From the Guidelines
A straight catheter is indicated for urinary retention when there is a need to screen for urinary retention via bladder scan or straight catheterization, particularly in patients who are retaining urine or experiencing incontinence, as recommended by the American Heart Association/American Stroke Association in 2021 1. The primary indications for straight catheterization include:
- Acute urinary retention with bladder distension
- Need for accurate urine output measurement in critically ill patients
- To obtain a sterile urine sample for diagnostic purposes
- To relieve urinary obstruction temporarily To perform straight catheterization:
- Use aseptic technique
- Choose an appropriate size catheter (typically 14-16 Fr for adults)
- Insert the catheter into the urethra and advance until urine flow begins
- Drain the bladder completely
- Remove the catheter immediately after drainage Perform intermittent catheterization every 4-6 hours or as needed based on bladder volume, as suggested by the American Heart Association/American Stroke Association in 2021 1. Monitor for signs of urinary tract infection. Straight catheterization allows for immediate bladder emptying while reducing the risk of long-term complications associated with indwelling catheters, and is a recommended initial management for patients with urinary retention, as stated in the 2021 guidelines from the American Heart Association/American Stroke Association 1. Other indications for straight catheterization may include neurogenic bladder, emergent pelvic ultrasound, and patient status post recent surgery, as mentioned in the 2014 geriatric emergency department guidelines 1. However, the most recent and highest quality study, published in 2021, prioritizes the use of straight catheterization for screening and initial management of urinary retention 1.
From the Research
Indications for Straight Catheter
- A straight catheter is indicated for urinary retention, which is a common postoperative complication that mandates urinary catheterization 2.
- Urinary retention causing bladder damage is a well-known complication in patients during hospital care, and the most common treatment for urinary retention is an indwelling urinary catheter 3.
- Straight catheterization may be used for patients with temporary or permanent disability in emptying the bladder, which is expressed by large post-voided urine/urine retention and related complications 4.
Management of Urinary Retention
- The use of bladder ultrasonography can reduce the rate of bladder damage as well as the need to use an indwelling urinary catheter 3.
- Alternative ways of relieving urinary retention, such as the use of hot pack or lukewarm-water-soaked gauze on the suprapubic region, may be effective in reducing the need for urinary catheterization 2.
- Clean intermittent catheterization (CIC) is indicated for the treatment of temporary/permanent disability in the emptying of the bladder, and it is recommended to perform CIC at regular intervals during the day 4.
Catheter-Associated Complications
- Urinary catheterization is associated with different physical, mental, and financial problems for both patients and healthcare systems, including urinary tract infections, increased hospital stay, and expenses 2.
- Catheter-associated complications, such as urinary tract infections, urethral and/or bladder damage, can occur, although they are rare 4.
- The use of single-use catheters is preferable, and pre-shielding should be used before using catheters without external coating 4.