Urinary Catheterisation and Bladder Care

Urinary catheterisation is a common invasive procedure performed in UAE healthcare facilities for patients who cannot void naturally, those requiring accurate urinary output measurement, and patients undergoing certain surgical procedures. The DOH (UAE) examination tests your knowledge of indications, technique, catheter types, and most importantly — the prevention of catheter-associated urinary tract infections (CAUTIs), which are among the most common healthcare-associated infections (HAIs) worldwide and a major patient safety priority in UAE hospitals under the UAE National Health Regulatory Authority (NHRA) standards.

---

🟢 Lite — Quick Review (1h–1d)

Rapid summary for last-minute revision before your exam.

Key Principles:

• Indwelling catheters (Foley) stay in the bladder continuously
• Intermittent catheters are inserted to drain urine, then removed
• The decision to catheterise must always be clinically justified — document the indication clearly
• Duration is the biggest risk factor for CAUTI — remove the catheter as soon as it is no longer needed

CAUTI Prevention — Non-Negotiable Practices:

• Aseptic technique during insertion
• Maintain closed drainage system (do not disconnect tubing)
• Keep drainage bag below bladder level at all times (but never on the floor)
• Daily meatal care with antiseptic solution (per facility protocol)
• Maintain unobstructed urine flow (no kinks in tubing)

Catheter Sizes:

• 12–16 Fr (French) for most adults
• Larger sizes (18–22 Fr) only for patients with clots, debris, or postoperative haematuria
• Balloon size: 10 mL (standard) or 30 mL (prostate/bladder neck procedures)

⚡ Exam Tip: Never inflate the balloon before confirming the catheter is in the bladder. If a catheter is incorrectly placed in the urethra and the balloon is inflated, it can cause severe urethral trauma. Always confirm placement by waiting for urine return before inflating.

---

🟡 Standard — Regular Study (2d–2mo)

Standard content for students with a few days to months.

1. Types of Urinary Catheters

A. Intermittent (In-and-Out) Catheter

• Inserted to drain bladder, then removed immediately
• Used for: Spinal cord injury patients, urinary retention, post-void residual measurement
• Preferred for: Long-term catheterisation where possible (lower infection risk than indwelling)
• Sizes: 12–16 Fr for adults; smaller sizes for children

B. Indwelling (Foley) Catheter

• Remains in bladder with balloon inflated
• Types by material:
  • Latex (silver-coated or uncoated) — standard; least expensive; can cause latex allergy
  • Silicone — preferred for patients with latex allergy or long-term use; harder, requires smaller balloon
  • Silicone-coated (hydrogel/silver alloy) — reduces biofilm formation; used for long-term catheterisation

C. Three-Way Catheter

• Has an additional lumen for bladder irrigation
• Used after: Prostate or bladder surgery; haematuria with clots
• Allows continuous bladder irrigation (CBI) to prevent clot retention

D. Suprapubic Catheter

• Inserted through a surgical incision above the pubic symphysis into the bladder
• Used for: Long-term catheterisation when urethral catheterisation is contraindicated or impossible; spinal cord injury patients
• Advantages: Lower CAUTI rates than urethral catheters; better patient comfort
• Requires surgical insertion by physician

2. Indications for Catheterisation

Acute indications (typically short-term):

• Accurate I/O measurement in critically ill patients
• Acute urinary retention (e.g., post-operative, medication-induced)
• Perioperative use for surgical procedures (urological, gynaecological, orthopaedic)
• Bladder decompression (e.g., neurogenic bladder, urodynamic studies)
• Acute urological obstruction pending definitive treatment

Chronic indications (long-term — must be regularly reviewed):

• Severe pressure injuries where toileting would worsen skin integrity
• End-of-life care where patient comfort is the priority
• Spinal cord injury with neurogenic bladder (may use intermittent catheterisation instead)
• Patients requiring prolonged immobilisation (e.g., multiple fractures)

Contraindications to urethral catheterisation:

• Known urethral trauma
• Recent urological surgery (check with surgeon)
• Suspected urethral stricture (may require suprapubic catheter)
• Patient refuses (always obtain consent)

3. Insertion Procedure (Female — Most Common Exam Scenario)

Equipment:

• Sterile catheterisation pack (receiver, disposal bag, drapes)
• Sterile gloves (2 pairs — one for cleaning, one for insertion)
• Sterile gauze
• Antiseptic solution (povidone-iodine or chlorhexidine)
• Sterile water-soluble lubricant
• Foley catheter (appropriate size)
• 10 mL syringe (for balloon inflation)
• Sterile saline or water for irrigation (if needed)
• Drainage bag (closed system)
• Collection bag (if on bedpan)

Procedure for Female Patient:

