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Urinary Catheter Insertion


The ability to insert a urinary catheter is an essential skill
in medicine.

Catheters are sized in units called French, where one French equals
1/3 of 1 mm. Catheters vary from 12 (small) FR to 48 (large) FR
(3-16mm) in size.

They also come in different varieties including ones without a bladder
balloon, and ones with different sized balloons – you should check
how much the balloon is made to hold when inflating the balloon
with water!

Universal precautions

The potential for contact with a patient’s blood/body fluids while
starting a catheter is present and increases with the inexperience
of the operator. Gloves must be worn while starting the Foley, not
only to protect the user, but also to prevent infection in the patient.
Trauma protocol calls for all team members to wear gloves, face
and eye protection and gowns.



By inserting a Foley catheter, you are gaining access to the bladder
and its contents. Thus enabling you to drain bladder contents, decompress
the bladder, obtain a specimen, and introduce a passage into the
GU tract. This will allow you to treat urinary retention, and bladder
outlet obstruction.

Urinary output is also a sensitive indicator of volume status and
renal perfusion (and thus tissue perfusion also).

In the emergency department, catheters can be used to aid in the
diagnosis of GU bleeding.

In some cases, as in urethral stricture or prostatic hypertrophy,
insertion will be difficult and early consultation with urology
is essential.


Foley catheters are contraindicated in the presence of urethral
trauma. Urethral injuries may occur in patients with multisystem
injuries and pelvic factures, as well as straddle impacts. If this
is suspected, one must perform a genital and rectal exam first.
If one finds blood at the meatus of the urethra, a scrotal hematoma,
a pelvic fracture, or a high riding prostate then a high suspicion
of urethral tear is present. One must then perform retrograde urethrography
(injecting 20 cc of contrast into the urethra).


Sterile gloves – consider Universal Precautions

Sterile drapes

Cleansing solution e.g. Savlon

Cotton swabs


Sterile water (usually 10 cc)

Foley catheter (usually 16-18 French)

Syringe (usually 10 cc)

Lubricant (water based jelly or xylocaine jelly)

Collection bag and tubing


Insertion of an urinary catheter

in a female

Insertion of an urinary catheter

in a male

Review the female anatomy

in more detail

Review the male anatomy

in more detail


  1. Gather equipment.
  2. Explain procedure to the patient
  3. Assist patient into supine position with legs spread and feet
  4. Open catheterization kit and catheter
  5. Prepare sterile field, apply sterile gloves
  6. Check balloon for patency.
  7. Generously coat the distal portion (2-5 cm) of the catheter
    with lubricant
  8. Apply sterile drape

  9. If female, separate labia using non-dominant hand. If male,
    hold the penis with the non-dominant hand. Maintain hand position
    until preparing to inflate balloon.
  10. Using dominant hand to handle forceps, cleanse peri-urethral
    mucosa with cleansing solution. Cleanse anterior to posterior,
    inner to outer, one swipe per swab, discard swab away from sterile

  11. Pick up catheter with gloved (and still sterile) dominant hand.
    Hold end of catheter loosely coiled in palm of dominant hand.
  12. In the male, lift the penis to a position perpendicular to
    patient’s body and apply light upward traction (with non-dominant
  13. Identify the urinary meatus and gently insert until 1 to 2 inches
    beyond where urine is noted
  14. Inflate balloon, using correct amount of sterile liquid (usually
    10 cc but check actual balloon size)
  15. Gently pull catheter until inflation balloon is snug against
    bladder neck
  16. Connect catheter to drainage system
  17. Secure catheter to abdomen or thigh, without tension on tubing
  18. Place drainage bag below level of bladder
  19. Evaluate catheter function and amount, color, odor, and quality
    of urine
  20. Remove gloves, dispose of equipment appropriately, wash hands
  21. Document size of catheter inserted, amount of water in balloon,
    patient’s response to procedure, and assessment of urine


The main complications are tissue trauma and infection. After 48
hours of catheterization, most catheters are colonized with bacteria,
thus leading to possible bacteruria and its complications. Catheters
can also cause renal inflammation, nephro-cysto-lithiasis, and pyelonephritis
if left in for prolonged periods.

The most common short term complications are inability to insert
catheter, and causation of tissue trauma during the insertion.

The alternatives to urethral catheterization include suprapubic
catheterization and external condom catheters for longer durations.


