Assessment and treatment of patients with urethral catheters

The following guidance covers all aspects of urethral catheterisation and the management of urethral catheters.

The first rule of urinary catheter care should be to avoid all unnecessary catheterisations.
The second rule of urinary catheter care should be to remove all catheters as soon as possible³.

Acute and chronic retention requires further assessment by Urologist, GP or Specialist Continence Nurse prior to commencing Intermittent Catheterisation.

Indications for catheterisation

Indications for catheterisation⁴

Verbal/implied consent on urethral catheterisation should be recorded in the patient notes.

Urethral catheterisation may be carried out for many reasons, some of which are stated below:

Drainage – surgical (pre and postoperative), acute and chronic retention.
Instillation – drugs, washout.
Investigation – bladder function tests, measure residual volume. (In absence of a bladder scanner).
To manage incontinence when all other means have been exhausted following discussion with the Continence Team.
Record accurate residual urine volume and ongoing output.

Indications specific to intermittent catheterisation

Relieve and manage acute and chronic retention of urine, which may be due to physical and neurological obstruction or Detrusor hypoactivity⁵.
Incomplete bladder emptying to reduce the incidence of urinary tract infection and preserve renal function⁶.
Estimation of residual urine as a last resort in the absence of a bladder scanner.
Management of overflow urinary incontinence as instructed by urologist.
Following specific surgical intervention e.g. Clam cystoplasty or Mitroffanoff.
Management of urethral stenosis e.g. bulbar urethral or meatal stricture.
Maintenance of continence e.g. Detrusor sphincter dyssynergia.

Contraindications for nurses undertaking catheterisation

Clarification should always be sought from medical staff prior to carrying out catheterisation. If the patient has had previous surgery or treatment to the genito-urinary tract, caution should be taken with these patients.
Lack of patient consent (verbal or implied).
Medical instruction not to undertake intermittent catheterisation.

Precautions when undertaking intermittent self catheterisation/intermittent catheterisation

Cautions should be exercised when undertaking intermittent self catheterisation / intermittent catheterisation (ISC/IC) in patients with the following conditions:

Active inflammation of the lower urinary tract
Recent radiotherapy to the lower urinary tract
Penile/vaginal pain
Penile/vaginal bleeding or discharge
Haematuria
In spinal injured patients in view of risks of autonomic dysreflexia
Congenital abnormality (hypospadias/epispadias)
Previous sexual abuse
Previous traumatic catheterisation.

Assessment (see appendix 1 and 2)

In order for the treatment to be successful a comprehensive assessment must be carried out and a plan of care devised. The assessment will include:

Diagnosis of bladder dysfunction as indicated above.
Physical ability of the patient/carer to carry out the procedure.
Psychological aspects including motivation and cognitive ability of the patient/carer.

Intermittent catheterisation will only be successful if the following criteria are met:

The bladder must be able to store at least 100mls.
The urinary sphincter must be competent.
There should be a sensation of bladder filling, or a strict regime to empty the bladder. Initial assessment of voiding diaries must be carried out to determine the frequency of catheterisation. Residual urine should be no more than 400-500mls¹. This will then determine the frequency of ISC (up to 4/5 daily)
The patient/carer must be able to understand the benefits, procedure and technique.
The patient/carer must be highly motivated.
Regular follow up must be made.