Catheterisation (Guidelines)

TAM (Treatments and Medicines) NHS Highland
NHS Highland

Audience

  • All NHS Highland
  • Primary & Secondary care
  • Adults only

Indications for catheterisation

  • Acute urinary retention (AUR)
  • Chronic urinary retention, only if symptomatic and/or with renal compromise
  • Monitoring renal function hourly during critical illness.
  • Monitoring /recording/draining residual urine volumes (wherever possible, a bladder scanner is the preferred option to measure residual urine volumes).
  • During and post-surgery, for a variety of reasons.
  • Allowing bladder irrigation / lavage.
  • Allowing instillation of medications, for example, chemotherapy.
  • Bypassing an obstruction / voiding difficulties.
  • Enabling bladder function tests, for example, urodynamic assessment.
  • Facilitating continence and maintain skin integrity (when all conservative treatment methods have failed).
  • Obtaining a sterile urine specimen.

Catheter insertion

Process

Catheter Selection and equipment

All catheters should be secured using a fixation device and appropriate drainage bag should be attached, which is placed below the level of the bladder.

Administration tips:

  • Adult catheter sizes range from 12ch to 20ch.
  • Size 12ch is likely to curl in the prostatic urethra in men, so should be avoided.
  • Use at least size 18ch if there is debris or mucus, to prevent blockage.
  • It may be beneficial to use a Tiemann tip catheter in men as this will be more likely to pass through the prostatic urethra without difficulty. The tip should point upwards towards the umbilicus during insertion.

Escalation

Number of attempts: 

  • There should be a maximum of 3 attempts to catheterise by 3 different people.
  • If these are unsuccessful then a dose of gentamicin should be given (unless other sensitivities available) and either the urologist on-call or surgical registrar should be contacted to consider suprapubic catheterisation.

Visible haematuria: 

  • Consider inserting a 3-way catheter and performing a bladder lavage and commencing irrigation.

If unsure how to proceed or for advice:

  • Contact on-call urology consultant: pager 1305 Mon to Fri 8am to 5pm and Saturday and Sunday 8am to 12pm.
  • Out with these times: contact the surgical registrar on-call.

Management of bypassing blocked catheter (flowchart)

Always consider suitability for patient to learn ISC, or, Does patient need catheter?

 

Mechanical
Indwelling or SP catheter blocked or bypassing
Physical causes
  • Check tubing kinked
  • Ensure correct size catheter
  • Catheter fixation device?
  • Drainage bag below level of bladder
  • Clothing (restricted)
  • Check for constipation
  • Assess for bladder spasms
  • Assess fluid intake
  • Check urology history
Treat
Treat
  • Position of catheter
  • Does catheter need to be upsized
  • Does catheter need to change to open ended
  • Lifestyle changes first
  • Bladder spasm or over active bladder - use appropriate Antimuscarinic or Mirabegron
  • Appropriate bowel management - soft form movement daily with no straining or pushing (Bristol Stool Chart)
Yes
Resolved?
Continued planned care or change
Yes
Resolved?
No
Investigate encrustation or other blockages
No

Recurrent UTI with urethral or supra pubic catheter (flowchart)

Non-symptomatic
Symptoms (by 7 days most catheters colonised by bacteria)
Symptomatic
  • Unlikely UTI
  • Monitor symptoms for 72 hours
  • Ensure adequate hydration
  • Pain
  • Shaking
  • Chills
  • Delirium
  • Rule out other causes
  • May need referred with repeat infections
  • Catheter change before end of course of treatment
Seek advice if unsure

Encrustation or debri (flowchart)

Please refer to guidance on catheter maintenance solutions (Uro-Tainer catheter maintenance solution flowchart)
Encrustation
Inspect catheter
Debri/ blood clots
  • Check urine pH (Uro-Tainer flowchart)
  • Catheter maintenance based on flowchart
  • Consider alternative catheter or upsize
  • Check other symptoms (UTI)
  • Increase fluid intake
  • Consider checking for UTI symptoms
  • If new haematuria (haematuria pathway)
  • Consider changing size or alternative catheter (open)
  • Weekly instillation sodium chloride or follow Uro-Tainer flowchart
Yes
Resolved?
Continued planned care or change
Yes
Resolved?
No
Seek advice
No

Abbreviations

  • AUR: Acute urinary retention 
  • Ch: Charrière (catheter diameter size)
  • ISC: Intermittent self-catheterisation
  • pH: Power of hydrogen
  • PPE: Personal protective equipment
  • UTI: Urinary tract infection

Editorial Information

Last reviewed: 30/04/2025

Next review date: 31/08/2029

Author(s): Urology.

Version: 1

Approved By: TAM subgroup of the ADTC

Reviewer name(s): K Laing, consultant urologist.

Document Id: TAM698

Related resources

Further information for Health Care Professionals

  • eg SIGN
  • eg NICE
  • Other reference