THE FAQs

WHAT IS IT?

HOW DOES IT PRESENT?

QUICK EXPERT

1. Urinary Catheterisation refers to the insertion of a

catheter into the bladder to

drain urine otherwise unable

to be passed through normal

voiding processes.

2. It is indicated for various

pathologies, some of the most

common being urinary

retention (not responsive to

other interventions), urinary

incontinence, post/pre-surgery

and neurological conditions

that affect the function of the

bladder.

3. There are different types of

catheters that are

manufactured for specific

aetiologies. For example,

suprapubic catheters (mainly

used for neurological

conditions), intermittent

catheters, indwelling and so

on.

4. While it may be a commonly

practised procedure in

hospitals and aged care

homes, it is associated with

various risk factors that

can have disastrous

outcomes!

WHY CATHETERISE?

Urinary Catheterisation can be

indicated for a wide range of

aetiologies and disease conditions.

These aetiologies can also be further

classified as acute or chronic. Within

the aged care setting, nurses and care

workers are more likely to encounter

chronic urinary issues that require

continuous care, maintenance and

vigilance. The most common reasons

for catheterisation in the elderly are

urinary retention and incontinence,

which have proven untreatable by

others methods. Other reasons may

be around neurological conditions

which impact the normal function of

the bladder (i.e. multiple sclerosis),

inability to mobilise (or bed bound) or

post-surgical procedure (such as hip

replacement.

.

POINTS TO REMEMBER

Involve the carers in the

procedure of catheterisation

and educate them around

catheter care, hygiene and

maintenance

Urinary Catheterisation is a

procedure that is associated

with a host of serious risk

factors and should not be

taken lightly. UTIs (which can

lead to bacteruria and sepsis)

are almost guaranteed to

occur with an indwelling long-

term catheter.

Know the Care Plan and

indications for

catheterisation well and

follow the guidelines set by

your organisation.

Share information.

Collaborate with the team.

Urinary Catheterisation

There are 4 MAIN TYPES of urinary

catheters, classified by location and

attachment to urinary system:

1. URETHRAL – indwelling

2. SUPRAPUBIC - indwelling

3. INTERMITTENT – indwelling

4. URIDOME – external

Understand the difference!

URINARY INCONTINENCE URINARY RETENTION Urinary retention refers to a condition

in which urine remains within the

bladder and it is either not voided at all

(no urine is expelled during urination) or

it is expelled in small quantities, still

leaving a majority of urine remaining in

the bladder. Any condition (i.e. BPH,

urethral stricture, urethral trauma)

which prevents the normal voiding

process from occurring can lead to

urinary retention.

Urinary incontinence is defined as the

uncontrollable continuous leakage of

urine. The prevalence of UI increases

with age, and it is much more prevalent

in older women then in older men (30-

50% in older women and 9-35% in adult

men). It is however, not a normal part of

ageing

CHOOSING THE RIGHT CATHETER

SIZE

Catheters measure in Fg or French.

Anything from 5-10 is paediatric, from

12-14 is female, 14-18 is male, 14-20 is

also suprapubic catheters and finally 18-

22 is usually for residents that may have

haematuria, requiring a larger gauge to

drain the clots and blood.

CHOOSING THE RIGHT CATHETER

TYPE

Selection of catheter type is a little bit

more complex, as catheters can be

created from different materials, such as

silver oxide (which prevents the

formation of biofilm), silicone (which

can act to resist encrustation) and so on.

Normally however, catheters are only

designed in a limited number of styles,

either internal or external The most

common indwelling are:

1. One-WAY: used for intermittent

catheterisation.

2. Two-WAY (Foley): the most

common cathter you may see. Used

for both short/long term indwelling

catheterisation.

3. Three-WAY (Foley): used for

bladder irrigation (haematuria) and

for medications.

CONTINUED…

Ensure that you document every

aspect of the urinary catheterisation

procedure. This is one for the most

important roles for the RN and care

worker. It can help with:

Establishing a diagnosis

Maintains a legal record

For communication

Indications for catheterisation

Need for ongoing

catheterisation

A focused nursing assessment is also

required both before, during and

following the catheterisation procedure.

Nurses and carers have the responsibility

to ensure the catheter is working as it

should, that the patient is improving or

the desired therapeutic goal is reached,

and most importantly, to advocate for

the timely removal of the catheter when

deemed of no more use.

WHO DOES IT AFFECT

Urinary issues, especially those that are

associated with urinary retention (UR)

and incontinence (UI), can strike at any

age and gender. It is however, more

prominent in the ageing population.

Males however are at increased

risk for UR as they age due to

enlargement of the prostate.

Females on the other hand can

have increased rates of urinary

incontinence due to a reduction

in oestrogen

INDWELLING URINARY CATHETERISATION

The above figure shows the processes involved in the

catheterisation of a female resident. The nurse is

using a 2-Way Foley catheter which has a drainage

bag attached on one end, and a lure lock opening for

the inflation of the catheter balloon. Females can be

at greater risk of infection from flora moving from

the perennial area onto the catheter and also from

placing the catheter into the incorrect location.

The above figure represents the catheterisation of a

male resident. Males can be at greater risk of

urethral trauma due to the length of the urethra and

also present difficulty in those suffering from BPH.

MALE AND FEMALE DIFFERENCES

The differences in males and

females in relation to catheterisation

can be mainly related to the

anatomical differences. The main

concern is the length of the female

urethra which is much shorter than

that of the male. For example, when

applying lubricant upon a catheter

ready for insertion for a female, we

would only lubricate the first 5-7cm.

While in males, we would lubricate

as far as 15-20cm (note also that not

all catheters need lubrication, some

are hydrophilic and lubricate when

in contact with water).

CATHETER CARE AND

MAINTENANCE

Catheter care is a continuous and

sometimes complicated process.

However, it can be broken down

into two simple overarching

principles:

1. Infection Control

2. Unbroken Catheter Drainage

Maintaining a clean environment

forms the basis of all catheter

management. UTI’s are a major and

common complication of

catheterisation and we need to stay

forever vigilant to ensure their

incidence is reduced. Unbroken and

adequate catheter drainage also

ensures that the risk of infection is

minimised and that the catheter is

not causing more harm than good.

GET TO KNOW ME…

Viktor Burcevski Viktor had dual degrees in both

nursing and health science, with a

focus on population health and

ageing within Australia and has an

interest in those issues which

govern how we perform our roles

as nurses from the macro to the

individual level. Viktor also has

extensive experience in the

compilation of best practise

guidelines for nurses and carers.

References: Godfrey, H. & Evans, A. ( 2000).

Management of long-term urethral catheters: Minimizing complications. British Journal of Nursing, 9, 74-81.

Stickler, D. J. (2014). Clinical complications of urinary catheters caused by crystalline biofilms. Journal of Internal Medicine, 276, 120-129. Doi: 10.1111/joim.12220

Urological Nurses Society Inc. (2013). ANZUNS - Catheterisation Clinical Guidelines 2013.

Winder, A. (2012). Good practise in catheter care. Journal of Community Nursing, 26, 15-20.