Background

Urinary catheterisation of the newborn is a procedure which is used to obtain urine for measurement and analysis when standard methods are inadequate/not able to be performed. It should not be carried out without careful consideration and consultation with medical staff.

Indication

• To monitor urine output accurately (eg as in therapeutic hypothermia for HIE)
• To relieve urinary retention
• To obtain a urine specimen for diagnostic purposes

Do not routinely send urine for culture from catheter without prior discussion with medical staff.

Contraindications

• Bleeding diathesis (bleeding tendency or predisposition)
• Known congenital abnormality of lower urinary tract (first seek advice from paediatric surgeon)

Complications

Trauma

• Risk of trauma during insertion
• Knotting of the catheter if generous insertion length used
• Perforation of bladder
• Minimisation of trauma
• Do not force catheter
• Do not insert extra tubing length as this will increase the risk of knotting
• Do not move the catheter in and out as this will increase the risk of urethral damage
• Secure the catheter to prevent pulling/displacement

Infection

• Remove as soon as possible to reduce risk

Urine bypassing catheter

• Do not flush with saline
• Remove catheter and observe urine output by weighing nappies
• Only replace if absolutely necessary

Insertion of Urinary Catheter

• Strict aseptic technique must be used
• Use catheter of smallest possible diameter to avoid trauma
• If urine is not obtained in female infant recheck position of catheter as it may have passed through introitus into the vagina

Equipment

• Sterile Gloves
• Betadine
• Sachet of sterile lubricant
• Dressing Pack +/- separate galipot
• Sterile gauze swabs/Sterile cotton wool
• Urinary Catheter – gastric feeding tube (see below for guidance on sizes)
• Urinary Catheter Bag
• Universal Container for collection of specimen if required
• Steristrips

Selecting the correct size of catheter

The smallest diameter of catheter should be used in order to minimise trauma. The sizes of catheter currently in use are the 5Fr and 6Fr nasogastric feeding tubes. The catheter length will be variable for each individual baby depending on their size and anatomy. Advancing until you see urine coming back into the catheter is acceptable as long as there is urine in the bladder. Below is a table which may provide some guidance with the size and length of the catheters – please remember to use the smallest catheter size.

Insertion Procedure

Female catheterisation:

• Set up sterile field. Squeeze a small amount of lubricant onto the sterile field.
• Place infant supine, with the thighs abducted (frog like position).
• Wash hands, use sterile gloves.
• With the non–dominant hand, separate the labia.
• Using the free hand for the rest of the procedure, clean the area around the meatus with betadine using front to back strokes. Rinse the betadine off with sterile water.
• Place sterile drape between and over the legs.
• Apply sterile lubricant to catheter tip.
• Place sterile galipot on drape ready to receive urine from catheter.
• Gently insert catheter until urine is visible in catheter. Do not insert extra tubing.
• If the catheter is accidentally inserted into the vagina, leave in place and insert new catheter anterior to the first catheter.
• Connect catheter to urine bag.
• Secure the catheter to the infant by taping to the thigh using steristrips.
• Document procedure in Badger.

Male Catheterisation:

• Set up sterile field. Squeeze a small amount of lubricant onto the sterile field.
• Place infant supine, with the thighs abducted (frog like position).
• Wash hands, use sterile gloves.
• Using the non-dominant hand stabilise the shaft of the penis, perpendicular to the body.
• Clean the shaft of the penis with betadine, starting at the meatus and moving down the shaft of the penis. Rinse the betadine off with sterile water.
• Place sterile drape between and over the legs.
• Place sterile galipot on drape ready to receive urine from catheter.
• Apply sterile lubricant to the catheter tip.
• Gently insert the catheter into the meatus until urine is visible in the catheter.
• Slight resistance may be felt as the catheter passes through the external sphincter. Hold the catheter in place with minimal pressure - generally spasm will relax after several minutes allowing easy passage.
• NEVER FORCE THE CATHETER
• Connect catheter to urine bag.
• Secure the catheter to the infant using steristrips wound round the catheter and onto the penis.
• Document procedure in Badger.

Removal of Urinary Catheter

• Remove catheter as soon as possible/when no longer required to avoid infection complications
• Do not send tip for culture following removal