AL-GHAD INTERNATIONAL COLLEGES FOR MEDICAL HEALTH SCIENCES

Madinah Almunawarrah, Male Branch

EMERGENCY MEDICAL SPECIALTY PROGRAM

URINARY CATHETERIZATION
Upon completion of discussion and demonstration of URINARY CATHETERIZATION
procedure, the students will be able to:
1. Discuss the purpose of urinary catheterization
2. List the complications of urinary catheterization
3. Demonstrate the knowledge and correct procedure for urinary catheterization

INDICATIONS
The placement of a urinary catheter is indicated in the following circumstances:
1. Urine Output Monitoring
Patients with low cardiac output, impaired renal function or suffering from conditions
such as rhabdomyolysis or acute immune hemolytic reactions often require urinary
catheterization to accurately monitor urine output
2. Chronically Bed-ridden Patients
Patients who are confined to their beds and unable to use bedpans are candidates for
urinary catheterization. The unconscious patient and patients with spinal injuries or
urinary incontinence are some examples
3. Acute Urinary Retention
Conditions or situations that can cause urinary retention requiring urinary catheterizations
include but are not limited to:
i.
Postoperative retention: urine retention as a result of surgery.
ii.
Postpartum perineal trauma: Most often a result of swelling of the urinary
meatus due to the trauma of a vaginal delivery.
iii.
Bladder papilloma: A benign tumor of the bladder, which interferes with the
drainage of urine.
iv. Cystocele: A condition when the wall between the bladder and the vagina
weakens. The bladder droops into the vagina and can interfere with the drainage
of urine.
v. Neurogenic bladder: A condition where nervous impulses between the bladder
and the brain are no longer functioning resulting in the inability to void.
vi.
Prostate conditions: Any condition resulting in changes in the prostate size such
as prostate cancer, benign prostate hyperplasia and prostatitis that interferes with
the flow of urine.
vii.
Urethral stricture: Any condition resulting in the narrowing of the urethra such
as scarring, trauma or chronic infections that interferes with the flow of urine.
When urinary retention is not treated with decompression of the bladder by catheterization,
increased urine collection can result in decreased or permanent loss of bladder tone. The obstruction
of urine can also cause hydronephrosis (swelling of the kidneys), which can lead to renal failure.

AL-GHAD INTERNATIONAL COLLEGES FOR MEDICAL HEALTH SCIENCES

Madinah Almunawarrah, Male Branch

CONTRAINDICATIONS
1. Suspicion of urethral injury following pelvic trauma. Blood at the urethral meatus, bruising to
the scrotum or significant mechanism of trauma involving the pelvic region are indications to
withhold catheterization until a physician can assess the patient.
2. Acute urethral and prostate infection.
3. Cautioned in patients with suspected acute myocardial infarction (AMI) and a candidate for
thrombolytic therapy
COMPLICATIONS
Despite best effort to perform urinary catheterization without complications, they are a
possibility:
1. Infection
The insertion of a urinary catheter provides a direct route for bacteria to enter the urinary
tract. Hand washing, proper preparation of the site, and strict aseptic technique is critical
to reduce this complication.
2. Trauma
Inserting a urinary catheter can cause trauma to the urethra. Ensuring the catheter is
lubricated with sterile water-soluble lubricant up to 5 cm for females and 17.5 cm for
males will reduce the incidence of trauma to the urethral canal and eases insertion. Never
force the catheter against resistance. If resistance is felt ask the patient to bear down as if
to void. This may cause the external sphincter to relax allowing further advancement of
the catheter.
3. Restricted Canal
Urethral stricture or an enlarged prostate gland can reduce the passageway of the urethra.
If the patient has a known or suspected history of this, consider using a smaller catheter.
4. Vaginal Catheterization
Inadvertent catheterization of the vaginal canal is a complication of urinary
catheterization. This will manifest as the absence of urine return despite ease of insertion.
Proper patient positioning can reduce the incidence of this occurring.
If vaginal catheterization is suspected, remove the catheter and discard it as it is now
contaminated. Reattempt urinary catheterization with a new catheter. (Note: Some
Practitioners will leave this catheter in place to aid in locating the urethral meatus prior to
the next attempt)
5. Inability to Locate Urethra
The incidence of the inability to locate the urethra in female patients can be reduced by
proper preparation. Correct patient positioning and thorough cleansing of the site will aid
in the landmarking process
6. Paraphimosis
Paraphimosis is the retraction and constriction of the foreskin behind the glans penis. To
prevent this complication, be sure to reduce the foreskin after catheterization