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Table of Contents
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This male catheterisation guide provides a step-by-step approach to performing catheterisation in an OSCE setting, with an included video demonstration.
1. Clean the top of a procedure trolley using a disinfectant wipe.
2. Collect the equipment required for the procedure and place it within reach on the clean trolley:
- Plastic apron
- Two pairs of sterile gloves
- Sterile water-filled syringe (10ml) for inflation of the catheter balloon.
- 0.9% sodium chloride (10mls)
- Lidocaine (1%) anaesthetic lubricating gel for insertion into the urethra.
- Male urinary catheter (12/14 french)
- Catheter pack: including cotton wool balls, sterile gauze, sterile drapes, absorbent pad and gallipot (a.k.a. a small pot).
- Catheter bag
- Urine collection bowl (a.k.a. a receiver)
3. Check the expiry date on the catheter, sterile water, normal saline and lidocaine gel.
4. Ensure a clinical waste bin is placed nearby.
Wash your hands using alcohol gel. If your hands are visibly soiled, wash them with soap and water.
Don PPE if appropriate.
Introduce yourself to the patient including your name and role.
Confirm the patient’s name and date of birth.
Briefly explain what the procedure will involve using patient-friendly language: “Today I need to insert a catheter. This will involve inserting a thin flexible tube into the 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.”
Explain the need for a chaperone: “One of the other staff members will be present throughout the procedure, acting as a chaperone, would that be ok?”
Gain consent to proceed with catheterisation.
Check if the patient has any allergies (e.g. latex).
Ask the patient if they have any pain before continuing with the clinical procedure.
Explain to the patient that they’ll need to remove their underwear and lie on the clinical examination couch, covering themselves with the sheet provided. Provide the patient with privacy to undress and check it is ok to re-enter the room before doing so.
Setting up the sterile field
1. Set up the sterile field by first removing the outer packaging from the catheter pack and then opening the catheter pack from the corners without touching the inner surface of the field. Make sure to keep the catheter packaging, as you’ll need to transfer the sticky label containing the details of the catheter into the patient’s notes.
2. Using aseptic non-touch technique (ANTT) place the catheter, lidocaine gel syringe, sterile water syringe and sterile gloves onto the field.
3. Pour the 0.9% sodium chloride solution over the cotton balls which should already be located within the gallipot of the catheter pack.
Positioning the patient
1. With the patient lying supine, ensure the bed is at an appropriate height for you to comfortably carry out the procedure.
2. Wash your hands again and don a pair of sterile gloves.
3. Ask your chaperone to remove the sheet covering the patient’s genitals to allow you to maintain sterility.
4. Place a sterile absorbent pad underneath the patient’s genital region, ensuring you maintain sterility.
Cleaning the penis
1. Hold the penis with your non-dominant hand using some sterile gauze and ensure the patient’s foreskin is retracted (if present).
2. With your dominant hand, pick up a cotton ball and use a single stroke moving away from the urethral meatus to clean an area of the glans. Dispose of the first cotton ball into the clinical waste bin and continue to repeat this process with a new cotton ball each time until all areas of the glans have been cleaned.
3. Discard your used gloves, wash your hands again and don a new pair of sterile gloves.
4. Place the sterile drape over the patient’s penis, positioned such that the penis remains visible through the central aperture of the drape. Some drapes come with a hole already present for this purpose, whereas others will require you to create one.
5. Place the sterile urine collection bowl below the penis but on top of the sterile drape.
Inserting the local anaesthetic
1. Hold the penis vertically with your non-dominant hand using a piece of sterile gauze.
2. Warn the patient that the anaesthetic gel might initially sting, but then should quickly cause things to become numb.
3. With your dominant hand place the nozzle of the syringe of anaesthetic gel into the urethral meatus.
4. Empty the entire 10mls of anaesthetic gel into the urethra at a slow but steady pace.
5. Continue to hold to the penis in the vertical position to ensure the gel remains within the urethra and allow 3 to 5 minutes for the lidocaine gel to reach its maximum effect.
Inserting the catheter
1. Pick up the catheter which should be on your sterile field in its wrapper.
2. Remove the tear-away portion of the wrapper near the catheter tip, making sure not to touch the catheter.
3. Hold the penis again using sterile gauze with your non-dominant ‘dirty hand’.
4. Warn the patient you are about to insert the catheter.
5. Insert the exposed catheter tip into the urethral meatus using your dominant ‘clean hand’.
6. Advance the catheter slowly whilst gradually removing more of the wrapper to expose more of the catheter. The key to removing the wrapper without also pulling the catheter back out is to ensure you have a good grip on the penis as you gently pull back on the wrapper. As you pass the prostate you may note some resistance and the patient may experience some discomfort. If the resistance is significant and the patient appears very uncomfortable you should remove the catheter and consider a repeat attempt or specialist input from urology.
7. You should continue to advance the catheter until it is fully inserted into the penis. As you enter the bladder urine should begin to drain from the catheter.
8. Once the catheter is fully inserted, inflate the catheter balloon with the 10ml syringe of sterile water to secure it within the bladder. Before doing this, ask the patient to let you know immediately if they experience any discomfort as you inject the water. If the patient begins to experience discomfort during the injection of the water stop immediately as this may indicate the tip of the catheter is within the urethra.
9. Once the balloon is fully inflated, remove the syringe and gently withdraw the catheter until resistance is noted, confirming the catheter is held securely within the bladder.
Attaching the catheter bag
10. Attach the catheter bag tubing to the end of the catheter securely.
11. Position the catheter bag below the level of the patient to facilitate effective drainage of urine.
12. Replace the patient’s retracted foreskin (if present) as failure to do so can result in the development of paraphimosis.
13. Clean away any urine spillage or excess lubricating gel and cover the patient with the sheet.
14. Dispose of your equipment into a clinical waste bin.
15. Provide the patient with privacy to get dressed.
To complete the procedure…
Explain to the patient that the procedure is now complete and that they should seek review if the catheter becomes painful or if they begin to feel unwell.
Dispose of PPE appropriately and wash your hands.
Ask the nursing staff to monitor the patient’s urine output and to contact you if they have any concerns.
Document the details of the procedure in the patient’s notes:
- Your personal details including your name, job role and GMC number.
- The date and time the procedure was performed.
- Confirmation that verbal consent was obtained.
- The details of the chaperone who was present including their name and job role.
- The indication for catheterisation.
- The volume of water injected into the catheter balloon (e.g. 10mls).
- The size of the catheter inserted (e.g. 14 french)
- The type and volume of local anaesthetic used.
- Any complications experienced during the procedure.
- The residual volume of urine drained.
- The appearance of the urine drained (e.g. straw-coloured, blood-stained).
Affix the sticky label from the catheter packaging beside your notes.
Senior Clinical Lecturer in Medical Education