Bladder Catheterization: Male (Pediatrics)

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SAMPLE EXCERPT
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PRE-PROCEDURE
INDICATIONS
  • To obtain sterile urine for analysis and culture in patients unable to provide a clean voided specimen
  • For placement of indwelling catheter to monitor urine output and assess fluid status
  • To measure bladder residual urine volume
  • To instill radiologic contrast dye for radiologic studies
  • To empty neurogenic bladder
  • To relieve urinary retention or obstruction
  • To maintain urethral patency in patients with perineal injury
CONTRAINDICATIONS

Absolute Contraindications

  • Known or suspected urethral trauma, indicated by blood at the meatus, perineal soft tissue trauma

Relative Contraindications

  • Patient unlikely to have sufficient urine in the bladder
  • Immunocompromise
  • Congenital genitourinary malformations
  • Recent urethral surgery
  • Previous difficulties with catheterization
  • Potential allergy to latex or iodine
EQUIPMENT
  • Sterile urethral catheter
  • Syringe with sterile water or saline for balloon, if placing a Foley catheter
  • Water-soluble bacteriostatic lubricant
  • Povidone-iodine swabs, or povidone, soap, and/or water or normal saline
  • Cotton balls or sponges
  • Forceps to handle cotton balls
  • Sterile drapes—one nonfenestrated and one fenestrated
  • Specimen collection tube(s) or cup(s), if collecting urine
  • Gloves, preferably latex-free
  • Nonsterile, warm, wet washcloth(s) to clean the perineum
  • Oral sucrose may decrease pain in neonates and infants up to 6 months of age.
  • Tape (plastic or cloth)
  • Benzoin
  • Connector tubing
  • Closed urine collecting receptacle
  • 2% viscous lidocaine gel and applicator to anesthetize the urethra before Foley placement is optional.
  • Equipment for bladder catheterization is also available as prepackaged commercially available kits.
ANATOMY
  • Urethra
    • The male urethra is relatively fixed at the level of the urogenital diaphragm and symphysis pubis; traction downward on the penis kinks and promotes urethral folding at the level of the penile suspensory ligament.
    • Posterior urethral valves, a malformation unique to males, may develop in the distal portion of the prostatic urethra.
  • Urethral meatus
    • In circumcised males, the urethral meatus should be easily visible. In uncircumcised males, the meatus is exposed by gently retracting the foreskin. A tight foreskin that cannot be retracted may prevent visualization of the meatus.
    • In males with hypospadias, the meatus is located on the ventral surface of the penile shaft.

PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE
  • Sample handling
    • Divide sample, if necessary, and place in tightly closed containers.
    • Label specimen container(s), and send to the laboratory as soon as possible.
  • Wash the perineum with a warm wet washcloth or cotton balls to remove all remaining povidone-iodine.
  • Attach the Foley to the urine collection receptacle.
  • Return the foreskin to its unretracted position (uncircumcised patients).
  • Provide physical or pharmacologic restraint as necessary to prevent unintended Foley removal.
  • To remove the Foley, deflate the balloon and gently pull out the tube.
COMPLICATIONS
  • Catheter placement between the glans and the foreskin
  • Urethral irritation
  • Urethral or bladder trauma
  • Catheter-associated urinary tract infection
  • Paraphimosis may occur if the foreskin is not returned to its unretracted position.
  • Knotting of the catheter within the bladder (rare)
  • Urethral stricture
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