• Suspected urethral injury (eg, blood at meatus,
• Unable to identify urethra (eg, labial adhesion).
|• All equipment
should be latex free. Allergy to latex is common, particularly in
certain populations (such as patients with meningomyelocele.)|
• Sterile collection cup.
• 10% povidone-iodine (or equivalent).
• Castile soap.
• Sterile gloves, drapes, and gauze.
• Lidocaine (2%) anesthetic jelly or water-based lubricant.
• Catheter sizing estimates:
• Infant: 5F feeding tube or 6F catheter
• Toddler: 6–8F catheter
• Older child: 8F catheter
• Adolescent: 8–10F catheters
|• Always choose the smallest catheter that
will work; a catheter that is too small might kink and one that is
too large will cause unnecessary pain.|
• Urethral trauma.
• Pain (common).
• Psychological stress (common, as child is restrained for procedure).
• Catheter mishaps (eg, knot forms in bladder) (very rare).
• Because spontaneous voiding may occur during
skin preparation or as the procedure is initiated, have a sterile container
available to collect the urine.
• When labial adhesions are present, holding the child in a frog-leg
position and rocking the hips back and forth may line up the opening
in the adhered labia with the urethral opening.
• Cotton gauze pads are useful to hold the penis or to apply traction
to the labia once the skin has been prepared and is slippery.
• Remember that many of the newer, non-latex gloves fit poorly,
making holding a slippery skin surface nearly impossible; wear tightly
fitting non-latex gloves when possible.
• Although 1 study showed that pain was reduced by applying lidocaine
topically and injecting anesthetic
into the urethra, this does not represent typical use of lidocaine jelly
in clinical practice.
• The child is placed supine.
• The female patient is placed in the frog-leg position.
• The male patient is placed with legs extended.
• Catheterization requires the passage of a tube
through the urethra into the urinary bladder.
• In girls, the urethra is a short tube that opens just rostral
to the vaginal introitus and is often obscured in younger girls
by vaginal tissue (Figure 31–1).
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