Urinary bladder catheterization in children can serve as both a diagnostic and a therapeutic intervention. Catheterization is a simple, sterile procedure that can be performed at the bedside in most circumstances. Ease of performing procedure, ability of nursing to catheterize, and decreased pain are some reasons catheterization has largely replaced suprapubic aspiration as the primary method of urine collection in young children.1 Children usually tolerate the procedure well when it is done carefully, requiring only a topical anesthetic, if any.2,3
The most common indication for urinary bladder catheterization is collection of urine for analysis and culture. A catheter specimen is recommended to rule out urinary tract infection in those children who are not yet toilet trained or who are unable to cooperate with a midstream clean-catch specimen. Catheterization is also indicated to relieve urinary retention or obstruction. This may be due to anatomic abnormalities such as posterior urethral valves or prolapsing ureterocele, inflammation of the urethra, or mechanical obstruction related to blood clots or debris in the bladder. Neurogenic bladder may also cause retention requiring catheterization. In critically ill patients, urinary catheterization is used to monitor urine output and assess fluid status.
Few contraindications exist for urinary catheterization. A general practitioner should not catheterize patients with known urethral trauma or acute pelvic fracture. Careful consideration should be given to catheterization in patients with recent genitourinary surgery or known genital abnormality such as hypospadias. Consultation with a urologist is recommended before placing a catheter in any of these patients.
A catheter is placed into the bladder via the urethral meatus. In males, the meatus is located in the center of the glans of the penis. If the patient is uncircumcised, the foreskin may need to be gently retracted to expose the urethra. In females, the urethra is located between the clitoris and the vaginal introitus. The labia majora and minora obscure the urethra in most patients and will need to be spread in order to visualize the meatus (Figure 189-1).
Transurethral bladder catheterization; anatomy and position in the female. (Reproduced with permission from Dieckmann RA, Fiser DH, Selbst SM, eds. Illustrated Textbook of Pediatric Emergency and Critical Care Procedures. St Louis: Mosby; 1997:415. Copyright © Elsevier.)
Catheters come in many shapes and sizes; common sizes are listed in Table 189-1. The two most common catheters used in children are a straight catheter and a self-retaining Foley catheter. A straight catheter is used for one-time or intermittent catheterization. If long-term catheterization is anticipated, a Foley catheter is appropriate. Choose the smallest lumen possible to pass the catheter easily and accomplish the goals of catheterization. ...