Urology: Urinary Catheter

Types of Catheters

• Urethral Catheter – Tube Placed through the Urethra to Drain the Bladder
• External Catheter – Suction Device Used to Externally Collect Urine without an Invasive Tube
• Suprapubic Catheter – Tube Placed Through the Abdominal Wall into the Bladder

Urethral Catheters

• Types:
  • Indwelling (Foley) Catheter – Long-Term Flexible Catheter to Continually Drain Bladder with a Distal Balloon to Prevent Catheter from Falling Out
  • Intermittent (Straight) Catheter – Flexible Catheter Removed After Each Use
    • Red Rubber Catheter – Straight Catheter Made of Rubber, More Flexible than Traditional Plastic Catheters
• Specialized Foley Catheters:
  • Coudé (Tiemann) Catheter – Curved Tip to Facilitate Passage through the Curved Prostatic Urethra
  • Council Tip Catheter – Small Hole at the Distal End Allows Catheter to Pass Over a Wire
  • Triple Lumen/Three-Way Catheter – Third Lumen Used to Infused Saline or Irrigation
• Material:
  • Silicone
  • Latex
  • PVC
• Coatings:
  • PTFE
  • Hydrogel
  • Silicone Elastomer
• Sizes:
  • 14-16 French (F) are Most Common in Adults
  • Other Common Sizes Range from 10-28 F

External Catheters

• Types:
  • Condom Catheter – Wraps Over the Penis for Use on Males
  • PureWick Catheter – Sits Between the Labia for Use in Females
• Used to Decrease the Risk of UTI Associated with Urethral Catheters
• Caution: Collects Voided Urine but Cannot Drain Bladder to Manage Urinary Retention

Suprapubic Catheter

• The Most Invasive Option
• Approaches: Percutaneous (Generally Preferred), Laparoscopic or Open
• Types:
  • Wing-Tip (Malecot) Drain
  • Mushroom Drain
  • Balloon (Foley) Catheter
• Benefits Over Urethral Catheters:
  • Prevents Urethral Trauma & Stricture
  • Increased Comfort & Satisfaction
  • Permits Voiding Trials without Catheter Removal
  • Less Interference with Sexual Activity
• Cather Should Not Be Removed for 4-6 Weeks to Allow Tract to Mature, Accidental Early Removal May Require Surgical Repair

Indications for Urethral Catheter Placement

• Acute Urinary Retention or Bladder Outlet Obstruction
  • Chronic Obstructions are Generally Better Managed by Intermittent Catheterization
• Need for Accurate Urinary Output Measurements in a Critically Ill Patient
• Perioperative Use:
  • Undergoing Urologic Procedures
  • Anticipated Prolonged Surgery
  • Anticipated Large Volume Infusion or Diuresis
  • Need for Intraoperative Monitoring of Urine Output
• Assist in Healing of Sacral/Perineal Wounds in Incontinent Patients
• Prolonged Immobilization
• Comfort in End of Life Cares if Needed

Complications

• Catheter-Associated Urinary Tract Infection (CAUTI) – The Most Common Healthcare-Associated Infection
  • *See Urology: Urinary Tract Infection (UTI)
  • Indwelling Bladder Catheter Risk: 3-10% Per Day of Catheterization
• Pain/Stinging Sensation
• Urethral Injury
• Paraphimosis
• Catheter Obstruction

CAUTI Prevention

• Avoid Unnecessary Catheters
• Use Sterile Technique in Placement
• Remove Catheter as Soon as Possible
• No Proven Benefit:
  • Antibiotic-Coated Catheters
  • Prophylactic Antibiotics
  • Routine Catheter Exchange at Fixed Intervals