Urinary Catheterisation

Urinary Catheter Opener.jpeg

This module describes how to insert a catheter through the urethra and into the urinary bladder.


  1. Drainage:

    1. To manage incomplete bladder emptying and urinary retention
    2. To drain the bladder during surgical or obstetric procedures
    3. Irrigation and drainage after urological surgery
    4. Palliation of chronic urinary incontinence
  2. Instilling medications or contrast agents

  3. To obtain a sterile urine specimen

  4. Fluid balance monitoring in critically ill patients



Always verify your patient’s identity and obtain informed consent before proceeding.

How do I explain this procedure?

“I need to place a thin tube in your bladder to drain urine into a bag. I will either strap it to your leg, or it will be placed on a bag stand.”

What can my patient expect?

“It may feel slightly uncomfortable when I pass the tube.”

What is my patient’s role?

“Tell me if you have any allergies. Stay still and try to remain relaxed while I insert the tube; it’ll help it to pass more easily. Let me know if you experience any pain. Afterwards, keep the bag lower than the level of your bladder, and tell the nursing staff if there are any problems with your catheter such as leaking or the plaster coming loose.”


Urinary Catheter Prep.png

Prepare a trolley with equipment.

Documentation

  1. Patient notes

Equipment

  1. Sterile gloves

  2. Alcohol-based hand rub

  3. A sterile pack

  4. Povidone iodine skin disinfectant or normal saline (follow hospital protocol)

  5. 10 ml syringe

  6. 10 ml

  7. Catheter drainage bag

  8. (Generally 16-18 Fr for males, 14-18 Fr for females and 5-10 Fr for children)

  9. Lubricant jelly or local anaesthetic jelly

  10. Surgical tape or a transparent film dressing


The patient should be positioned supine. Females should bring their heels to their buttocks with their legs separated.

Urinary Catheter Female Anatomy.jpeg

Urinary Catheter Male Anatomy.jpeg


Wash the perineal area with soap and water, using unsterile gloves.

Follow medical asepsis with sterile gloves.

  1. Perform hand hygiene.

  2. Open the sterile pack and create a sterile field on a clean, dry surface. Pour 10 ml sterile water into the empty well. Pour disinfectant into the well containing cotton balls. Open the syringe, catheter and bag onto the sterile field. Squeeze some lubricant jelly onto the sterile field.

  3. Don sterile gloves. Place a drape under the patient’s genital area.

  4. that the catheter balloon is working.

  5. Connect the catheter to the collection bag.

  6. Separate the labia/hold the penis with your non-dominant hand. This hand is now non-sterile.

    the urethral area using your sterile hand, taking care not to touch the patient’s skin.

  7. Use your dominant, sterile hand to pick up the catheter. Lubricate the tip.

  8. the catheter all the way to the Y-connection.

  9. Observe urine drainage into the urine drainage tube/urine bag.

  10. Inject 10 ml water into the balloon port while observing for discomfort; stop if this occurs.

  11. In men,

    .

  12. Gently retract the catheter until you feel resistance.

  13. Secure the catheter to the inner thigh in women, or the

    . Place the drainage bag below the level of the bladder.

  14. Dispose of medical waste safely.

  15. Record completion of the procedure in patient notes.


I inserted the catheter into the vagina.

Leave that catheter in place for the moment, so you know where not to insert on your next try. Get a new catheter. Look for the urethral meatus just above the vagina. Remove the incorrectly placed catheter after placing one successfully.

I’m encountering resistance.

This may be at the level of the external sphincter. Ask the patient to cough to help you to pass the catheter. In men, the prostate may interfere with catheter insertion. Do not use force to pass the prostate. Try gently re-angling the catheter as you insert it. Try using gentle traction on the penis. In some cases, the obstruction may be due to strictures. If you are unable to pass the catheter, attempt a smaller size. If unsuccessful, call a senior clinician for advice.

I inserted the catheter, but there is no urine drainage.

If the patient experiences pain with balloon inflation, you are probably in the urethra. Deflate the balloon and re-insert or advance the catheter until you see urine drainage.

If the patient did not experience pain during inflation, it is likely that you have reached the bladder. There may be lubricant jelly temporarily obstructing urine flow, or the bladder may be empty. Press gently on the suprapubic area to encourage urine flow.

Evaluate for urine drainage after 30 minutes if no urine was seen initially.


  1. Urinary structural trauma

  2. Catheter-associated urinary tract infections (CAUTI)

  3. Catheter

  4. Catheter

  5. on removal

  6. Paraphimosis

  7. Urethral erosion due to improper securing of tape

  8. Patient removal of catheter with balloon inflated in confused patients

  9. Pain or discomfort related to the catheter


  1. Shah J. Catheterisation. Ann R Coll Surg Engl. 2012;94(1):5-7. doi:10.1308/003588412X13171221500303. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3954178/

  2. Haider MZ, Annamaraju P. Bladder Catheterization. [Updated 2021 Aug 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560748/

  3. Cravens DD, Zweig S. Urinary catheter management. Am Fam Physician. 2000;61(2):369-376. Available from: https://www.aafp.org/link_out?pmid=10670503

  4. Vetrosky D. Urinary Bladder Catheterization. In: Dehn RW, Asprey DP, eds. Essential Clinical Procedures. 3rd edition. Elsevier; 2013.