1. Explain procedure; obtain verbal consent; provide privacy
2. Position: Supine, knees flexed, feet flat on bed (frog-leg position)
3. Perform hand hygiene; don sterile gloves
4. Place sterile draping under buttocks and over thighs
5. Separate labia majora with non-dominant hand (maintain separation throughout)
6. With sterile forceps/swabs, clean the labia: first far labia majora, then near labia majora, then the meatus — use separate swab for each stroke; use iodine-based solution
7. Identify the urethral meatus (below clitoris, above vaginal opening)
8. Lubricate catheter tip
9. Insert catheter gently into urethral opening — advance 4–6 cm or until urine flows
10. When urine flows, advance catheter another 2–3 cm (ensure balloon is inside bladder)
11. Inflate balloon with 10 mL sterile water (note: sterile water, not saline — saline can crystallise and clog the balloon port)
12. Gently pull back until resistance felt (balloon against bladder neck)
13. Connect to drainage bag (closed system — do not break circuit)
14. Secure catheter to patient’s thigh (use catheter stabilisation device or tape — prevents traction on urethra)
15. Ensure drainage bag is below bladder level; off the floor
16. Document: Date/time, indication, catheter size, balloon volume, amount of urine on insertion, patient tolerance

4. Male Catheterisation Differences

• Male urethra is longer (~18–20 cm vs ~4 cm in females) and has three natural narrowings (internal urethral meatus, membranous urethra, external urethral meatus)
• More difficult to catheterise; may require smaller size or coude (curved tip) catheter for patients with enlarged prostate
• Increased risk of trauma due to prostate enlargement (very common in Emirati men >50 years — BPH prevalence)
• Use extra lubricant; advance catheter slowly and patiently
• Never force the catheter past prostatic resistance without medical consultation

---

🔴 Extended — Deep Study (3mo+)

Comprehensive coverage for students on a longer study timeline.

5. CAUTI Prevention Bundle (UAE National Standards)

UAE healthcare facilities follow internationally recognised CAUTI prevention bundles:

A. Before Insertion:

• Confirm catheter is necessary (not just for convenience)
• Document indication
• Use aseptic technique
• Use smallest appropriate catheter size and shortest duration
• Consider alternatives: Bedside commode, urinal, condom catheter (for men without retention), intermittent catheterisation

B. After Insertion:

• Maintain closed system (critical — every break in the circuit increases infection risk 3–5x)
• Keep drainage bag below bladder level at all times
• Empty drainage bag when 2/3 full (prevents backflow); use separate container for each patient
• Do not irrigate unless ordered (routine bladder irrigation is NOT recommended)
• Daily meatal care: Clean with antiseptic solution during bathing; no antimicrobial creams unless ordered
• Secure catheter to prevent movement and urethral traction

C. Surveillance:

• Monitor urine appearance daily (cloudy, malodorous, bloody — report immediately)
• Monitor temperature and vital signs (fever may indicate CAUTI)
• Monitor WBC and urinalysis/culture results
• Remove catheter as soon as possible — every day of catheterisation increases CAUTI risk

6. Bladder Assessment and Urinary Problems

A. Urinary Retention (Acute) Signs: Suprapubic distension, pain, dribbling of urine, overflow incontinence Causes: Medication (anticholinergics, opioids, antihistamines), BPH, post-operative, neurological Management: Catheterisation; address underlying cause; bladder scan to monitor residual volume

B. Bladder Scan (Bedside Ultrasound)

• Non-invasive assessment of bladder volume
• Post-void residual (PVR) > 100–150 mL may indicate retention
• Used to determine need for catheterisation and to monitor effectiveness of bladder training

C. haematuria (Blood in Urine)

• Gross haematuria (visible) vs microscopic (found on dipstick/urine microscopy)
• Causes: Infection, stones, malignancy, trauma, anticoagulant therapy
• Requires: Physician notification; urinalysis; possible urology referral
• Three-way catheter and continuous bladder irrigation for clot retention

D. Urinary Incontinence

• Stress incontinence: Leakage with coughing, sneezing (pelvic floor weakness)
• Urge incontinence: Strong urge to void followed by leakage (overactive bladder)
• Overflow incontinence: Constant dribbling (bladder outlet obstruction or detrusor weakness)
• Functional incontinence: Physical/cognitive barrier to reaching toilet in time

E. Urine Assessment — Normal vs Abnormal:

Parameter	Normal	Abnormal
Colour	Pale yellow to amber	Red/brown (blood), orange (concentrated/jaundice), blue-green (dyes/infection)
Clarity	Clear	Cloudy (infection), frothy (proteinuria)
Odour	Slight	Foul-smelling (UTI), sweet/fruity (DKA), asparagus (after eating asparagus)
pH	4.5–8	Acidic (<4.5 — metabolic acidosis, high-protein diet); Alkaline (>8 — UTI with urea-splitting organisms, vegetarian diet)
Specific gravity	1.005–1.030	Very dilute (diabetes insipidus); Very concentrated (dehydration)

Exam Watch: A DOH examiner will frequently test CAUTI knowledge by presenting a patient with an indwelling catheter who develops fever and cloudy, malodorous urine. The correct management is: Obtain a urine sample via syringe from the catheter sampling port (NOT from the drainage bag), send for urinalysis and culture/sensitivity, and notify the physician. Do not remove the catheter without physician order unless specifically instructed — removing the catheter before obtaining a sample can result in loss of diagnostic information.

---

Content adapted based on your selected roadmap duration. Switch tiers using the selector above.