Chapter 25

1. Indications

1. To collect a urine specimen when a clean-catch specimen cannot be obtained or is unsatisfactory or suprapubic aspiration cannot be performed.

1. To monitor urinary output, relieve urinary retention, or to instill contrast to obtain a cystogram or voiding cystourethrogram.

1. To determine a bladder residual.

2. Equipment. Sterile gloves, cotton balls, povidone-iodine solution, sterile drapes, lubricant, a sterile collection bottle (often packaged together as a commercial set), urethral catheters (3.5, 5.0, 6.5, and 8F urinary catheters). A 5F feeding tube and a 3.5 or 5F umbilical catheter may be used as an alternative to a urethral catheter. General guidelines are: 3.5F, infants <1000 g; 5F, infants weighing 1000–1800 g; 8F, infants weighing >1800 g). Try to use the smallest catheter possible to avoid trauma.

3. Procedure

Bladder catheterization is an acceptable alternative to suprapubic aspiration but is not the method of first choice.

1. Males

1. Place the infant supine, with the thighs abducted (frog-leg position).

1. Cleanse the penis with povidone-iodine solution, starting with the meatus and moving in a proximal direction.

1. Put on sterile gloves, and drape the area with sterile towels.

1. Place the tip of the catheter in sterile lubricant.

1. Hold the penis approximately perpendicular to the body to straighten the penile urethra and help prevent false passage. Advance the catheter until urine appears. A slight resistance may be felt as the catheter passes the external sphincter, and steady, gentle pressure is usually needed to advance past this area. Never force the catheter (Figure 25–1).

1. Collect the urine specimen. If the catheter is to remain in place, some physicians believe it should be taped to the lower abdomen rather than to the leg in males to help decrease stricture formation caused by pressure on the posterior urethra.

1. Females

1. Place the infant supine, with the thighs abducted (frog-leg position).

1. Separate the labia, and cleanse the area around the meatus with povidone-iodine solution. Use anterior-to-posterior strokes to prevent fecal contamination.

1. Put on sterile gloves, and drape sterile towels around the labia.

1. Spread the labia with two fingers. See Figure 25–2 for landmarks used in the catheterization of the bladder in females. Lubricate the catheter, and advance it in the urethra until urine appears. Tape the catheter to the leg if it is to remain in position.

4. Complications

1. Infection. The risk of introducing bacteria into the urinary tact and then the bloodstream is common. Sterile technique is necessary to help prevent infection. "In-and-out" catheterization carries a small (<5%) risk of urinary tract infection. The longer a catheter is left in place, the greater is the infection risk. Infections that can occur include sepsis, cystitis, pyelonephritis, urethritis, and epididymitis.

1. Trauma to the urethra ("false passage") or the bladder. Urethral tear, erosion, stricture, meatal stenosis or perforation, or bladder injury (perforation) is more common in males. Minimize by adequately lubricating the catheter and stretching the penis to straighten the urethra. Never force the catheter if resistance is felt. Use the smallest catheter possible and advance only until urine is obtained.

1. Hematuria. Hematuria is usually transient but may require irrigation with normal saline solution. Gross hematuria on insertion may indicate a false passage.

1. Urethral stricture. Stricture is more common in males. It is usually caused by a catheter that is ...

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