Urethral Catheterisation in Infants

Publication: 11/02/2019  --
Last review: 19/05/2020  
Next review: 01/05/2023  
Standard Operating Procedure
CURRENT 
ID: 5892 
Approved By:  
Copyright© Leeds Teaching Hospitals NHS Trust 2020  

 

This Standard Operating Procedure is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Urethral Catheteterisation in Infants

Summary

This standard operating procedure is designed for nurses and medical staff who look after infants and children who may require short term urinary catheterisation.

Catheterisation may be a short or long term intervention. It is implemented when the bladder is unable to empty effectively or in critically ill infants/children.

The procedure involves the introduction of a catheter into the bladder to drain urine. Catheterisations can be performed by competent professionals as clinically indicated to promote continence or to prevent prolonged retention of urine, to promote bladder emptying avoiding renal damage and prevent urinary tract infection.

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Background and indications for standard operating procedure/protocol

Indications for Catheterisation:

  • To promote continence by ensuring the bladder is completely emptied
  • To prevent chronic retention and over distension of the bladder
  • Reduction of risk of damage to upper renal tracts
  • As an estimation of residual urine, in the absence of a bladder scanner
  • Management of overflow urinary incontinence
  • Strict monitoring of fluid balance in critically unwell patients

Advantages of Catheterisation:

  • To achieve urinary continence
  • To preserve renal function
  • To reduce the incidence of urinary tract infections due to high residual urine volumes
  • To improve quality of life

Exclusions and contra-indications:

  • Lack of consent, written, verbal or implied
  • Patient specific medical instructions that catheterisation is not to take place
  • Known urethral obstruction and unsuitability for urethral catheterisation

Precautionary measures:

Caution should be exercised when undertaking catheterisation in patients with the following conditions:

  • Urinary Tract Infection
  • Cystitis
  • Urethritis
  • Recent surgery to lower urinary tract
  • Trauma to the pelvis or abdomen
  • Recent radiotherapy to the lower urinary tract
  • Vaginal pain / bleeding / discharge
  • Haematuria
  • Congenital abnormalities

When to discontinue the procedure:

  • When it is no longer required ( i.e. complete bladder emptying)
  • Doubt over the position of the catheter
  • Obstruction is felt on insertion
  • Severe sphincter spasm is felt causing obstruction on insertion
  • Bleeding per urethra which is of concern

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Procedure

PROCEDURE                           

No.

Action

Rationale

1

 

Explain the procedure with the patient/family and obtain consent. Ascertain if any problems have been experienced with previous catheterisations. Check for ALLERGIES: latex, lidocaine (anaesthetic gel), duoderm, elastoplast. 

The provision of information to the patient/family can provide psychological benefit. Consent protects an individual’s freedom and ensures they are aware of the benefits and risks involved.

2

 

Technique should be demonstrated by a professional who has completed a competency package or is undergoing competency and is directly supervised by a competent professional. The procedure should be treated as sterile.

While infection remains low when an individual carries out the procedure, the risk is increased when carried out by a professional who is in contact with other clients, hence the need for sterile technique (Getliffe & Dolman 2003)

3

 

Assist the patient to get into the supine position, females with bent knees, hips flexed and feet resting apart. Males with their legs extended. Do not expose the patient at this stage of the procedure.

To enable safe access to the genital area.
 
To maintain the patient’s dignity and comfort.

4

 

Prepare equipment using aseptic technique (see guide for catheter size and lubricant). •Thorough handwashing technique and PPE as per LTHT guidelines. • Clean and open the Normasol (0.9% sodium chloride solution) and empty into the sterile tray. •Open outer packaging of the catheter and place onto aseptic field. •Prepare lubricant aseptically. •Clean hands with alcohol hand gel.  • Put on sterile gloves.  • Place the sterile paper appropriately over the patient to create a sterile field. It can help to tear a hole in the middle of the paper to perform the procedure through.

To minimise risk of infection.

5

 

If using a Foley catheter, check balloon patency prior to insertion. If a catheter is to be passed on a male, remove the guidewire approx. 1-2 inches to make the end softer and easier to pass through the angle to the bladder.
NB: Foley catheter not to be used on Neonatal Unit unless directed by Consultant in charge.

To ensure catheter balloon not damaged. Uninflated catheters have the highest risk of migrating or falling out.

6

Pass the urine catheter gently. See below for techniques. Utilise a ‘clean hand/dirty hand’ technique ensuring the hand used to pass the catheter remains sterile.

To minimise urethral damage and maximise patient comfort.

