Catheter insertion overview

Urinary catheterization is the insertion of a catheter into the bladder for the purpose of draining urine. It is an invasive procedure which should not be carried out without full consideration of all the presenting factors. Catheterization may be intermittent or continuous. As catheterization is associated with an increased risk of hospital-acquired infection, this is a sterile procedure.

Catheter selection

It is important that an appropriate catheter that is manufactured for the purpose of urinary catheterization is used. Catheters should conform to British Standards and the practice of using a polyvinyl chloride nasogastric tube as an alternative to a proper urinary catheter is discouraged. This non-recommended practice can cause harm to a patient.

Catheters come in a variety of lengths and diameter sizes, measured in Charriere (Ch) or French Gauge (Fg). Using an inappropriate size or length can cause trauma to the patient. Catheters of too large a diameter will cause irritation to the urethral mucosa and increase the possibility of a catheter-associated infection. The Foley indwelling catheter is the most commonly used and the table shows the recommended (Fg) sizes for the age of the child.

Consideration must also be given to the length of the catheter used and the size of the balloon to be inflated after insertion of the catheter.

Procedure

• Ask child to lie supine on the bed, maintain dignity by covering abdomen and lower legs.
  
• Place absorbent pad under the child’s buttocks.
  
• To prevent cross-infection, put on apron and wash hands.
  
• Open catheter pack to provide sterile field.
  
• Apply hand gel, allow to hands to dry then put on sterile gloves.
  
• Open catheter, although leave in sterile inner sleeve, and put other equipment on to sterile field.
  
• Pour saline solution into gallipot.
  
• Put some lubricating gel onto a gauze swab and apply the nozzle to the lidocaine gel.
  
• Fill the syringe with sterile water ready to fill the catheter balloon.
  
• Tear the end of the plastic sleeve of the catheter to expose tip and apply lubricating lidocaine gel to the tip of the catheter, place in sterile bowl ready for use.
  
• Tear a hole in the sterile towel and place towel over child’s groin area.
  
• Clean the child using gauze and normal saline.
  
• Apply the anaesthetic gel to the urethral meatus and wait 
4 minutes for it to be effective.
  
• Change gloves, as the first pair are now contaminated.
  
• Insert the catheter into the urethra ensuring it does not touch any of the surrounding area.
  
• To prevent contamination, ensure the other end of the catheter remains in the plastic sleeve and in the sterile bowl.
  
• Once urine starts to flow, insert the catheter a further 2–4 cm. This will ensure that the balloon of the catheter is clear of the neck of the bladder, the balloon can be inflated without causing injury.
  
• Inflate the balloon with sterile water with the volume indicated on the catheter,
  
• Gently draw the catheter back until resistance is felt, the balloon is now sitting at the neck of the bladder.
  
• Attach urine drainage system to the end of the catheter, maintaining sterility to prevent contamination.
  
• Attach the catheter to the child’s upper thigh to ensure there is no pull on the catheter which may cause trauma.
  
• Place the drainage bag on a hanger to keep the bag off the floor and below the level of the child’s bladder.
  
• Reassure the child the procedure is over, clear away equipment in line with local policy.
  
• Consider if a urine sample needs to be sent.
  
• Wash and dry hands thoroughly.
  
• Document procedure in child’s patient records.