Urinary Catheter Types and Being Part of the Insertion Team

Slide 1: Urinary Catheter Types and Being Part of the Insertion Team

Slide 2: Learning Objectives

Upon completion of this session, licensed staff who insert or assist in the insertion of urinary catheters will be able to—

  • Explain the similarities and differences between the four different types of urinary catheters;
  • Prepare for and insert an indwelling urinary catheter using aseptic technique; and
  • Summarize effective strategies in preventing CAUTIs.

Slide 3: Indwelling Urinary Catheters


Images: Figure l. Routes of entry of uropathogens to catheterized urinary tract.
An image depicts the male and female lower urinary tract system, and the difference in placement of a catheter in the bladder.

Source: Maki DG, Tambyah PA. Engineering out the risk of infection with urinary catheters. Emerg Infect Dis. 2001 Mar-Apr;7(2):342-7.
*CMS, State Operations Manual, 2014.

1. Maki DG, Tambyah PA. Engineering out the risk for infection with urinary catheters. Emerg Infect Dis. 2001;7(2):342-7. PMID: 11294737.

Slide 4: Alternative Catheter Types

Straight Catheters

  • Inserted directly into the urethra and bladder.
  • Removed after insertion and drainage of bladder.
  • Used intermittently.

Suprapubic Catheters

  • Placed surgically directly through skin into the bladder.
  • Connected by tubing to a bag used to collect and measure urine.

External “Condom” Catheters for Men

  • Does not enter the bladder.
  • Four different types to adhere to the penis.
  • Connected by tubing used to collect and measure urine output.
  • Cannot be used to treat acute urinary retention.

Slide 5: Quiz


Which of the following are appropriate indications for placing an indwelling urinary catheter?

  1. Bladder outlet obstruction
  2. Urinary incontinence
  3. Incontinence and sacral wound
  4. Resident’s request for end-of-life
  5. Transferred from hospital with catheter

2. Gould CV, Umscheid CA, Agarwal RK, et al. Centers for Disease Control and Prevention. Guidelines for prevention of catheter-associated urinary tract infections 2009. Atlanta, GA: US Department of Health and Human Services, CDC; 2009. Accessed January 28, 2016.

Slide 6: Preparing to Place an Indwelling Urinary Catheter

  • Review the doctor’s order and verify that the catheter is clinically indicated.
  • Gather your catheter insertion kit and other supplies.
  • Use the buddy system—get a second pair of hands to help!

Image: Section of AHRQ poster showing appropriate indications for a urinary catheter.

Slide 7: Catheter Insertion Kit Contents


  • Drape with opening, sterile gloves.
  • Antiseptic solution for periurethral cleaning before insertion, swabs and tongs to use for applying antiseptic solution.
  • Single-use packet of lubricant.
  • Single-use dose of topical lidocaine jelly.
  • Sterile urinary catheter, of smallest size effective for patient (14 or 16 French) connected to tubing and bag.
  • Catheter securing device.

3. Willson M, Wilde M, Webb M, et al. Nursing interventions to reduce the risk of catheter-associated urinary tract infection: part 2: staff education, monitoring, and care techniques. J Wound Ostomy Continence Nurs. 2009;36(2):137-54. PMID: 19287262.

Slide 8: Prepping for Catheter Insertion Procedure


  • Cleanse hands and don gloves
  • Get your buddy to help at the bedside
  • Place resident in the supine position
  • For a female—apply topical lidocaine jelly if needed for comfort
  • For a male—if uncircumcised, retract foreskin. Inject 10-15 mL of topical lidocaine into urethral meatus; gently pinch tip of penis for several minutes to retain lidocaine
  • Inspect catheter kit and remove it from its outer packaging to form a sterile field
  • Remove gloves and wash hands!

3. Willson M, Wilde M, Webb M, et al. Nursing interventions to reduce the risk of catheter‐associated urinary tract infection: part 2: staff education, monitoring, and care techniques. J Wound Ostomy Continence Nurs. 2009;36(2):137-54. PMID: 19287262.

Slide 9: Hygiene and Standard PrecautionsCatheter Insertion Procedure


  • Don sterile gloves.
  • Cover resident’s lower abdomen and upper thighs with dignity cover.
  • Organize contents of tray on sterile field
    • Pour antiseptic solution over swabs in tray compartment.
    • Squeeze sterile catheter lubricant onto tray.

2. Gould CV, Umscheid CA, Agarwal RK, et al. Centers for Disease Control and Prevention. Guidelines for prevention of catheter-associated urinary tract infections 2009. Atlanta, GA: US Department of Health and Human Services, CDC; 2009. Accessed January 28, 2016.
3. Willson M, Wilde M, Webb M, et al. Nursing interventions to reduce the risk of catheter‐associated urinary tract infection: part 2: staff education, monitoring, and care techniques. J Wound Ostomy Continence Nurs. 2009;36(2):137-54. PMID: 19287262.

