What are the indications, supplies, and proper techniques for inserting an indwelling urinary catheter, as well as its contraindications and possible complications?

Indwelling Urinary Catheter: Indications, Supplies, Technique, and Complications

Indwelling urinary catheters should only be used when absolutely necessary, as they significantly increase the risk of urinary tract infections and other complications. 1

Indications for Insertion

Indwelling urinary catheters should be inserted only for specific, well-documented indications:

• Urinary retention/obstruction that cannot be managed by other means 1
• Need for accurate measurement of urinary output in critically ill patients who require very close monitoring 1
• Open wounds in sacral or perineal area with urinary incontinence to prevent wound contamination 1
• Patient too ill, fatigued, or incapacitated to use alternative urine collection methods 1
• Perioperative use for specific surgical procedures (e.g., urologic surgeries) 1
• Management of urinary incontinence only when all other approaches have failed and at patient's request 1, 2
• Neurogenic bladder when intermittent catheterization is not feasible 1
• Hospice or palliative care settings for comfort 1

Supplies Needed for Insertion

• Sterile catheterization kit containing:
  • Appropriate size catheter (typically 14-16 Fr for adults) 3
  • Sterile gloves 3
  • Sterile drapes 3
  • Antiseptic solution (e.g., chlorhexidine) 3
  • Sterile cotton balls or swabs 3
  • Sterile lubricant 3
  • Pre-filled syringe with sterile water (for balloon inflation) 3
  • Sterile collection container for urine specimen if needed 3
  • Closed drainage system with collection bag 1
  • Securing device to prevent catheter movement 3

Proper Technique for Insertion

1. Preparation:

   • Perform thorough hand hygiene 1
   • Position patient appropriately (supine with legs spread and feet together for females; supine for males) 3
   • Open sterile kit using aseptic technique 3
   • Don sterile gloves 3

2. Cleansing:

   • For females: Separate labia with non-dominant hand; use dominant hand to cleanse from front to back (urethra to anus) with antiseptic solution 3, 4
   • For males: Hold penis with non-dominant hand; retract foreskin if uncircumcised; cleanse glans penis in circular motion from urethral meatus outward 3, 4

3. Insertion:

   • Apply sterile lubricant to catheter tip 3
   • For females: Insert catheter 5-7.5 cm until urine flows 3
   • For males: Hold penis perpendicular to body and insert catheter 17-22.5 cm until urine flows 3

4. Securing the catheter:

   • Inflate balloon with recommended amount of sterile water (typically 5-10 mL) only after confirming proper placement by urine return 1, 3
   • Connect catheter to closed drainage system 1
   • Secure catheter to patient's leg (for urethral catheters) to prevent movement and urethral trauma 1, 3
   • Position drainage bag below bladder level but not touching the floor 1

Contraindications and Complications

Contraindications:

• Urethral trauma or suspected urethral injury 2
• Acute prostatitis 2
• When intermittent catheterization is feasible (preferred over indwelling catheter) 1
• Presence of urethral stricture 2

Complications:

1. Infectious complications:

   • Catheter-associated urinary tract infection (CAUTI) - risk increases approximately 5% per day 1
   • Bacteremia and sepsis 1
   • Increased risk of antimicrobial resistance 5

2. Mechanical complications:

   • Urethral trauma and bleeding 1
   • Urethral stricture and erosion with long-term use 1, 5
   • Bladder spasms 6
   • Catheter blockage due to encrustation 6, 5
   • Bladder stones 1
   • Urinary leakage around catheter 6

3. Other complications:

   • Patient discomfort and reduced quality of life 1, 6
   • Restricted mobility 6
   • Psychological dependence 6

Best Practices to Reduce Complications

• Use intermittent catheterization whenever possible instead of indwelling catheters 1
• Consider suprapubic catheterization over urethral catheterization for long-term use 1
• Use external condom catheters for appropriate male patients 1
• Maintain a closed drainage system to reduce infection risk 1
• Remove catheters as soon as no longer needed 1
• Ensure proper catheter care including perineal hygiene 1
• Avoid routine catheter changes but change when clinically indicated 4
• Ensure adequate hydration to maintain good urine flow 1

Remember that the most effective way to prevent catheter-associated complications is to avoid unnecessary catheterization and to remove catheters as soon as they are no longer needed 1.