Urinary catheterisation (male)

• Urinary catheterisation should never be considered first line treatment for those people who are incontinent
• Use of urinary catheterisation should be avoided where possible
• Nurses are individually responsible to ensure they are confident and competent in the knowledge and skills of practice aligned to local guidelines, procedures and policies
• It is essential to ensure accurate documentation relating to urinary catheterisation and catheter care

Assessment of individual needs should take place before catheterisation (Box 1) and it is essential to gain the individual's valid consent for the procedure. The person must be given sufficient information to understand and provide informed consent for the procedure to take place.

Box 1. Indications for intermittent, suprapubic or urethral catheterisation

• Acute urinary retention
• Chronic urinary retention
• Monitoring renal function hourly during critical illness (for example, those who are in shock)
• Monitoring/recording/draining residual urine volumes
• During and post surgery, for a number of reasons
• Before certain investigations
• Allowing bladder irrigation (for example, after prostatectomy)
• Allowing instillation of medications (e.g. chemotherapy)
• To insert radioactive materials (e.g. into the prostate gland)
• Bypassing an obstruction (for example, stones)
• Facilitating bladder function tests (these are known as urodynamics)
• Assisting with continence and maintaining skin integrity (only used when all other treatment methods have failed)
• Obtaining a sterile urine specimen

Types of catheter

In intermittent catheterisation, the catheter is temporarily inserted into the bladder and removed once the bladder is empty (short term). With indwelling catheterisation, the catheter remains in place for many days or weeks (long term). The decision as to which type of catheter is to be used must be based on a detailed assessment of individual needs (Marjoram, 2011). 

Catheters come in a large variety of sizes, materials (latex, silicone, Teflon) and types (Foley catheter, straight catheter, Coudé tip catheter) (Table 1).

There are differences with regards to the insertion of a urethral catheter for males and females. Concerning female urethral catheterisation, there are a few small differences due to anatomical variation e.g. the female urethra is shorter than the male; and the absence of the prostate gland in women. Identifying the urethral orifice can sometimes be a challenge in the female.

Guidelines for performing male urethral catheterisation

1. Gather the equipment to be used:
   1. Sterile catheterisation pack
   2. Sterile gloves
   3. Disposable plastic apron
   4. Disposable incontinence pad (to protect bedding)
   5. Suitable antiseptic
   6. Swabs or cotton wool
   7. Sterile paper towels
   8. Antiseptic, anaesthetic lubricating gel
   9. Appropriate range of catheters
   10. Receptacle for urine or, if the catheter is to be left in situ, a urine bag with tube to connect to the catheter
   11. Universal specimen container
   12. A sterile syringe of appropriate size and water or saline to inflate the balloon at the tip of the catheter
2. Explain the

Urethral catheterisation is not without complications and one of the biggest risks is infection (NHS Inform, 2020). Adherence to strict aseptic technique during insertion, as well as when carrying out catheter care, can help to reduce the risk of infection. Some other complications are outlined in Box 2.

Box 2. Some complications associated with urethral catheterisation

• Traumatic complications, including:
• Creation of false passages
• Urethral strictures
• Urethral perforation
• Haemorrhage
• Urethral mucosal irritation, resulting in an inability to tolerate an indwelling catheter
• Penile pain on erection
• Formation of crusts around the meatus
• Dysuria
• Retention of urine
• Loss of self-esteem (National Institute for Health and Clinical Excellence (NICE), 2017).

After catheterisation has occurred, the nurse must ensure that they provide the person with a urinary catheter with evidence-based, person-centred catheter care. The person should be provided with information on how to maintain and care for the catheter and drainage system, so that they

References

Marjoram BA. Elimination. In: Hogston RMarjoram BA. Foundations of Nursing Practice: Leading the Way. 2011. 4th edn. Palgrave Macmillan, Basingstoke

McNamara C. Elimination. In: Dougherty LLister S. 2012. The Royal Marsden Hospital Manual of Clinical Nursing Procedures. Student edn: 8th edn. Wiley-Blackwell, Oxford

National Institute for Health and Clinical Excellence (NICE). Healthcare-associated infections: prevention and control in primary and community care. 2017. http://guidance.nice.org.uk/CG139 (accessed 27 April 2021)

NHS Inform. Urinary catheterisation. 2020. https://www.nhsinform.scot/tests-and-treatments/medicines-and-medical-aids/medical-aids/urinary-catheterisation#risks (accessed 27 July 2021)

Peate I, Gault C. Clinical skills series/3: urinary catheterisation. British Journal of Healthcare Assistants, vol 7 no 4. 2013. https://doi.org/10.12968/bjha.2013.7.4.169

Royal College of Nursing. Catheter Care. 2021. https://www.rcn.org.uk/Professional-Development/publications/catheter-care-guidance-for-health-care-professionals-uk-pub-009-915 (accessed 12 January 2023)