Transurethral Bladder Catheter

Transurethral bladder catheterization is a common medical procedure used for various therapeutic and diagnostic purposes. It involves the insertion of a catheter through the urethra into the bladder to drain urine.

Indications

Therapeutic:

• Urinary retention disorders (e.g., prostate adenoma, incontinence, postoperative care)
• Bladder decompression (e.g., bladder fistula, bladder suturing)
• Inability to void spontaneously in unconscious or sedated patients

Diagnostic:

• Monitoring urine output during surgical procedures
• Urine output control in operative interventions
• Microbiological urine analysis

Complications

• Injury to the urinary tract
• Creation of a false passage (fistula)
• Ascending urinary tract infections

Materials Needed

• Sterile Catheter: Typically 14–18 Ch in internal diameter
• Lubricant with Local Anesthetic: (e.g., Instillagel)
• Urine Bag
• Sterile Gloves
• Swabs and Disinfectants
• Sterile Gauze Pad
• Urinary Basin
• Syringe and Saline Solution

Procedure for Women

1. Discuss the Procedure: Explain the procedure to the patient.
2. Positioning: Place the patient in a supine position with legs elevated and spread apart, resting on a pillow under the buttocks.
3. Sterile Preparation:

• Cover the area with a sterile drape.
• Wear sterile gloves.
• Use the left (or right) hand to spread the labia.

1. Disinfection:

• Cleanse the vulva, major and minor labia, urethral opening, and vaginal entrance from front to back using disinfectant-soaked swabs.
• Place the last swab in the vaginal entrance.

1. Catheter Insertion:

• Gently insert the catheter approximately 5 cm.
• Inflate the balloon with 5–10 ml of water and carefully retract the catheter until resistance is felt.

1. Connect Urine Bag: Attach the sterile urine bag and remove the vaginal swab.

Procedure for Men

1. Discuss the Procedure: Explain the procedure to the patient.
2. Positioning: Place the patient in a supine position with legs together and a pillow under the buttocks.
3. Sterile Preparation:

• Wear sterile gloves (right hand remains sterile for right-handed individuals).
• Use the left hand to hold the penis, retract the foreskin, and disinfect with disinfectant-soaked swabs.

1. Disinfection:

• Cover the penis with a sterile drape and disinfect again.

1. Lubrication:

• Instill anesthetic lubricant into the urethral opening and wait for 1 minute while gently compressing the urethral opening.

1. Catheter Insertion:

• Hold the catheter approximately 5 cm from the tip with the right hand.
• Insert the catheter into the extended penis with the left hand (for Tiemann-K., orient the tip upwards).
• Continue inserting and advancing the catheter, feeling for the external sphincter after 15–20 cm.
• Once urine begins to flow a few centimeters further, advance the catheter until resistance is felt again.

1. Secure the Catheter:

• Inflate the balloon as described above and retract slightly.

1. Connect Urine Bag: Attach the sterile urine bag.

Note: Always reposition the prepuce to prevent the risk of paraphimosis.

Catheter Removal

• Deflate the Balloon: Remove the water from the balloon.
• Remove the Catheter: Withdraw the catheter in one smooth motion; bladder training is ineffective.

Long-term Catheter Replacement

Transurethral catheters should be replaced every 2–4 weeks, depending on the level of contamination.

Note: If the urine appears cloudy, encrusted, or shows signs of infection, the catheter must be replaced immediately.

Antibiotic Prophylaxis

Consider antibiotic prophylaxis as indicated to prevent infections.