Urinary catheterisation

Indwelling urethral urinary catheterisation is a common clinical intervention undertaken by a competent health professional to relieve the symptoms of bladder dysfunction (Royal College of Nursing, 2021). It is an invasive aseptic procedure and should not be undertaken without full considerations of the benefits and risks associated with the insertion (Martin et al, 2020).

The catheter is a thin hollow flexible tube that can be inserted into the urethra and has a retaining balloon to keep it in place (Geng et al, 2024). The catheter can be inserted for either a short- or long-term period, depending on the indication for use. Geng et al (2024) defined short term as a duration less than 14 days in situ and long term as over 14 days. However, most manufacturers recommend that their short-term catheters can be used for 28 days and long-term catheters for up to 12 weeks. Healthcare professionals should check

The insertion of an indwelling catheter can be a traumatic event for individuals and have significant implications for body image, mobility, pain and comfort (Martin et al, 2020). Therefore, an assessment should take into account the necessity of the catheter by considering its clinical requirement.

The indications for indwelling urethral catheterisation are:

• acute or chronic retention
• voiding difficulties (eg neurological disorders, enlarged prostate in men)
• monitoring renal function during critical illness
• selected surgical procedures, such as urological surgery (eg transurethral resection of prostate)
• facilitating continence and maintenance of skin integrity (eg in open sacral wounds)
• intractable incontinence when conservative treatment methods have failed
• prolonged immobilisation (eg multiple traumatic injuries, such as pelvic fractures)
• improving comfort for end-of-life care
• instillation of medications
• bladder function tests (eg urodynamics) (Yates, 2019; Royal College of Nursing, 2021; Geng et al, 2024)

As with all procedures, informed consent must be obtained from the patient and

• personal protective equipment
• appropriate indwelling catheter
• sterile catheterisation pack (containing gallipots, receiver, low-linting swabs, disposable towels)
• cleansing fluid (usually sterile 0.9% sodium chloride)
• sterile gloves (two pairs)
• sterile lubricating gel or anaesthetic gel lubricant containing 2% lidocaine hydrochloride (prescribed)
• pre-filled 10 ml syringe with sterile water or syringe and sterile water
• appropriate drainage system, valve, securing and fixing devices and stand
• universal container if specimen is required

Check all expiry dates of equipment.

Table 1 outlines the step-by-step procedure for inserting a urinary catheter for a male patient.

There are several risks and complications associated with urinary indwelling catheters, including:

Catheter associate urinary tract infection (CAUTI) – this can be minimised by:

• avoiding unnecessary catheter insertion
• removing the catheter as soon as possible
• using a closed drainage system
• adhering to hand washing and infection control policies
• using small lumen catheters
• assessing the need for a catheter daily (Geng et al, 2024)

Interventions that include ‘prompting/requiring the removal of the catheter based on time or clinical criteria for removal’ is known as a stop order (Geng et al, 2024). These stop orders can assist in the prevention of inappropriate insertion of urinary indwelling catheters or their removal when used (Geng et al, 2024).

Catheter blockage – this can be either mechanical or intraluminal. Mechanical blockage can occur as a result of:

• constipation
• blocked tubing from sitting or kinked drainage tubing

Intraluminal blockage is usually from encrustation. This

Healthcare professionals can use the information in this article to improve their catheter insertion procedure skills. They must understand the clinical indicators for the catheter and recognise the risks and complications associated with its insertion and continued use. Healthcare professionals must ensure that their skill and practice with regards to urinary catheterisation is based on up-to-date evidence. With this knowledge, they can influence better practice and education for future professionals.

Nursing and Midwifery Council: standards of proficiency for registered nurses

Part 2: Procedures for the planning, provision and management of person-centred nursing care

6. Use evidence-based, best practice approaches for meeting needs for care and support with bladder and bowel health, accurately assessing the person’s capacity for independence and self-care and initiating appropriate interventions

6.2 Select and use appropriate continence products; insert, manage and remove catheters for all genders; and assist with self-catheterisation when required

9.6 use evidence-based hand hygiene techniques

Geng V, Lurvink H, Pearce I, Lauridsen SV. Evidence-based guidelines for best practice in urological health care: indwelling catheterisation in adults. 2024. https://nurses.uroweb.org/wp-content/uploads/EAUN-Guideline-indwelling-catheterisation-2024.pdf (accessed 6 June 2024)

Martin R, Allen G, Hardy K et al. Elimination. In: Lister S, Hofland J, Grafton H (eds). The Royal Marsden manual of clinical nursing procedures. 10th edn. Chichester: Wiley-Blackwell; 2020

National Patient Safety Agency. Rapid response report. 2009. https://www.cas.mhra.gov.uk/ViewandAcknowledgment/ViewAttachment.aspx?Attachment_id=100861 (accessed 6 June 2024)

Royal College of Nursing. Catheter care. 2021. https://www.rcn.org.uk/Professional-Development/publications/catheter-care-guidance-for-health-care-professionals-uk-pub-009-915 (accessed 6 June 2024)

Yates A. Urinary catheters 3: catheter drainage and support systems. Nursing Times. 2017a;113(3):41-43

Yates A. Urinary catheters 1: male catheterisation. Nursing Times. 2017b;113(1):32-34

Yates A. Urinary catheters 2: inserting a catheter into a female patient. Nursing Times. 2017c;113(2):50-52

Yates A. Indwelling urinary catheterisation: current best practice. Journal of Community Nursing. 2019;33(2):44-50