What is the procedure for performing a straight catheterization (straight cath) on a patient with urinary retention who hasn't voided in 8 hours?

How to Write Orders for Straight Catheterization in a Patient Who Hasn't Voided in 8 Hours

For a patient with 8 hours of no voiding, perform bladder scanning first to confirm urinary retention (post-void residual >100 mL), then order straight catheterization using aseptic technique to decompress the bladder and measure residual volume. 1, 2

Initial Assessment and Documentation

Confirm urinary retention before catheterization:

• Order bladder ultrasound scanning to quantify residual volume 2, 3
• If bladder scan shows >100 mL residual volume after attempted void (or >100 mL without recent void attempt), this confirms retention requiring intervention 1
• Document the clinical indication: "Patient has not voided in 8 hours with bladder scan showing [X] mL residual volume" 2

Key risk factors to document:

• Male sex, pre-existing prostatism, recent surgery, medications (anticholinergics, opioids, alpha-agonists), neurological conditions, or constipation 1, 4, 5

Ordering the Straight Catheterization

Write the order as follows:

• "Straight catheterization (in-and-out catheterization) using aseptic technique" 1, 4
• "Measure and document volume obtained" 1, 2
• "If volume >400-500 mL, consider leaving indwelling catheter temporarily rather than complete rapid decompression" 4

Catheter specifications:

• Use standard sterile technique with appropriate size catheter (typically 14-16 Fr for adults) 4
• Consider silver alloy-coated catheters if indwelling catheter becomes necessary, as they reduce UTI risk 2, 4

Post-Catheterization Management Algorithm

If residual volume is >100 mL on three consecutive checks:

• Initiate scheduled intermittent catheterization every 4-6 hours 1
• This is preferred over indwelling catheterization to minimize infection risk 1, 6

If an indwelling catheter must be placed:

• Remove within 24-72 hours maximum to reduce UTI risk 1, 6
• For post-surgical patients, aim for removal on postoperative day 1 if possible 1
• Order daily assessment for catheter removal readiness 1

Before catheter removal, consider:

• Starting an alpha-blocker (tamsulosin 0.4 mg or alfuzosin 10 mg daily) in men with suspected BPH, as this improves successful voiding trial rates from 29-39% (placebo) to 47-60% (treatment) 2, 3, 6

Monitoring Orders

Post-catheterization surveillance:

• Order bladder scan 30 minutes after next spontaneous void to check post-void residual 1
• If PVR <100 mL on three consecutive checks, monitoring can be discontinued 1
• If PVR remains >100 mL, continue scheduled intermittent catheterization every 4-6 hours 1

Additional orders to address underlying causes:

• Bowel regimen if constipation suspected (bisacodyl suppository or oral magnesium hydroxide) 1
• Review and discontinue/reduce anticholinergic medications, opioids, or alpha-agonists if possible 4, 5
• Urology consultation if urethral stricture suspected or if retention persists beyond 48-72 hours 1

Critical Safety Considerations

Before attempting catheterization, check for contraindications:

• If blood at urethral meatus (especially after trauma), order retrograde urethrography BEFORE catheterization attempt to rule out urethral injury 2, 3
• Blind catheter passage with suspected urethral injury can worsen the injury; suprapubic catheter may be needed instead 2

Avoid these common pitfalls:

• Do not leave indwelling catheters longer than necessary—each day increases UTI risk exponentially 1, 6
• Do not assume successful voiding after catheter removal means no recurrence risk; patients remain at increased risk and need counseling 2, 3, 6
• Do not perform rapid complete decompression if volume >1000 mL; consider staged decompression to avoid hematuria and hypotension 4