 

i. For male patients, wrap sterile gauze around the penis and retract the foreskin if necessary. Clean with gauze soaked Normasol solution using single strokes away from the urethral meatus. Grasp the penis behind the glans and extend upwards, i.e in an upright position 60-90 degrees from the patient. Maintain extension throughout the procedure. Do not force the foreskin back. If using anaesthetic lubricating agent, instil the 1% lignocaine lubricant to the area around the urethral meatus and the catheter – wait for 5 minutes for it to work before proceeding. If using non-anaesthetic lubricant, lubricate end of catheter prior to insertion.  Holding the catheter through the packaging gently insert the catheter using a slow steady pressure until urine flows, then advance carefully up to the Y-connection. DO NOT use force.

i. For female patients, using gauze, separate the labia minora so that the urethral meatus is seen. One hand should be used to maintain labial separation until catheterisation is completed. Clean with gauze soaked in Normasol using single downward strokes away from the meatus (front to back). If using anaesthetic lubricating agent, instil the 1% lignocaine lubricant to the area around the urethral meatus and the catheter – wait for 5 minutes for it to work before proceeding. If using non-anaesthetic lubricant, lubricate end of catheter prior to insertion. Holding the catheter through the packaging gently insert the catheter using a slow steady pressure, into the meatus, upward at ~ 30° angle until urine flows, and then advance carefully up to the Y-connection. DO NOT use force.

ii. Remove the guidewire carefully if present, ensure catheter does not get pulled back at this point. Inflate the catheter balloon slowly using the syringe of sterile water observing the patient for discomfort – the volume of sterile water to use is detailed on the catheter packaging. ALWAYS ensure urine is flowing before inflating the balloon. • Withdraw the catheter gently.

 

7

Obtain a clean catch urine sample if necessary into a white universal container or a sterile gallipot. Then attach the urine catheter drainage bag.

To observe colour, smell and volume of urine and prevent back-flow into the bladder.

8

Secure and stabilise the catheter by fully extending the leg and position the catheter straight on the front of the thigh. Then back the catheter up a couple of centimetres to create some slack but not so much that it can kink. Duoderm to the skin and Elastoplast may be used as securing devices.

To maximise comfort for the patient and to reduce risk of catheter migration/falling out.

9

Complete documentation of insertion, including the type and size of the catheter. Always follow manufacturer’s instructions.

To promote communication and fulfil Trust policy and to create a clear audit trail.
To ensure effective use of product.

10

Regularly assess clinical need for urine catheter and if not required, ensure prompt removal. Always deflate the balloon prior to removal. The catheter should be gently removed using a rotating action and all waste disposed of appropriately. Disinfect and wash hands as per LTHT guidelines.

To maximise comfort for the patient and to prevent increased risk of infection.

Guidelines for catheter sizes:  *choose the smallest size possible that provides adequate drainage

Neonates

Vygon

Preterm or small for gestational age

4fr

Term infant

6fr

Older infant

6-8fr

Foley Catheter (Consultant Led)

 

Term infant or older

6-8fr

 

Paediatrics:

Age

Weight

Catheter Size (Foley)

0-6 months

3-6kg

6 Fr

1 years

10kg

6-8 Fr

2 years

12kg

8 Fr

3 years

14kg

8-10 Fr

5 years

18kg

10 Fr

6 years

21kg

10 Fr

8 years

27kg

10-12 Fr

>12 years

Variable

12-14 Fr

Provenance

Record: 5892
Objective:

Aims
To facilitate the nurse, or medical professional in the clinical skill of catheterisation and to understand the reasons for this procedure


Clinical condition:
Target patient group:
Target professional group(s): Secondary Care Nurses
Adapted from:

Evidence base

Kaye I, Payan M, Vemulakanda V  (2016) Association between clean intermittent catheterisation and urinary tract infection in infants and toddlers with spina bifida. Journal of Pediatric Urology. Vol 12, Issue 5, p284 e1 -284-e6 C

Gerard L, Cooper C, Duethman K, Gordley B & Kleiber C (2003) Effectiveness of lidocaine lubricant for discomfort during paediatric urethral catheterization. The Journal of Urology. Vol 170 pp564-567  C

Getliffe,K & Dolman,M. (2003) Promoting confidence. A clinical research resource.  B                                                                                           

Hellstrom et al (1991) Efficacy & Safety of clean intermittent catherterization in adults. European Urology. pp117-121.C

Mularoni P, Cohen L, DeGuzman M, Mennuit-Washburn J, Greenwald M & Simon K (2009)     A randomized clinical trial of lidocaine gel for reducing infant distress during urethral catheterization. Paediatric Emergency Care. Vol 25, Issue 7  C

Naish,W. (2003) Intermittent Self Catheterisation for managing urinary problems. Professional Nurse. pp585-587.

NMC (2002) Code of Conduct. NMC. C

Pellowe C, Rogers J (2007) Preventing healthcare-associated infections when using urinary catheters. Infant. Vol 3, Issue 4 C

Pratt R, Pellowe C, Wilson J et al (2007) National evidence based guidelines for preventing healthcare associated infections in NHS hospitals in England. Journal of Hospital Infections, Volume 65, Issue 1 A

Evidence levels:

A. Meta-analyses, randomised controlled trials/systematic reviews of RCTs

B. Robust experimental or observational studies

C. Expert consensus.

D. Leeds consensus. (where no national guidance exists or there is wide disagreement with a level C recommendation or where national guidance documents contradict each other)

Document history

LHP version 2.1

Related information

Not supplied

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