Understanding the different types of catheters
Before discussing the insertion process, it's important to differentiate between the primary types of urinary catheters. The most common are intermittent catheters and indwelling catheters (often called Foley catheters). Intermittent catheters are single-use devices inserted to drain the bladder and then immediately removed. Indwelling catheters are designed to remain in the bladder for an extended period, held in place by a small inflatable balloon. The insertion procedure is similar for both, but indwelling catheters require an extra step to inflate the balloon.
Essential supplies for catheter insertion
Regardless of whether the patient is male or female, a sterile catheterization kit is essential. A standard kit contains the following items:
- Sterile gloves
- Antiseptic cleansing solution (e.g., povidone-iodine or BZK wipes)
- Lubricating jelly, preferably one that is sterile and water-soluble
- A waterproof drape or underpad
- The catheter of the correct French size and a collection bag (for indwelling)
- Prefilled syringe with sterile water to inflate the balloon (for indwelling)
- A specimen container, if a urine sample is needed
How to insert a catheter in a female patient
- Preparation: Begin by washing your hands thoroughly and setting up your sterile field. Place the waterproof pad underneath the patient. Position the patient on their back with their knees bent and feet together. Open the catheterization kit and put on sterile gloves.
- Patient Cleaning: With your non-dominant hand, gently spread the labia to fully expose the urinary meatus (urethral opening). This hand is now considered contaminated and should not be used to touch sterile items. Using your sterile (dominant) hand, pick up an antiseptic swab with sterile forceps. Clean the labia and urethral area, wiping from front to back. Use a new swab for each wipe, cleaning one labial fold, then the other, and finally, the area directly over the urethral meatus.
- Insertion: Apply a generous amount of lubricating jelly to the tip of the catheter. Hold the catheter 3 to 4 inches from the tip. Ask the patient to take a deep breath to relax the pelvic muscles. Gently and slowly insert the catheter into the urethra until urine begins to flow. Advance the catheter another 1 to 2 inches to ensure it is fully in the bladder.
- Inflation and Securing (for indwelling): If inserting an indwelling catheter, use the prefilled syringe to inflate the balloon. Once inflated, gently pull back on the catheter until you feel resistance, which confirms the balloon is seated at the bladder neck. Secure the catheter to the patient's inner thigh with a securement device.
How to insert a catheter in a male patient
- Preparation: Position the patient on their back. Wash your hands and set up the sterile field. Place the waterproof pad underneath the patient. Don sterile gloves.
- Patient Cleaning: With your non-dominant hand, grasp the penis firmly, holding it upright. This hand is now contaminated. If the patient is uncircumcised, retract the foreskin. Use your sterile (dominant) hand to clean the glans of the penis with antiseptic swabs. Use a circular motion, starting at the meatus and working outward. Use new swabs for each circular swipe.
- Insertion: Apply lubricating jelly directly into the urethral opening. Hold the catheter in your sterile hand. Ask the patient to take a deep breath. Gently insert the catheter into the urethra. If you meet resistance, do not force it. Steady pressure and asking the patient to cough or bear down can help relax the urethral sphincter. Continue advancing until urine begins to flow, then advance fully to the port.
- Inflation and Securing (for indwelling): Slowly inflate the balloon with the prefilled syringe. Gently pull back on the catheter to confirm placement. After securing the catheter to the thigh or lower abdomen, return the foreskin to its normal position if it was retracted.
Recognizing and preventing complications
While catheter insertion is a routine medical procedure, there are potential complications. The most common is a catheter-associated urinary tract infection (CAUTI). To prevent this, strict adherence to sterile technique during insertion is paramount. Other risks include urethral trauma, bleeding, and bladder spasms. If resistance is met during insertion, it should never be forced, as this can cause damage. Always use the correct catheter size and ensure ample lubrication.
| Feature | Indwelling Catheter | Intermittent Catheter |
|---|---|---|
| Duration | Remains in place for days or weeks | Inserted and removed multiple times daily |
| Mechanism | Held in place by an inflatable balloon | No internal mechanism; removed after use |
| Risks | Higher risk of CAUTI and urethral irritation | Lower risk of CAUTI with proper sterile technique |
| User | Typically inserted and managed by a healthcare provider, though can be self-managed | Often used for self-catheterization |
| Application | Continuous drainage, post-surgery, critical care | Bladder management for urinary retention, spinal cord injury |
Catheter care after insertion
Proper ongoing care is vital for anyone using an indwelling catheter to prevent infection and discomfort. This includes daily cleaning of the insertion site with soap and water, ensuring the tubing is not kinked, and keeping the collection bag below the bladder to allow for gravity drainage. Individuals should also stay well-hydrated to help flush the urinary system. For more detailed guidelines on preventing catheter-associated urinary tract infections, refer to resources from reputable organizations like the Centers for Disease Control and Prevention (CDC).
Conclusion
Inserting a catheter is a safe and effective procedure when performed with the correct sterile technique and careful attention to detail. Whether performing it for a patient or learning for self-management, understanding the steps, potential pitfalls, and ongoing care requirements is essential. Always consult a healthcare professional for guidance and to determine the appropriate catheter type and size for your specific needs.