Slide 10: Male Catheter Insertion Procedure

  • Using gloved nondominant hand, grasp penis taut and perpendicular to the plane of the resident’s body.
  • Cleanse the glans of penis using the antiseptic soaked swabs using tongs, in expanding circular motion. Discard used swabs away from sterile field.
  • Keep nondominant hand in this position, do not remove!
  • Lubricate tip of catheter with sterile lubricant jelly.
  • Holding the coiled catheter in dominant hand, gently introduce the catheter tip into the urethral meatus.
    • If using coude catheter, point catheter tip upward to 12 o’clock position.
  • Slowly advance the catheter through the urethra into the bladder. If substantial resistance is met, do not force the catheter!
  • If tip of catheter is accidentally contaminated by touching anything that is not sterile, discard, and get a new one.

Slide 11: Female Catheter Insertion Procedure

  • Using gloved nondominant hand, identify urethra by spreading the labia
    • Spread inner labia slightly with gentle traction and pull upwards toward resident’s head.
    • Clean periurethral area and urethral opening using antiseptic soaked swabs using tongs, in expanding circular motion. Discard used swabs away from sterile field.
  • Lubricate tip of catheter with sterile lubricant jelly.
  • Holding the coiled catheter in dominant hand, gently introduce the catheter tip into the urethral meatus.
  • Slowly advance the catheter through the urethra into the bladder. If substantial resistance is met, do not force the catheter!
  • If catheter is accidentally contaminated by touching anything that is not sterile, discard, and get a new one.
  • If catheter is accidentally inserted in to vagina, discard, and get a new one.

Slide 12: Securing Drainage Bag

  • Advance tubing another 3-5 cm once you see urine in the tubing
    • Inflate balloon with 10 cc sterile water
  • Once inflated, pull gently on catheter to make sure it’s secure
  • Secure catheter to medial thigh
  • Place drainage bag below the level of the bladder
  • Remove personal protective equipment and wash hands immediately

Slide 13: Insertion Avoiding Common Mistakes


  • Wash hands BEFORE and AFTER procedure
  • Put on your sterile gloves after opening catheter kit
    • If sterile, gloved hand gets contaminated or glove rips, then remove glove, wash hands, and don NEW sterile gloves
  • Sterile urinary catheters can get contaminated by touching labia, being inserted into vagina, or touching any other part of body besides cleansed urethra
    • If this happens, STOP procedure and get NEW sterile catheter to use
  • Use tongs to cleanse the urethral area with your sterile hand
  • Do not switch hands

4. Manojlovich M, Saint S, Meddings J, et al. Indwelling urinary catheter insertion practices in the emergency department: an observational study. Infect Control Hosp Epidemiol. 2016;37(1):117-9. PMID: 26434781.

Slide 14: References

  1. Maki DG, Tambyah PA. Engineering out the risk for infection with urinary catheters. Emerg Infect Dis. 2001;7(2):342-7. PMID: 11294737.
  2. Gould CV, Umscheid CA, Agarwal RK, et al. Centers for Disease Control and Prevention. Guidelines for prevention of catheter-associated urinary tract infections 2009. Atlanta, GA: US Department of Health and Human Services, CDC; 2009. Accessed January 28, 2016.
  3. Willson M, Wilde M, Webb M, et al. Nursing interventions to reduce the risk of catheter‐associated urinary tract infection: part 2: staff education, monitoring, and care techniques. J Wound Ostomy Continence Nurs. 2009;36(2):137-54. PMID: 19287262.
  4. Manojlovich M, Saint S, Meddings J, et al. Indwelling urinary catheter insertion practices in the emergency department: an observational study. Infect Control Hosp Epidemiol. 2016;37(1):117-9. PMID: 26434781.

Equipment, Patient Preparation, Monitoring and Follow-up


Gil Z Shlamovitz, MD, FACEP Associate Professor of Clinical Emergency Medicine, Keck School of Medicine of the University of Southern California; Chief Medical Information Officer, Keck Medicine of USC

Gil Z Shlamovitz, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association

Disclosure: Nothing to disclose.

Chief Editor

Edward David Kim, MD, FACS Professor of Urology, Department of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American Society for Reproductive Medicine, American Urological Association, Sexual Medicine Society of North America, Society for Male Reproduction and Urology, Society for the Study of Male Reproduction, Tennessee Medical Association

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Endo, Antares.


