Procedure for male catheterisation

NHS Ayrshire & Arran guidelines
NHS Ayrshire and Arran

Prior to opening packs and commencing the procedure, it may be necessary to cleanse the genital area with soap and water. Catheterisation technique must be aseptic.

Intermittent Catheterisation when carried out by nursing staff should always be a strict aseptic technique14.

Equipment

  • Sterile dressing pack
  • Appropriate catheter and spare
  • Alcohol hand rub
  • Pre filled syringe with sterile water/glycerine sol
  • Sterile closed urinary drainage bag
  • Fixation device
  • Clinical waste bag in accordance with Clinical Waste Policy
  • Disposable pad
  • Instillagel15
  • Sterile syringe
  • PPE
  • Gloves - sterile nitrile gloves (x2 pairs) and non-sterile gloves

Procedure

  1. Explain the procedure to the patient. Reassure patient and obtain consent for procedure to be performed.
  2. a. Assist the patient to get into the supine position with the legs extended.
    b. Do not expose the patient at this stage of the procedure.

    Catheter removal
  3. Decontaminate hands as per the WHO 5 moments for hand hygiene.
  4. Put on PPE.
  5. Using a 10ml syringe deflate catheter balloon fully and remove catheter slowly. Observe for discomfort and resistance.
  6. Remove PPE and decontaminate hands as per the WHO 5 moments for hand hygiene.

    Catheter insertion
  7. Prepare equipment required on a clean working surface.
  8. Open the outer cover of the dressing pack.
  9. Using an aseptic technique, open the supplementary packs.
  10. Decontaminate hands as per the WHO 5 moments for hand hygiene.
  11. Put on PPE.
  12. Place sterile drape across the patient’s thighs.
  13. Retract foreskin and wash with saline solution or soap and water.
  14. Wrap sterile swab around the penis.
  15. Prime Instillagel. Insert Instillagel (11mls) into the urethra (Instillagel, pharmacy have drawn attention to chlorhexidine contents, be aware of risk of anaphylaxis, consult patient's GP especially on first use). Squeeze the gel into the urethra slowly over the course of one minute. Gel should be left in situ for 5 minutes16. This minimises urethral trauma and infection.
  16. Grasp the shaft of the penis, raising it until it is almost totally extended. This manoeuvre straightens the penile urethra and facilitates catheterisation. Maintain grasp of penis until the procedure is finished this prevents contamination and retraction of the penis.
  17. Insert the catheter into the urethra.
  18. When catheter reaches bladder neck ask the patient to cough, this assists by relaxing the external sphincter, and allows passage of catheter into the bladder. Also, increase the traction on the penis slightly and apply steady, gentle pressure on the catheter until it reaches the bifurcation. If this is unsuccessful, seek medical advice/ more senior nurse advice.
  19. Observe for 30-50mls of urine prior to inflating the balloon.
  20. Inflate the balloon according to the manufacturer’s direction with sterile water, and ensure the catheter is draining properly beforehand. Inadvertent inflation of the balloon in the urethra causes pain and urethral trauma. Deflate the balloon, remove immediately and seek advice.
  21. Withdraw the catheter slightly and attach it to the sterile drainage system.
  22. Ensure that the glans penis is clean and then reduce or reposition the foreskin. Retraction and constriction of the foreskin behind the glans penis (paraphimosis) may occur if this is not done.
  23. Make the patient comfortable. Ensure that the area is dry. If the area is left wet or moist, secondary infection and skin irritation may occur.
  24. Remove PPE and decontaminate hands as per the WHO 5 moments for hand hygiene.
  25. Dispose of equipment as per Waste Management Policy.
  26. Implement appropriate documentation stating, date and time and reason for catheterisation, size, type and length of catheter, balloon volume, batch number, expiry date. Record batch number, volume and expiry date of Instillagel (CAUTI bundle)
  27. Ensure patient has contact telephone number for the Named Nurse (Community)
  28. Review regularly the patient’s clinical need for continuing urinary catheterisation and remove the catheter as soon as possible if no longer required.
  29. Provide patients with written information in relation to the maintenance and action to be taken if catheter should be accidentally removed.