pediatrics
How To Catheterize the Bladder in a Male Child
Step by Step Description of Bladder Catheterization: Male Child
The in-and-out insertion of a catheter is described here. Allow one or both parents or caretakers to remain present to comfort the child. Having them hold the child's hand, provide a stuffed animal for the child to play with, or engage in other distraction techniques can help. Occasionally sedation is needed. Place all equipment within easy reach on an uncontaminated sterile field on a bedside tray. Open the prepackaged kit, taking care not to contaminate the contents. Place the absorbent underpad with the plastic side down beneath the buttocks. Remove diaper if present and clean the area with a wet washcloth using soap and water. Dry the area with a dry towel. Then wash your hands with soap and water. Put on gloves using sterile technique. Apply the sterile lubricant to the end of the catheter and place on the sterile field. Saturate the application sticks, cotton balls, or gauze pads withpovidone-iodine. Place the sterile fenestrated drape over the pelvis so that the penis remains exposed. Grasp the shaft of the penis using your nondominant hand, hold the penis perpendicular to the abdominal wall, and apply gentle traction. Retract the foreskin enough to visualize the urethral meatus if the patient is uncircumcised. Do not force the foreskin to retract. Remember to hold the sides of the penis and not directly underneath; the urethra runs through here and you may compress the area, making it difficult to advance the catheter.This hand is now nonsterile and must not be removed from the penis or touch or any of the equipment during the rest of the procedure.If needed, new sterile gloves can be used. Cleanse the glans penis with each application stick, gauze pad, or cotton ball saturated inpovidone-iodine. Use a circular motion, beginning at the meatus, and work your way outward. Discard or set aside the newly contaminated application sticks, gauze pads, or cotton balls. If usingpovidone-iodine, cleanse 3 times then allow the area to dry. Hold the catheter in your dominant free hand. Advance the catheter slowly through the urethra just until urine is obtained. If the patient is old enough to cooperate, ask him to relax and take slow deep breaths as you continue to apply steady pressure. There may be some resistance due to bladder sphincter contraction during insertion of the catheter. Maintain steady gentle pressure so the catheter will advance when the sphincter relaxes. Do not poke repeatedly or force the catheter. Urine should flow freely. Collect urine in the specimen container. If the volume is insufficient, gently massage the lower abdomen over the bladder (suprapubic area). Remove the catheter by pulling out gently. Remove all remainingpovidone-iodinewith a wet washcloth. Reposition the foreskin in the uncircumcised male over the glans to avoid paraphimosis. 