Andrew K Chang, MD Associate Professor, Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center

Andrew K Chang, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Luis M Lovato, MD Associate Clinical Professor, University of California, Los Angeles, David Geffen School of Medicine; Director of Critical Care, Department of Emergency Medicine, Olive View-UCLA Medical Center

Luis M Lovato, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.


The authors and editors of Medscape Reference gratefully acknowledge the assistance of Lars Grimm with the literature review and referencing for this article. They also thank Michel Rivlin, MD, and G Rodney Meeks, MD, for the videos and several of the images in this article.

Suprapubic Catheter | Bladder & Bowel Community

Who inserts a suprapubic catheter?

The doctor will insert your first suprapubic catheter during the initial operation. A small balloon at the tip of the catheter is inflated to prevent it falling out. A doctor or nurse can change the catheter in your home, or in their surgery or urology department. You, or a member of your family, may also be taught to change the catheter. You must not try to remove it without medical advice.

What happens to the urine?

There are two options:

  1. Free drainage – where the urine drains out from the catheter and is then generally stored in a drainage bag.
  2. Catheter valve – a valve at the end of the catheter used in place of a drainage bag. Urine is stored in the bladder and is emptied through the catheter straight into the toilet or bag.

There are several different types of drainage bag: leg bags held in place with straps or in a holster and worn under your normal clothes during the day, night drainage bags which are attached to a leg bag at night, a Belly Bag is also appropriate to use with a supra-pubic catheter.  This bag is attached to the catheter and held in place around the waist.  A night drainage bag is much larger and is attached to the leg bag to hold all the urine that drains from the bladder overnight.

B&BC has an information sheet with further details of drainage bags in the downloads section.

How often does a suprapubic catheter need changing?

The first catheter change is usually always done in the hospital/clinic that put the catheter in. After this, it can vary from 4-12 week intervals depending on the type of catheter and your own situation and will usually be done by your nurse.

If the suprapubic catheter comes out unexpectedly, it must be replaced within a short time.  Contact your doctor or nurse as soon as possible.  Out of normal working hours, you should proceed to Accident & Emergency.

How do I look after my suprapubic catheter?

Always wash your hands before and after emptying your catheter bag, or before and after emptying your bladder using the valve. You should wash the area around the insertion site with cooled boiled water once or twice a day.  Some people find cleaning the wound with a sterile saline solution a good method of keeping the area clean.

A dressing will cover the wound after the operation and you should keep it in place until the wound has healed. Although not always necessary, many people prefer to wear a dressing around the wound all the time. The type of dressing may vary, your healthcare professional will be able to advise you of an appropriate dressing. Do not put any creams or talc around the site.  To prevent pulling, it may be advisable to secure the catheter to the abdomen with a fixation device or tape.  Your health care professional will advise you if this is necessary and help you decide on the best method.

In order to prevent urinary infections and encourage drainage, you should ensure you have an adequate daily fluid intake (average being 1.5 to 2 litres). A good mix of fluid types is recommended i.e. water, squash and juice. Keep bladder-irritating drinks e.g. tea, coffee and fizzy drinks to a minimum.  Cranberry juice can be helpful to prevent bladder infections but should be avoided if you are taking Warfarin. Try to avoid constipation – make sure that you include wholemeal bread, fruit and vegetables in your diet.

It is better to take showers rather than baths as sitting in water for long periods may delay the wound from healing. For the first few days after the operation, you should keep a waterproof dressing on. Once the wound has healed it is perfectly okay to shower normally, although avoid using scented products as these can irritate the skin.

What kind of problems should I watch out for?

Here are some of the problems to watch for:

  • Urine stops draining out of the catheter
  • You feel unwell with pain, fever and abdominal discomfort
  • Urine is leaking around the catheter – this can be normal around a new catheter site
  • The area around the catheter becomes red and sore
  • Bleeding. It is not unusual to see blood in the urine following a change of catheter but this usually settles in 24 hours.

Occasionally the skin around the catheter heals over and small skin tags form.   If they become problematic i.e. bleed easily and interfere with catheter changes, they can be treated by your healthcare professional.

Some healthcare professionals recommend turning the catheter when cleaning the area to help prevent the catheter sticking to the bladder wall.
If you notice anything unusual or feel unwell, contact your doctor or nurse.

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    Peripherally inserted central catheter (PICC) line


    A peripherally inserted central catheter (PICC), also called a PICC line, is a long, thin tube that’s inserted through a vein in your arm and passed through to the larger veins near your heart. Very rarely, the PICC line may be placed in your leg.

