Urinary catheterization – male

Equipment
Method
Potential problems

• Urinary catheters – male or female length, sizes 12–16
• Catheter dressing pack
• Sterile gloves
• Lidocaine gel
• 10 ml saline in a syringe
• Urometer or urine collection bag
• Saline for cleaning
• Kidney bowl

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• Tell the patient what you are about to do.
• Open all of the necessary equipment on your cart.
• Place a clean drape around the patient's penis.
• Retract the foreskin and clean the glans thoroughly with saline.
• Coat the end of the catheter with lidocaine gel. Insert the nozzle of the lidocaine gel gently into the preputial orifice and squeeze.
• Give the gel time to work (a few minutes).
• Place the kidney bowl on the bed between the patient's legs.
• Gently insert the catheter tip and advance. You might need to twist the catheter gently from side to side. Drape the other end of the catheter into the kidney bowl to catch any urine spillage.
• Push the catheter all the way in, even if urine starts to flow before it is fully inserted.
• Inflate the retaining balloon with 10 ml of saline.
• Attach a urine collection bag or urometer.

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Urine doesn't flow: either the bladder is empty or you are in a false passage. You can try a 50 ml flush of saline using a bladder syringe. If this can be introduced and withdrawn, you are probably in the bladder

Catheter won't pass: try a bigger catheter. This sounds paradoxical, but a bigger catheter is stiffer and thus might negotiate a stricture or enlarged prostate. Make sure that the lidocaine gel has had long enough to work. If passing the catheter is painful, the perineal muscles will go into spasm, making passage of the catheter much more difficult.

Blood in the urine: a small amount of blood in the urine or around the penile orifice indicates trauma inserting the catheter. If clots or dark blood are present in the urine, consider a three-way catheter to allow for irrigation.

If you are still having problems, talk to a urologist. A suprapubic catheter is sometimes required, but urologists have a number of other tricks that are useful for passing catheters.

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