system, and tape the catheter to the inner thigh.
12. If the patient has discomfort, deflate the balloon, advance the catheter 1 inch, and reinflate to confirm it is in the bladder, not the urethra.
13. Hang the drainage bag below bladder level on the bed frame, never on the side rails or floor, and check the tubing is not kinked.
14. Reposition the patient and document the amount and characteristics of urine and the patient's response.

Removing an Indwelling Foley Catheter

1. Explain the procedure.
2. Hand hygiene and clean gloves.
3. Position comfortably (supine for males, dorsal recumbent for females) with a waterproof pad under the buttocks.
4. Attach a syringe to the balloon port and deflate it by slowly withdrawing all the sterile water.
5. Have the client take deep breaths and gently withdraw the catheter.
6. Inspect the catheter to confirm it is intact and no balloon fluid remains.
7. Dispose of the catheter and gloves and perform hand hygiene.
8. Document the procedure.
9. Monitor output and watch for discomfort or infection. Burning or irritation on the first few voids is common from urethral irritation.

Frequently Asked Questions

What is the main risk of urinary catheterization? Catheter-associated urinary tract infection (CAUTI). The catheter bypasses the body's natural flushing defenses and gives bacteria a direct route into the bladder, which is why aseptic insertion and prompt removal are central to CDC prevention guidance (CDC).

How do you prevent CAUTI? Insert only when there is a clear indication, use aseptic technique with sterile equipment, perform hand hygiene before and after any catheter contact, keep the drainage system closed, hang the bag below bladder level, and remove the catheter as soon as it is no longer needed (CDC; SHEA/IDSA/APIC 2022).

What size catheter is used? Males are typically catheterized with a 12 to 16 French catheter and females with 10 to 14 French, chosen by anatomy and clinical need. Smaller sizes that still drain adequately reduce urethral trauma.

Why is the drainage bag kept below the bladder? To keep urine flowing by gravity and prevent backflow of contaminated urine into the bladder, a known CAUTI risk. The bag is hung on the bed frame, never on the side rails or the floor, and the tubing is kept free of kinks.

What is the difference between the catheter types? A single-lumen (straight) catheter has one channel for short-term use such as a sample or surgery. A double-lumen indwelling (Foley) catheter has one channel to drain and one to inflate the retention balloon. A triple-lumen catheter adds an irrigation channel for continuous bladder irrigation.

Is burning normal after catheter removal? Mild burning or irritation on the first few voids is common from urethral irritation and usually settles quickly. Persistent burning, fever, cloudy or foul-smelling urine, or inability to void should be reported, as they may signal infection or retention.