    A PICC line gives your doctor access to the large central veins near the heart. It’s generally used to give medications or liquid nutrition. A PICC line can help avoid the pain of frequent needle sticks and reduce the risk of irritation to the smaller veins in your arms.

    A PICC line requires careful care and monitoring for complications, including infection and blood clots. If you’re considering a PICC line, discuss the benefits and risks with your doctor.

    A PICC line is one type of catheter used to access the large veins in your chest (central venous catheter). Examples of other types of central venous catheters include implantable ports and central lines.

    Video: PICC line placement

    Show transcript for video Video: PICC line placement

    The veins in your arms are called peripheral veins. That simply means they’re not in the center part of your body. A catheter inserted into a peripheral vein and guided to a central vein is called a peripherally inserted central catheter. It’s also called a PICC line. PICC line placement involves inserting a PICC line into a large blood vessel that leads to your heart.

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    Why it’s done

    A PICC line is used to deliver medications and other treatments directly to the large central veins near your heart.

    Your doctor might recommend a PICC line if your treatment plan requires frequent needle sticks for medicine or blood draws. A PICC line is usually intended to be temporary and might be an option if your treatment is expected to last up to several weeks.

    A PICC line is commonly recommended for:

    • Cancer treatments. Medicines that are infused through a vein, such as some chemotherapy and targeted therapy drugs, can be delivered through a PICC line.
    • Liquid nutrition (total parenteral nutrition). If your body can’t process nutrients from food because of digestive system problems, you may need a PICC line for receiving liquid nutrition.
    • Infection treatments. Antibiotics and antifungal medicines can be given through a PICC line for serious infections.
    • Other medications. Some medicines can irritate the small veins, and giving these treatments through the PICC line reduces that risk. The larger veins in your chest carry more blood, so the medicines are diluted much faster, reducing the risk of injury to the veins.

    Once your PICC line is in place, it can be used for other things, too, such as blood draws, blood transfusions and receiving contrast material before an imaging test.


    PICC line complications can include:

    • Bleeding
    • Nerve injury
    • Irregular heartbeat
    • Damage to veins in your arm
    • Blood clots
    • Infection
    • A blocked or broken PICC line

    Some complications can be treated so that your PICC line can remain in place. Other complications might require removing the PICC line. Depending on your situation, your doctor might recommend placing another PICC line or using a different type of central venous catheter.

    Contact your doctor right away if you notice any signs or symptoms of PICC line complications, such as if:

    • The area around your PICC line is increasingly red, swollen, bruised or warm to the touch
    • You develop a fever or shortness of breath
    • The length of the catheter that sticks out of your arm gets longer
    • You have difficulty flushing your PICC line because it seems to be blocked
    • You notice changes in your heartbeat

    How you prepare

    To prepare for your PICC line insertion, you might have:

    • Blood tests. Your doctor may need to test your blood to make sure you have enough blood-clotting cells (platelets). If you don’t have enough platelets, you may have an increased risk of bleeding. Medicine or a blood transfusion can increase the number of platelets in your blood.
    • Imaging tests. Your doctor might recommend imaging tests, such as an X-ray and ultrasound, to create pictures of your veins to plan the procedure.
    • A discussion of your other health conditions. Tell your doctor if you’ve had breast-removal surgery (mastectomy), as that may affect which arm is used for placing your PICC line. Also let your doctor know about previous arm injuries, serious burns or radiation treatment. A PICC line generally isn’t recommended if there’s a chance you may one day need dialysis for kidney failure, so let your doctor know if you have a history of kidney disease.

    What you can expect

    The procedure to insert the PICC line takes about an hour and can be done as an outpatient procedure, meaning it won’t require a hospital stay. It’s usually done in a procedure room that’s equipped with imaging technology, such as X-ray machines, to help guide the procedure. PICC line insertion can be done by a nurse, doctor or other trained medical provider.

    If you’re staying in the hospital, the procedure might be done in your hospital room.

    During PICC line insertion

    During the PICC line insertion you’ll lie down on your back with your arm extended to your side. You’ll be awake during the procedure, but numbing medicine will be used to minimize discomfort.

    A PICC line is usually inserted in a vein in your upper arm, above your elbow. Which arm is used depends on your particular situation, but usually the nondominant arm is used.

    The doctor or nurse may use an ultrasound machine to assess the veins in your arm and make sure they’re healthy enough to use for the PICC line. You might have a cuff tightened around your arm so that your veins stand out for inspection.

