Intended for healthcare professionals

Student Practical skills

Inserting a catheter into a male patient

BMJ 2011; 342 doi: (Published 19 April 2011) Cite this as: BMJ 2011;342:d1436
  1. Catherine Riley, foundation year two doctor1,
  2. Tim Briggs, consultant surgeon1
  1. 1Department of Urology, Barnet General Hospital, Barnet EN5 3DJ, UK

Every junior doctor will need to insert a urinary catheter

Every junior doctor will need to insert a urinary catheter during their practice, and 26% of inpatients are estimated to have an indwelling catheter during their admission.1

The procedure is not without its dangers. A one year study found that 6% (51/864) of urological consultations during the study were related to male urethral catheterisation. Of these 51 cases of catheter related morbidity, 38 (74%) resulted from junior doctors performing urethral catheterisation; 28 of these (73%) occurred during the first six months of internship.2

Part of the problem might be junior doctors’ inexperience. A questionnaire sent to final year medical students and recent graduates of Oxford medical school found that 92% had been taught how to catheterise male patients as a medical student, but 48% of students had done fewer than two catheterisations on qualification. Also, 68% of house officers had received no additional instruction even though 69% of house officers said they were “very confident” in their ability to perform male urethral catheterisation.3

Choosing a catheter

The choice of catheter depends on the indication for catheterisation. The most common indications are close monitoring of the patient’s fluid balance and acute urine retention. Foley catheters are the most suitable in these situations. Box 1 lists which type of catheter is used for which indication.

Box 1: Indication for urethral catheterisation

  • Monitoring urine output—use Foley catheter

  • Acute urinary retention—use Foley catheter

  • Intermittent self catheterisation—use Lofric/Nelaton catheter

  • Management of bladder outflow obstruction with:

    • Acute or chronic urinary retention—use Lofric/Nelaton catheter

    • Hydronephrosis with or without renal failure—use Lofric/Nelaton catheter

  • Haematuria or clot retention—use three lumen catheter, Ch 18-24

  • Management of urinary incontinence—use Foley catheter

  • Long term bladder drainage or failure to advance a catheter up the urethra—for example, due to a tight urethral stricture or iatrogenic trauma to the urethra—use …

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