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Penile catheterisation occasionally shows up as an OSCE station. It’s often feared because of the relatively large number of steps and pieces of equipment involved. There’s often a significant number of marks available for communication skills. There are generally two approaches to catheterisation, the two gloved technique and the clean hand / dirty hand technique. Please use the method taught at your medical school (this guide demonstrates the clean hand / dirty hand method). Check out the penile catheterisation mark scheme here.


Introduction

Introduce yourself – state your name and role

Confirm patient details – name / DOB

Ensure a chaperone is present

 

Explain procedure:

I need to insert a catheter to allow monitoring of your urine output.

This will involve inserting a thin flexible tube into penis to reach the bladder.”

The procedure will feel a little uncomfortable but shouldn’t be painful.”

“I’ll insert some local anaesthetic into the penis to make the procedure as comfortable as possible.”

One of the nursing staff will be present and acting as a chaperone.”

 

Gain consent – “Do you understand everything I’ve said?”  “Are you happy to go ahead with the procedure?”


Gather equipment

Trolley – to place your sterile field and other equipment onto

Sterile gloves – 2 pairs

Apron

Male catheter – 12/14  french 

Water filled syringe – 10mls – for inflation of catheter balloon

Saline (0.9%) – 10mls

Catheter bag

Catheter pack:

  • Small pot – “Gallipot”
  • Cotton wool balls
  • Sterile drapes
  • Sterile gauze
  • Absorbent pad

Lidocaine gel (1%) – for insertion into urethra for anaesthesia / lubrication

Sterile receiver


Setting up

1. Clean the trolley using disinfectant wipes

2. Wash hands – with soap and water

3. Don apron

4. Set up your sterile field:

  • Remove the outer packaging from the catheter pack
  • Open catheter pack aseptically to create your sterile field
  • Empty the various pieces of equipment (catheter / sterile gloves / lidocaine) from their packaging onto the field aseptically
  • Pour the 0.9% saline over the cotton balls located within the small plastic pot
  • Clean a trolley

 

5. Position the patient:

  • Position the patient supine
  • Ensure the bed is at an appropriate height for you to comfortably carry out the procedure
  • Expose the patient’s genitalia (or ask your chaperone to do this)

6. Wash hands again and don sterile gloves

7. Place sterile absorbent pad underneath patient’s genital area

  • Expose patient's genitals

 

8. Clean the penis:

  • Hold the penis with your non-dominant hand using some sterile gauze
  • Ensure the foreskin is retracted
  • Pick up the wet cotton balls and begin to clean the penis
  • Clean in the direction away from the meatus
  • Clean the penis

9. Discard used gloves, wash hands and don a new pair of sterile gloves 

10. Place sterile drape over the patient’s penis and place sterile receiver below the penis

11. Insert the anaesthetic gel:

  • Check the expiry date and ensure the gel is the correct medication
  • Warn the patient that the anaesthetic might initially sting, but will go numb quickly
  • Hold the penis vertically with your non-dominant hand using sterile gauze
  • With your dominant hand place the nozzle of the syringe of anesthetic gel into the penile meatus
  • Empty the entire 10mls of anaesthetic gel into the urethra – at a slow steady pace
  • Continue to hold to penis in the vertical position to ensure the gel remains within the urethra
  • Give the gel 3-5 minutes to take full effect
  • Discard gloves & wash hands

Inserting the catheter

The catheter should be on your sterile field in a plastic wrapper.

1. Remove the tear-away portion of the wrapper near the catheter tipdon’t touch the catheter!

2. Hold the penis again using gauze with your dirty hand

3. Insert the exposed catheter tip into the urethral meatus using your clean hand – warn patient 

4. Advance the catheter slowly but firmly – slowly removing the wrapper to expose more catheter

The key to removing the wrapper without also pulling the catheter back out is to ensure a good grip on the penis as you pull back on the wrapper.

5. As you pass the prostate you may notice some resistance and the patient may feel more discomfort

If the resistance is significant and the patient is in a lot of discomfort, you should remove the catheter and consider a repeat attempt or input from urology.

6. As you enter the bladder you will see urine begin to drain from the catheter

7. You should continue to advance the catheter until it is fully inserted

8. Once fully inserted, inflate the catheter balloon with your 10ml syringe of water

  • Ask the patient to let you know immediately if they feel any discomfort during this

9. Once the balloon is fully inflated, withdraw the catheter until resistance is felt

  • This confirms the catheter is held firmly within the bladder

10. Attach the catheter bag tubing to the end of the catheter, ensuring a tight seal

11. Place the catheter below the level of the patient

12. Replace the patient’s retracted foreskinfailure to do so can result in paraphimosis

13. Clean up the patient and dispose of your equipment

14. Allow the patient to get dressed

  • Open catheter wrapper

To complete the procedure…

Thank patient

Wash hands

Ask nursing staff to monitor urine output.

 

Document the procedure, making sure to include:

  • Your details – name / grade / GMC number
  • Date / time
  • Consent gained
  • Chaperone present
  • Reason for catheterisation
  • Volume of water inserted into balloon e.g. 10mls
  • Size of catheter
  • Use of local anaesthetic
  • Any complications during the procedure
  • Residual volume of urine drained
  • Appearance of urinegolden / haematuria 

REVIEWED BY

Graham Bone Senior Clinical Lecturer in Medical Education