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  • • Diagnostic evaluation.

    • Temporary relief of urinary retention.

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Absolute

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  • • Suspected urethral injury (eg, blood at meatus, laceration).

    • Unable to identify urethra (eg, labial adhesion).

    • Neutropenia.

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• All equipment should be latex free. Allergy to latex is common, particularly in certain populations (such as patients with meningomyelocele.)
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  • • Catheter.

    • • Feeding tube (4–5F).

      • Urinary catheters (6F and up).

    • 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

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• 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.
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  • • Urethral trauma.

    • • Hematuria.

      • Pain (common).

    • Psychological stress (common, as child is restrained for procedure).

    • Catheter mishaps (eg, knot forms in bladder) (very rare).

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  • • 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.

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  • • Keep the patient covered until ready to begin.

    • Good lighting is helpful.

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  • • The child is placed supine.

    • The female patient is placed in the frog-leg position.

    • The male patient is placed with legs extended.

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  • • 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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  • • A common problem with catheterization of young females results from confusion and erroneous passage of the catheter into the vagina (Figure 31–2).

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  • • In boys, the urethra begins at the meatus and passes down through the penile shaft and into the urinary bladder after passing through the prostate gland (Figure 31–3).

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