› Male Catheterization

Male Catheterization Made Easy

Male catheterization is easier than female in that there is little question as to where the catheter should go. However, because of the longer urethra from meatus to bladder and the fact that the urethra must pass through the prostate gland, there can still be complications to a relatively straightforward skill. I’ll go over all the things to watch out for and how to deal with them.

I have multiple videos that demonstrate particular areas about the male catheterization that I think will be useful to you. For those things I don’t agree with, I’ll also make comment. 

As mentioned on the page about the urinary system, there are several types of internal catheters. Three broad catagories are: 

  • Straight
  •  Foley or indwelling
  • Three way or retention

How you hold the penis when doing a male catheterizaton is important. If you look at the illustration below and follow the urethra, it makes two 90 degree turns from meatus to bladder if you leave the penis in the flaccid position.

perspective of the urethra with the patient lying down

If, however, you hold the penis straight up, pointing towards the ceiling, you eliminate one of those turns thereby making it easier for the catheter to be advanced to the bladder.

For male catheterizations, I always lubricate as much of the catheter as possible. Yes, it makes it a bit more slippery in my hand, but not lubricating makes the catheter stick to the meatus as I'm trying to get it inserted. Just putting a little on the tip just doesn't cut it.

And it's not very comfortable for my patient.

Straight Catheterization

When performing a straight cath, once you have drained all the urine out of the bladder you remove the catheter until the next time this needs to be done. You can use a regular catheter insertion kit if you have nothing else, but there are now several straight catheter kits that make the process pretty darn easy.

Here is one where the catheter is in the bag and already covered with lubricant from tip to end. It cuts down on the number of steps to accomplish your goal as well as reduce the possibility of breaking sterile technique.

The following video shows what happens internally so you have a good picture of what you are actually doing to your patient during the male catheterization:

Here is a video of a catheterization on an uncircumcised male

TIP: If you have difficulty getting past the prostate, just hold the catheter at the point of resistance and wait a minute or two. Sometimes the prostate “relaxes” and the catheter will then pass. 

TIP: If you can't get the catheter past the prostate, use a Coude (or Tieman). It is made specifically for male catheterization as it has a curved tip that allows the catheter to pass through the prostate and to the bladder easier. Make sure you keep the tip pointing up as you advance to the bladder. The way you know the direction it is pointing once inside the patient is to note what side a little bump at the end of the catheter is facing.

coude catheter

Male Catheterization Demo on a Manniquin

Good that she asked about allergies to betadine. One should also make sure the patient isn't allergic to latex.

I don’t usually clean prior to using the betadine unless the meatus is obviously dirty.

Foley catheter kits will have the size (Fr = French. The bigger the number the bigger in diameter the catheter) and balloon size (5 cc, 10 cc, 30 cc). If the package just states the size of the catheter but not the size of the balloon, you are looking at a straight cath kit not a foley cath kit.

Also, depending on the facility you work, you may have a kit like in this video which includes the foley and the bag already connected together. But many kits leave the catheter out and you have to pick out your own size separately. So read your labels!!.

I don't know of any kits that have Coude catheters in them.

The shiny side of the sterile drape (which will become unsterile as soon as it hits the bed) faces down. It is the plastic side that prevents liquid from leaking onto the sheets. The other side has some absorbance to it so any spills don’t roll off the drape. That side is considered sterile.

DO NOT tuck the drape under the legs because then you have contaminated the sterile field.

I have always just taken the drape and placed it close to the groin without even opening it up. I haven’t found a real need for a big sterile field other than the catheter kit box and cover.

Many demonstrations have the nurse open the kit on the overbed table then move it to the bed. I find this just an extra unnecessary step. I've always opened right on the bed between the patient's legs. 

In this video the demonstrator is opening a separate pair of sterile gloves. She may have been doing that so she gets a specific size she needs. When you are new I would ALWAYS bring an extra set of gloves with you so if you mess up you don't have to leave the patient to get more supplies. 

Some kits have betadine swabs, some have cotton balls and a packet of betadine solution. If you have swabs the packet has quite a bit of betadine in it and will spill out if laid flat after you open it. So prop it up on the side of the box. When ready to use, squeeze the bottom of the packet to remove some of the betadine from the swabs.

If you have cotton balls, pull them apart with your sterile gloves and throw away all but 3 before you start. If you don’t separate them, it may be hard to do once you are using the forceps and only have one hand free (the other would be on the patient.)

Pull the foreskin back to clean before insertion and remember to push it back over the head of the penis when done or you will end up with a very swollen penis if you forget. You would think most men would know this and mention they need to have it repositioned, but they don’t.

Some kits have the lubricant in a syringe so in male catheterization procedures, you can take the sterile syringe and squirt all the lubricant into the urethra. If it is just an envelope try to get the lubricant as far up the catheter as possible so it doesn’t stick to the urethra as you insert it. 

I always insert male catheters up to the bifurcation (the “Y”). 

If the insertion is very painful for the patient some doctors order lidocaine gel to be inserted in the urethra before insertion. You could do this before starting the procedure so the lidocaine has some time to work.

It Is not necessary to inflate the balloon before insertion.

If you start to inflate the balloon and the patient complains of pain, chances are you are not all the way into the bladder, which is why you insert up to the bifurcation.  Remove any water from the balloon, advance the catheter further a few inches and try again.

Some men find the insertion particularly uncomforatble. For the, the physician can order lidocaie instead of plain lubricant. It will numb the urethra to make insertion easier.

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