A catheter is a medical instrument composed of a long thin tube that can have several ends depending on the functions to be performed. Catheters are inserted into the body as part of different procedures, for example they are used to diagnose genitourinary tract hemorrhages, to monitor intracranial pressure and also to administer certain medicines. In the common sense, "inserting a catheter" usually refers to the urinary catheter that is inserted into the patient's bladder through the urethra to drain urine. Like all medical procedures, this one too requires fairly rigorous safety and sterilization procedures. Start with step 1.
Steps
Part 1 of 2: Prepare for Insertion
Step 1. Explain the process to the patient before starting
Most patients are not used to inserting any object, least of all a tube, into the urethra. Even if it is not described as "painful", this experience is still considered "uncomfortable" even at intense levels. Out of respect for the patient, explain each step of the procedure to him before starting.
By explaining the steps and what to expect, you can help the patient relax and avoid anxiety
Step 2. Ask him to lie on his back
The legs should be spread wide and the feet together. By standing on your back, your bladder and urethra relax, making it easier to insert the catheter. A strained urethra compresses the catheter, resisting insertion and thereby causing pain, sometimes even damage to the lower tissue of the urethra. In the worst cases, even bleeding.
If necessary, assist the patient to get him into the position
Step 3. Wash your hands and put on gloves
Sterile gloves are important to protect the hands and the patient himself during the procedure. In the case of catheter insertion, gloves are used to prevent bacteria from entering the urethra and the patient's body fluids from coming into contact with your hands.
Step 4. Open the catheterization kit
Single catheters are placed inside sterile kits. Before opening one, make sure it is the right one for the purpose. You will need a catheter that fits the patient's measurements. The catheters have sizes and units called French (1 French = 1/3 mm) and are available in sizes ranging from 12 (small) to 48 (wide) French. Smaller ones are usually better for the patient, but a larger catheter may be needed to drain very thick urine or to make sure it stays in place.
- Some catheters have special tips that serve different functions. For example, the catheter called Foley usually serves for urine as it has a balloon attached, which inflates to secure the catheter behind the bladder neck.
- You will also need a medical disinfectant, cotton swabs, surgical drapes, lubricant, water, tubing, drainage bag, and patch. Everything must be perfectly clean and sterilized.
Step 5. Sterilize and prepare the patient's genital area
Swipe a swab dipped in disinfectant into the genital area. Rinse with sterile solution or alcohol to remove any particles. Repeat as needed. Once finished, place the drapes around the genital area leaving space to access the penis or vagina.
- For women, be sure to thoroughly clean the vaginal lips and urethral meatus (the outside of the urethral opening that sits above the vagina). In men, the urethral opening is on the penis.
- Cleaning should be done from the inside to the outside so as not to contaminate the urethra. In other words, you start at the urethral opening and come forward in a circular motion.
Part 2 of 2: Insert the Catheter into the Bladder
Step 1. Apply lubricant to the catheter tip
Coat the distal portion of the catheter (the 2-5cm top) with a generous dose of lubricant. This is the part that will be inserted into the meatus. If you are using a catheter with a balloon, lubricate the part of the balloon beyond the tip as well.
Step 2. If the patient is a woman, keep the labia open and insert the catheter into the urethral meatus
Hold it with your dominant hand and use the other to keep your lips open so you can see the urethral opening. Gently insert the tip of the catheter into the urethra.
Step 3. If the patient is male, hold the penis and insert the catheter into the urethral opening
Hold the penis still with the non-dominant hand and gently pull upwards, perpendicular to the patient's body. Insert the tip of the catheter into the urethra with your dominant hand.
Step 4. Keep pushing until the catheter enters the bladder
The length of the tube should smoothly penetrate the urethra and bladder until some urine is noticed. Once the urine starts flowing, keep pushing the catheter another couple of centimeters into the bladder to make sure it rests against the bladder neck.
Step 5. If you are using a catheter with a balloon, inflate it with saline
Use a syringe filled with saline to fill it through the sterile tube connected to the catheter. The balloon serves as an anchor, so that the catheter does not descend during the movements. Once inflated, pull lightly to make sure the balloon is in place, snugly against the bladder neck.
The amount of saline used to inflate the balloon depends on the size of the balloon. Usually 10cc is needed, but check to be sure
Step 6. Connect the catheter to the drainage bag
Use a sterile tube to drop urine into the drainage bag. Secure the catheter to the patient's thigh or abdomen using a patch.
- Make sure the drainage bag is lower than the patient's bladder. Catheters work with gravity - urine does not go "uphill".
- In a medical setting, catheters can be kept for up to 12 weeks before being changed, although they are often removed first. Some, for example, are removed immediately after all urine has been drained.
Advice
- Empty the drainage bag every 8 hours.
- The catheters are made of various materials, including latex, silicone and Teflon. They are also available without a balloon or with balloons of various sizes.
- Most nurses use universal precautions which include wearing gloves, face and eye protection, and an apron when fitting the catheter.
- Evaluate the amount, color and smell of urine collected in the drainage bag.
Warnings
- Beware of complications: strong odors, cloudy urine, fever or bleeding.
- Some patients may be allergic to latex. Watch for any reactions.
- If there is very little or no urine dripping or coming out, the catheter may have been inserted incorrectly.
