Urinary catheterization

Encyclopedia of Medicine, Apr 06, 2001 by Paula Anne Ford-Martin

Urinary catheterization is the insertion of a catheter into a patient's bladder. The catheter is used as a conduit to drain urine from the bladder into an attached bag or container.

Urinary catheterization is employed in hospital and nursing home settings to maintain urine output in patients who are undergoing surgery, or who are confined to the bed and physically unable to use a bedpan. Critically ill patients who require strict monitoring of urinary output are also frequently catheterized.

Intermittent insertion of a urinary catheter is a treatment option for patients with certain types of urinary incontinence. Patients who are unable to completely empty the bladder during urination (urinary retention), or patients who have a bladder obstruction, may also require intermittent urinary catheterization. Disabled individuals with neurological disorders that cause paralysis or a loss of sensation in the perineal area may also use regular intermittent catheter insertion to void their bladders.

Because urinary catheterization carries a risk of causing urinary tract infection (UTI), precautions should be used to keep the catheter clean and free of bacteria. Patients requiring intermittent catheterization should be well trained in the technique by a qualified health care professional.

Intermittent catheterization is performed a minimum of four times a day by the patient or a care giver. The genital area near the urethral opening is wiped with an antiseptic agent, such as iodine. A lubricant may be used to facilitate the entry of the catheter into the urethra, and a topical local anesthetic may be applied to numb the urethral opening during the procedure. One end of the catheter is placed in a container, and the other end is inserted into and guided up the urethra until urine flow begins. When urine flow stops, the catheter may be moved or rotated, or the patient may change positions to ensure that all urine has emptied from the bladder. The catheter is then withdrawn, cleaned, and sterilized for the next use. Recommended cleaning practices vary, from the use of soap and water to submersion in boiling water or a disinfectant solution. Some patients prefer to use a new catheter with each insertion.

Nonintermittent catheterization, which is initiated in a hospital or nursing home setting, uses the same basic technique for insertion of the urinary tract catheter. The catheter is inserted by a nurse or other health care professional, and remains in the patient until bladder function can be maintained independently. When the catheter is removed, patients will experience a pulling sensation and may feel some minor discomfort. If the catheter is required for an extended period of time, a long-term, indwelling catheter, such as a Foley catheter, is used. To prevent infection, it should be regularly exchanged for a new catheter every three to six weeks.

Use of indwelling catheters should be restricted to patients whose incontinence is caused by urinary tract obstruction that can not be treated, and for which alternative therapy is not feasible.

If a patient wishes to perform intermittent catheterization himself, training in the technique by a qualified health care professional is required. Basic instruction in the anatomy, antiseptic techniques, catheter insertion, and proper catheter care should be provided. Patients learning chronic intermittent urinary catheterization may also benefit from an ultrasound examination to verify that they are completely emptying their bladder during the procedure.

Patients using intermittent catheterization as a treatment for incontinence will experience a period of adjustment as they try to establish a catheterization schedule that is adequate for their normal level of fluid intake.

Antibiotics may be prescribed as a preventative measure in long-term urinary catheterization patients who are at risk for urinary tract infection.

A patient with an indwelling catheter must be reassessed periodically to determine whether alternative treatment may be more effective in treating the problem.

Trauma to the urethra and/or bladder may result from incorrect insertion of the catheter. Repeated irritation to the urethra during catheter insertion may cause scarring and/or stricture, or narrowing, of the urethra. The catheter may introduce bacteria into the urethra and bladder, resulting in urinary tract infection. UTI can cause fever and inflammation of the bladder and urethra. Patients who practice intermittent catheterization can reduce their risks for UTI by using antiseptic techniques for insertion and catheter care.

When used correctly, catheterization facilitates complete voiding of the bladder.

• Periodicals
• Hunt, Gillian M., Pippa Oakeshott, and Robert Whitaker. "Intermittent Catheterization: Simple, Safe, and Effective but Underused." British Medical Journal 312, No. 7023 (Jan 1996):103-7.
• U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research. "Urinary Incontinence in Adults: Acute and Chronic Management." Clinical Practice Guideline No. 2, (Update 1996).