    Once a suitable vein is identified in your arm, the skin around the area is cleaned and prepared. Numbing medicine is injected into the skin to minimize pain.

    To place the PICC line, a needle is inserted through your skin and into the vein in your arm. Ultrasound or an X-ray might be used to confirm the placement. A small incision is made in the vein so that a thin, hollow tube (catheter) can be inserted.

    Once the catheter is in your arm, it’s carefully advanced along the vein. The catheter continues up your arm and toward your heart.

    When the catheter reaches the right location, you might have an X-ray to verify the catheter is in place. If the procedure is being done in your hospital room, the doctor or nurse may use a heart-monitoring device to determine that the catheter has reached the correct location. You might have an X-ray later.

    The other end of the catheter will stick out of your arm. A cap is placed over the end of the catheter to keep it free of germs. It may be taped down so it won’t get in the way of your daily activities.

    After PICC line insertion

    After a PICC line insertion, there may be some tenderness in the area where the catheter enters your arm. It should go away within a few days.

    As you adjust to life with a PICC line, you’ll need to consider:

    • PICC line protection. Your doctor may recommend specific ways to protect the arm with the PICC line. For instance, don’t lift heavy objects and don’t have blood pressure readings taken on the affected arm. Your doctor might recommend avoiding jarring activities with your arm, such as throwing a ball. Avoid submerging the PICC line in water, such as might happen with swimming or using a hot tub.
    • PICC line care. A nurse or other provider will show you how to care for your PICC line. This might involve checking the area daily for signs of infection and flushing the line with solution weekly to keep it clear from clogs. It’s easier if you have someone to help you with PICC line care. If you need help, you might consider hiring a home health care provider.
    • PICC line covers. You’ll need to cover your PICC line when you take a shower, as the area shouldn’t get wet. Your doctor or nurse might provide a cover or you can buy one at a drugstore. Other PICC line covers are available for daily use to protect the area or make it less obvious to other people.


    Your PICC line is kept in place for as long as you need it for treatment.

    PICC line removal

    Your PICC line can be removed when your treatment ends. To remove the line, a doctor or nurse gently pulls on the end of the catheter to remove it from your arm.

    PICC line removal reduces your risk of complications, such as infection. But if there’s a chance you may need a PICC line again, your doctor may recommend keeping it in place. That’s because repeatedly placing the PICC line increases the risk of damage to your veins.

    90,000 Peripheral catheters and the risk of infection: if you see something – so don’t be silent about it!

    print version

    By Russ Nassof

    Anyone who has ever entered a hospital as a patient or visitor has undoubtedly noticed patients with IVs, which now look like plastic tubes attached to an arm, stuck into bottles from which some kind of liquid drips. It can be drugs, solutions for replenishing the lack of fluid – in a word, everything that happens to be administered to a person, in addition to through his gastrointestinal tract.In most cases, in such patients there is a thin tube – a catheter in the peripheral vein, sometimes it is called the slang word “intravenous”.

    A great variety of venous catheters are now manufactured and sold, and this is the most commonly used device for providing venous access in the United States (more than 300 million catheters are used in hospitals alone per year), practically, there is one catheter per inhabitant of the country per year. Approximately 70% of patients in the hospital require peripheral vein catheterization during hospitalization.

    Unfortunately, most people are not familiar with such a problem as a hospital infection, which kills 100,000 people every year, and today, in case of emergency medical care, a hospital infection develops in one out of 20 patients. These infections can occur with any violation of the integrity of the skin, when the gateway opens for pathogenic microorganisms, they can end up in the bloodstream and cause, without exaggeration, a catastrophe.

    When a vein is catheterized, both the catheter and the needle pass through the skin; The needle, of course, is then removed, but the catheter remains, that is, 300 million catheterizations per year – this is three hundred million entrance gate for infection! And although most studies suggest that the risk of catheter infection in this case is below 0.1%, three hundred thousand cases – this is a terrifying figure!

    A recent study showed that approximately 10,000 cases of bacterial (staphylococcal) infections in the United States per year are the result of peripheral catheters, and most importantly, in many cases, the source of the infection remains unrecognized as such catheters are used. within a short time, and the patient has time to forget about the use of such a catheter before clinical signs of infection appear.

    Despite the rather heterogeneous information that can be obtained from studies of catheter-associated infections, there are well-known risk factors for such complications that need to be identified early and that everyone should know so that one day you or the person you are love, did not fall victim to catheter infections by waking up with a catheter in a vein. It doesn’t matter that this very catheter costs only a few hours. Many problems arise directly during the installation of the catheter, and some – while the catheter is in the vein.

