Topic 5: Introduction to urethral catheterisation
The insertion of a urinary catheter is a procedural skill that interns are expected to perform independently; however, this can be associated with patient safety risk. Most of the focus of teaching in medical school is, quite rightly, on how to perform the procedure safely and aseptically. However, interns will also be expected to manage complications that occur after the insertion of urinary catheters. This workshop will allow the intern to identify, manage and, if possible, prevent patient safety risks associated with urinary catheters.
At the end of the training, interns should be able to:
- understand and applytechnical tips that can be implemented if insertion of the IDC is difficult
- know when to call for help if unable to insert an IDC
- diagnose and appropriately manage urinary retention
- recognise and manage clot retention.
- prevent and manage iatrogenic paraphimosis
- recognise and manage common complications following relief of urinary retention and urethral catheterisation
- Facilitator Notes for Urethral Catheterisation Workshop
- Urethral Catheterisation Scenarios
- Learning Resources - Urethral Catheterisation
To safely manage patients with urinary retention and indwelling urinary catheters, interns will:
- have knowledge of technical tips that can be implemented if insertion of the IDC is difficult
- know when to call for help when you are unable to insert an IDC
- be able to diagnose and appropriately manage urinary retention
- be able to recognise and manage clot retention.
- be able to prevent and manage iatrogenic paraphimosis
- be able to recognise and manage common complications following relief of urinary retention and urethral catheterization.
- Progress notes
- Fluid balance chart
- Image of paraphimosis
- IDC (different sizes, three way catheter)
Facilitator questions for IDC scenarios
- What is your approach?
- How do you diagnose acute urine retention diagnosed (symptoms and signs, bladder scan)?
- What are the precipitants of urinary retention?
- Contrast acute and chronic urinary retention?
- Discuss the indication and contraindications for the insertion of IDC.
- Outline the different sizes of IDC available.
- Discuss methods to improve the chance of successful insertion of an IDC.
- Outline appropriate escalation if unable to insert an IDC.
- What are the risks associated with urinary catheterisation?
- Discuss the recognition of clot retention.
- Discuss the role (if any) for flushing urinary catheters that are blocked.
- Discuss the indications of a 3 way catheter.
- Discuss the diagnosis of paraphimosis and how to prevent it
- Outline strategies to reduce the paraphimosis.
- Discuss the common complication of haematuria post relief of chronic obstruction and its management.
- What would you do if he had bleeding around the catheter site?
- Discuss management of post obstructive diuresis including evidence for strategies such as chasing urine output and clamping the IDC.
- Discuss diagnosis of urethral spasm and strategies to manage it.
Mr Albert is a 70 year old man who is 2 days post op following a right Total Hip Replacement. His intravenous fluids and Patient Controlled Analgesia morphine were stopped earlier today. His IDC was removed this morning at 0600. It is now 1600. He has been passing small amounts of urine but he feels that he needs to void. The patient is uncomfortable and he is rolling around in bed.
Mr Williams is a 65 year old man who had a L4/5 laminectomy 1 day ago. His IDC was removed earlier today but he hasn’t been able to void. He has 1200ml on a bladder scan and is very uncomfortable. The day intern tried twice and he couldn’t insert an IDC.
Mr Wood presented to the Emergency department after a cystoscopy and biopsy as a day stay procedure yesterday. He had haematuria and clot retention. An IDC was inserted with good relief of the patient’s symptoms. It blocked earlier this evening but the covering intern flushed it. It was working but now it’s blocked again.
Mr Richards required an Open Reduction Internal Fixation (ORIF) for a right mid-shaft femoral fracture and his left tibia/fibula fractures. The intern put an IDC in this afternoon as he couldn’t pass urine and was going to be confined to bed. His penis had become very swollen and the nurse is concerned that he may have some sort of allergic reaction to the catheter.
Mr Thomas presented to the Emergency department with acute renal failure with a creatinine of 300. He was in painless urine retention. He was admitted under the urology team and an IDC inserted. It drained about 1.5 L in ED. a) His urine is now red. b) The IDC is now draining 500ml/hr. He is receiving an 8 hourly bag of NS.
Mr Parry had an IDC inserted earlier today as he couldn’t void after his hemorrhoidectomy. The IDC is draining but the patient is complaining about pain around his penis and is requesting to have the IDC removed.
Videos in Clinical Medicine
Thomsen T.W. and Setnik G.S.Male Urethral Catheterization. N Engl J Med 2006; 354:e22 http://www.nejm.org/doi/full/10.1056/NEJMvcm054648
On the wards Tips and Tricks for IDC insertion by Dr Nariman Ahmadi http://www.onthewards.org/pods/urology/