Urethral Catheterization
(Passing Foley’s Catheter into the Urinary Bladder)
Common Bed Side Procedure No. 1
Section Editor: Prof. T.K. Partha Sarathy

Urethral catheterization is a frequently performed bed side procedure; if done haphazardly it may lead to infection, particularly if the catheter is left for long periods.
Urethral catheterization is done usually with a balloon tip Foley Catheter of varying sizes (8 Fr* to 26 Fr). The balloon size for most of the applications is designed to hold little over 5 ccs of fluid. Larger Foley catheters with balloon capacity in excess of 30 ccs are available for specific urology purposes. For an average adult sizes 14 to 18 Fr catheters are usually utilized.

Indications for urethral catheterization:
1. Urinary retention (palpable, prominent urinary bladder)
2. To keep the patient dry and manageable when he is obtended or comatose
3. Management

of incontinence of urine
4. To watch hourly urine output in intensive care situation.
5. As a part of urologic studies and also managing post operative status.
6. To obtain a catheterized specimen of urine for culture and sensitivity when specially

required.
(Spontaneously voided midstream specimen is good enough under majority of circumstances and it is rarely necessary to catheterize for diagnosis of UTI).

Requirements:
a. Water, sterile Foley catheter bag with or without hourly monitoring facility as the case may be.
b. Betadine solution (povidone Iodine) – paint.c. Where an assistant is not available, it is better to have a table set up with a catheter ready for use. Otherwise, a trained assistant to hand over sterile catheter is desirable.

Procedure:

Although the procedure may vary minimally between male and female patients, the basic principles of aseptic precautions and positioning are essentially the same.
Preliminary hand wash and wearing of cap and mask recommended.
Patient should be in the supine position with legs slightly apart for the male and with legs apart and knees flexed for the female patient.
A preliminary soap and water wash to the external genitalia is desirable.
From this point all procedures are done with sterile gloves.
External preparation of genitalia is performed using betadine pain and sterile drapes are laid to provide adequate exposure to the external genitalia.
Appropriate catheter is picked up and the integrity of the balloon is checked by introducing 5 cc of water into the balloon and deflated.
The sterile catheter is lubricated adequately with sterile jelly lubricant.

Catheterization of the male patient
The penis is held with the left hand away from the scrotum and holding the catheter firmly with the right hand the well lubricated catheter is gently passed through the external urethral meatus. This is gently and gradually advanced and under most circumstances it is passed through the urinary sphincter without any problem. Occasionally some resistance may be encountered at the level of the sphincter due to prostatic hypertrophy. By gently advancing further through the sphincter this can be overcome to some extent and catheter can be passed into the bladder.
Occasionally a larger catheter or a “coude” type of catheter may be required to overcome this obstruction. When the catheter passes into the bladder, urine will be seen coming through the catheter. At this point, it is advanced by another 1 to 2 cms and the balloon is inflated with 5 cc or sterile water. The Foley catheter after collecting specimens for urinalysis and culture is then connected to the Foley bag. Some physicians prefer to apply betadine ointment at the external urethral orifice. The Foley catheter may be stabilized to the medial aspect of one of the thighs using adhesive tapes. This prevents the Foley catheter advancing more towards the bladder thereby carrying infection and also prevents it from unnecessary movements causing discomforts.

Catheterization of the female patient
In the female, the vulval outlet and labia are carefully washed and painted with betadine and appropriate sterile drapes are laid. With the left hand exposing the urethral meatus by separating the labia with the thumb and index fingers the external urethral meatus is identified and previously lubricated catheter is carefully and gently advanced through it into the bladder.
Care should be taken not to contaminate the catheter by touching the unprepared parts of the genitalia and the vagina. Once the catheter is well placed inside the bladder and the urine is seen coming out of the tube the balloon is distended with 5 cc of sterile water and catheter connected and fixed as described earlier.

Post Catheterization management has to be carefully planned to avoid infections. Except in selected patients, routine antibiotic administration is not necessary. Catheter care and change of catheters when necessary should be remembered. In a hospital set up, catheter induced nosocomial infections of the urinary tract are fairly common. When prolonged catheterization is required appropriate urological and where necessary neurological consultations are obtained to plan long term management of the catheter dependent patient. Ambulatory patients who have Foley catheters left in situ are given appropriate instructions and training in the care of the catheters and also plan periodical visits to the doctors and health care staff.
Consider – use of silicon coated catheter for long-term placements.