    Several risk factors are listed below.

    Place of insertion of the catheter and its installation

    If the site of insertion of the catheter or the sticker on it becomes contaminated, you should immediately inform the staff about it.

    For adults, catheters are usually placed in the arm, if not, ask why.

    Check how experienced the nurse is in inserting the catheter, as insertion of the catheter is critical and thorough skin disinfection is required prior to inserting the catheter.

    Catheter Care

    Catheters should be flushed regularly to maintain patency, ask if this has not been done.

    Reliable fixation of the catheter is very important: it must be tightly fixed with a plaster and be immobile, if you feel that it moves, immediately inform the staff.

    Personnel should check the condition of the catheter at least once a day to ensure that you are not experiencing any complications. There is still no consensus about how long a peripheral catheter can be left in a vein and when to move the catheter.In any case, it will be useful to find out how it is done in the institution where you are being treated.

    While some of the above seems self-evident, it is surprising how many patients and their loved ones feel that it is “uncomfortable” to ask questions, it is “not good” to disturb staff even when they feel that something has gone wrong.

    Unfortunately, until now the workload on the nurse remains very large and everything is only complicated if one of the patients begins to be persistently interested in the nursing process.But everyone – both healthcare providers and patients – needs to understand that early detection of problems with peripheral catheters saves lives, saves a lot of money, reduces hospital stay, and open relationships with patients increase the safety of medical care.

    Foley catheter: an effective method of stimulating labor

    Foley catheter helps not only patients with diseases of the genitourinary system. Often, obstetricians and gynecologists choose it as a method of stimulating labor.How does it work in this case, and can its use lead to complications?

    Indications for use

    The main indication is absent or extremely weak labor at the onset of labor. Doctors switch to stimulating them if a woman is unable to give birth to a child on her own. There are different methods for stimulation, and a Foley catheter is used when the following indications are present:

    • fetus prolongation for 10 days or more,
    • diseases in women in labor: heart disease, severe forms of preeclampsia, hypertension, diabetes mellitus,
    • high blood pressure, physical weakness,
    • earlier discharge of amniotic fluid or their excess,
    • very large fetus or multiple pregnancies,
    • non-opening cervix, when contractions have already begun.

    Also, the catheter is used if the woman in labor has contraindications that do not allow resorting to other methods of stimulating labor.

    Foley catheter for cervical dilatation

    The insertion of this type of catheter stimulates the dilatation of the cervix. This procedure should be performed exclusively by a doctor or qualified medical personnel.

    Preparation for catheter insertion includes:

    • cleaning the vagina with a disinfectant,
    • sterile mirror installation,
    • Removing the catheter from the packaging with sterile gloves.

    Then the doctor proceeds to insert the catheter:

    • takes it with a clamp, so as not to violate sterility,
    • very carefully inserts through the cervix so that the balloon remains over its internal os,
    • Fills the balloon with saline with a medical syringe,
    • the outer end of the catheter is attached to the inner surface of the thigh.

    How long does labor start after the Foley catheter is inserted?

    The principle of its action is very simple – a filled balloon presses down on the uterus and exerts an expanding effect on it, thereby increasing its tone and motor skills.The time during which the effect of the installation of the Foley catater occurs is individual – but most often the uterus begins to contract after about 6 hours. However, sometimes the child is ready to be born in just an hour, but in some cases, this will require waiting from 8 to 12 hours.

    Foley Catheter Care

    While a woman is waiting for the onset of labor, she needs to carefully monitor the position and condition of the catheter in order to avoid unpleasant consequences. For this you need:

    • Wear cotton underwear that does not restrict movement,
    • Ensure that the Foley catheter does not fall out and that the tube does not bend or pinch.

    Foley catheter removal

    The procedure for removing the catheter should be carried out only by the attending physician, in two stages:

    • through the 2nd passage of the catheter, with a syringe, remove all liquid from the balloon,
    • pull the tube out with a clamp and gently pull it out of the vagina.

    Almost always, a patient with a Foley catheter remains in the hospital until labor begins. Very rarely, such women in labor are allowed to go home. if the catheter falls out, only a doctor can replace it. Any independent manipulations with the catheter are strictly prohibited!

    Possible complications when using a catheter

    • Severe pain during catheter insertion – in this case, the doctor can administer intravenous pain relievers,
    • Catheter prolapse – the doctor can insert a new one or choose a different method of stimulating labor,
    • Labor has begun, but the catheter is still inside – then the nurse or the doctor himself removes it from the uterus.

