Hi there! Let’s take a look at urinary catheters and catheter insertion for male patients.

A urinary catheter (also known as an ‘indwelling’ or ‘long-term’ catheter) is a hollow, flexible tube inserted through the urethra into the bladder to drain urine into an external collection bag.

Once the catheter has been inserted, a small balloon on the internal end is inflated with sterile water to keep it in situ.

Catheters are used often in healthcare settings to assist with a variety of conditions, such as both urinary incontinence and urinary retention, or by patients who may be unable to go to the toilet without assistance.

Procedure

The following demonstration is based on the Catheterisation Clinical Guidelines by the Australia and New Zealand Urological Nurses Society.

Remember to always refer first to your organisation’s internal policies and procedures when performing any procedure like this one.

• To start, gather all equipment required for the procedure.
• Discuss the procedure with the client. Consider using other educational resources such as brochures or interpreters if needed.
• Obtain the client's consent.
• Check current medications and any known allergies.
• If the client has a latex allergy, a 100% silicone catheter is needed for this procedure.
• Ensure adequate lighting.
• Maintain the client's privacy by using means such as hospital screens or bed curtains. Ensure the client is warm and not exposed.
• Have the client lie in their bed on their back.
• Ask the client to slightly flex their knees, with their feet slightly apart.
• Place a waterproof sheet under the client's buttocks.
• Perform hand hygiene.
• Prepare and sanitise the trolley or a clean surface.
• Using an aseptic technique, open the catheterisation pack, and add sterile equipment such as the catheter.
• Pour cleansing solution onto tray.
• If a specimen is needed, open the specimen container at this time.
• Empty sterile water (which may be included in the package) into tray in preparation for balloon inflation.
• Take covering off the client.
• Perform hand hygiene, and don non-sterile gloves.
• Pull the foreskin back if needed. Cleanse the glans penis with cleansing solution using a circular motion from the penile meatus to the base of the penis.
• Remove non-sterile gloves, perform hand hygiene and don sterile gloves.
• Put the fenestrated drape on the client.
• Apply anaesthetic gel to the catheter length.
• Prepare a syringe to inflate the balloon with by drawing up sterile water into the syringe.
• Advise the client that there is a risk of stinging from the anaesthetic gel.
• With a piece of gauze, hold the penis and apply gel to the meatus, then introduce the remaining gel into the urethra.
• Discard the gel container.
• Hold the penis behind the glans and raise the penis to a 90-degree angle to the body.
• Insert the catheter until resistance is felt at the external urethral sphincter muscle.
• Then gently continue until the ‘Y’ of the catheter tube is at the urethral opening to ensure that the balloon is passed the prostate.
• If the balloon is inflated in the prostatic urethra, this will cause pain and urethral trauma.
• If resistance at the urethral sphincter muscles persists, apply gentle, steady pressure on the catheter and advise the client to take a deep breath, cough or bear down, and/or try to pass urine.
• Gently rotate the catheter and consider using a second tube of lubricant if resistance persists.
• Once inserted successfully, slowly inflate the balloon per manufacturer instructions.
• Do not inflate if the client complains of pain or urine is not flowing freely, as this could indicate incorrect catheter placement or bladder spasm.
• Once correctly inflated, pull on the catheter slightly until resistance is felt.
• Connect the catheter to a drainage system or compatible valve.
• Secure the catheter in place using tape or a catheter strap.
• Leave some slack to ensure that the catheter does not become taut when the client moves to reduce the risk of injury.
• Ensure the glans penis is kept clean and dry to avoid skin irritations or infections.
• Reposition foreskin if necessary.
• Remove gloves and perform hand hygiene.
• Check in regularly to ensure the client is comfortable.
• Dispose of used equipment and gloves in a biohazard bag, and clinical waste bag in an appropriate waste system.
• Remember to maintain hand hygiene and complete any relevant documentation.