What are the considerations and care instructions for using a size 24 French (F) urinary catheter?

Size 24 French Urinary Catheter: Clinical Considerations and Care

Indications and Patient Population

A 24 French (F) urinary catheter is a large-bore catheter primarily indicated for specific clinical scenarios requiring high-volume drainage or management of significant hematuria with clot evacuation. 1

Appropriate Clinical Uses:

• Gross hematuria with clot retention requiring continuous bladder irrigation and clot evacuation 2, 3
• Post-urological surgery (e.g., transurethral resection of the prostate) where significant bleeding is anticipated 1
• Traumatic urinary tract interventions requiring large-bore drainage 1

Size Selection Context:

• Pediatric guidelines recommend urinary catheters ranging from 6F–22F for children 1
• A 24F catheter falls into the adult chest tube size range (16F–24F for children, 28F–40F for adults), indicating this is a large-bore device 1
• Standard adult urinary catheterization typically uses smaller sizes (14F–18F) for routine bladder drainage 2, 4

Catheter Material Selection

Use polytetrafluoroethylene (Teflon) or polyurethane catheters rather than polyvinyl chloride or polyethylene, as these materials are associated with fewer infectious complications. 5

• Silicone catheters may be preferred for long-term use due to reduced encrustation risk 1, 6
• Material choice impacts patient comfort and complication rates during the catheter's dwell time 4, 6

Insertion Technique and Positioning

Pre-Insertion Considerations:

• Minimize catheterization duration to the shortest medically necessary period 1
• Assess for contraindications including urethral trauma, stricture, or recent urethral surgery 3
• Use appropriate local anesthetic/antiseptic gel to minimize insertion pain 6

Insertion Protocol:

• Employ strict aseptic technique during insertion 1, 7
• In males, ensure the penis is positioned perpendicular to the body during insertion to straighten the urethra 2
• Avoid excessive force during insertion; resistance may indicate urethral obstruction requiring urological consultation 3

Post-Insertion Verification:

• Confirm proper balloon inflation (typically 10-30 mL for adult catheters) 2, 4
• Ensure urine return before securing the catheter 3
• Position drainage bag below bladder level to prevent reflux 1, 7

Infection Prevention and Catheter Maintenance

The duration of catheterization is the single most important risk factor for catheter-associated urinary tract infection (CAUTI); evaluate daily for removal. 1, 7

Daily Management Protocol:

• Evaluate catheter necessity daily and remove as soon as clinically appropriate 1
• Replace or remove the catheter before initiating antimicrobial therapy for symptomatic CAUTI 1
• Maintain a closed drainage system at all times 1, 7

Specific Care Instructions:

• Do not apply topical antiseptics or antimicrobials to the catheter, urethra, or meatus 1
• Do not use prophylactic antimicrobials to prevent CAUTI 1
• Use sterile 0.9% sodium chloride to flush catheters in frequent use 1
• Perform hand hygiene before and after catheter manipulation 1, 7

Monitoring for Complications:

• Inspect the insertion site for signs of urethral trauma, bleeding, or discharge 6
• Monitor for catheter-related pain, which may indicate bladder spasm, blockage, or encrustation 6
• Assess for signs of systemic infection (fever, altered mental status, hypotension) 1

Management of Catheter Obstruction

If catheter obstruction occurs, attempt clearance using a 10 mL or larger syringe to avoid excessive pressure that may damage the catheter. 1

Obstruction Management:

• For clot obstruction: Manual irrigation with sterile saline using gentle pressure 1
• For suspected thrombosis: Consider urokinase administration per established protocols (5,000 U/mL) 1
• Replace the catheter if obstruction cannot be cleared or if infection is suspected 1

Special Considerations for Large-Bore Catheters

Urethral Trauma Risk:

• Large Charrière size catheters (24F) create increased pressure on the urethra, potentially causing discomfort and tissue damage 6
• Secure the catheter to prevent drainage bag traction, which can cause meatal trauma in men and urethral discomfort in women 6
• Monitor for paraphimosis in uncircumcised males after catheter insertion 6

Duration Limitations:

• For non-cuffed catheters: Use only in hospitalized patients for less than 1 week 1, 5
• For cuffed/tunneled catheters: May be used longer term but require ongoing assessment 1, 5
• Femoral catheters should remain in place for no more than 5 days and only in bed-bound patients 1

Common Pitfalls to Avoid

• Never use routine antimicrobial prophylaxis for catheter insertion or maintenance 1
• Avoid treating asymptomatic bacteriuria in catheterized patients (exception: before traumatic urinary procedures) 1
• Do not combine leftover contents of single-use vials for catheter care 1
• Never leave femoral catheters in ambulatory patients due to high infection and dislodgment rates 1