    Contraindications to the use of Foley catheter

    In some cases, the use of a two-way catheter can complicate the course of labor or even cause intrauterine infection of the fetus, and therefore Foley is not used in the following situations:

    • the presence of an infection in the vagina that causes inflammatory processes – cervitis (in the cervix), vaginitis (in the vaginal mucosa, etc.),
    • low placenta previa,
    • internal bleeding,
    • rupture of the amniotic fluid.

    If you have been prescribed stimulation of labor with a Foley catheter, then you can purchase them in the Sterilo.com online store. Our advantage is direct cooperation with all manufacturers presented in the catalog. And also leave feedback on your experience using this method of stimulating labor. Your review will be important and useful for expectant mothers!

    Related articles:

    Cystostomy (Epicystostomy) – Catheter Care, Patient Guide



    What is a suprapubic urinary catheter – cystostomy (epicystostomy)?
    The suprapubic urinary catheter is a hollow, flexible tube that is used to drain urine from the bladder.It is inserted into the bladder through a small incision in the abdomen above the pubis below the navel. This is usually done by a urologist under local or general anesthesia in the operating room.

    Why do I need a suprapubic urinary catheter – cystostomy (epicystostomy)?
    Anyone who cannot urinate on their own needs a urinary catheter. A suprapubic catheter may be chosen because it is more comfortable and less likely to develop a urinary tract infection.

    Other causes may include:
    • Traumatic injury to the urethra (urethra).
    • In patients who require prolonged catheterization and are sexually active
    • After some gynecological operations
    • Some patients who use a permanent wheelchair, this method is preferred
    • People who cannot catheterize on their own

    Advantages of a cystostomy:
    When a catheter is used for a long time through the urethra, it leads to its damage.Also, a balloon urethral catheter damages the bladder neck, leading to urine leakage along the catheter.
    • The catheter is less likely to be pulled out of the bladder
    • If the suprapubic catheter becomes blocked (clogged), it can cause urine to leak through the urethra, which is a “precautionary mechanism”.
    • A suprapubic catheter leaves your genitals free for sexual activity.
    • Easier to maintain hygiene around the suprapubic catheter site.
    • If you have normal hand function, you can change the suprapubic catheter yourself, the urethral catheter is more difficult to change.
    • The procedure is reversible. The catheter site quickly becomes overgrown after the tube is removed.
    • Thicker size is used to reduce the likelihood of catheter malfunction. The urethral catheter is usually no thicker than 16-18 CH, while the suprapubic catheter can be wider.

    Disadvantages of a cystostomy – what are the risks?
    • Some patients have hypersensitivity around the catheter, most often this will disappear over time.
    • If you are overweight, placing a suprapubic catheter can be problematic.
    • The catheter site may be wet. For most, it goes away within a few weeks, while for some it may be permanent. This requires a simple small bandage around the tube.
    • Bladder and urethral spasms may occur.
    • All indwelling urinary catheters inserted into the bladder are more likely to develop infections and inflammation than intermittent self-catheterization or penile forceps for incontinence.
    • Over time, catheters may become blocked (clogged).

    How to prevent cystostomy prolapse?
    First, after the catheter insertion operation, the tubes are sutured to the skin. You may also have a sticker slightly farther than the skin entry point to prevent the catheter from being pulled out if it is accidentally pulled. Some catheters in the bladder may inflate the balloon, preventing prolapse. After 4-5 weeks, the stitches are usually cut. By this time, it is necessary to replace the catheter.

    How can urine be passed?
    There are 2 options:
    Free flow: urine flows freely through the tube into the drainage bag.
    Closing the catheter: A clamp valve closes the suprapubic catheter, urine accumulates in the bladder and is emptied into the toilet or drainage bag. Your urologist will advise you on which method is best for you.
    If the placement of the catheter is prolonged (more than 1 month), you should be sure to close the bladder training catheter.Failure to do so will result in bladder shrinkage.

    How often should the catheter be changed?
    The first time the catheter should be replaced 6-8 weeks after insertion. Your catheter can then be changed every 4 to 8 weeks with the help of your local urology nurse. You or family members can learn how to make the replacement yourself, it’s not difficult.
    There may be blood in the urine after replacement, but most often this stops within 24 hours.

    What should I do with the urine collection bag (drainage bag)?
    There are 2 types of bags:
    Day bag
    This is a bag that is attached to the leg with straps.There are many different types of drainage bags, your doctor may recommend which one is best, although this does not really matter.

    Night bag
    Used when you sleep. They are large in size and may or may not have a drain valve.

    On average, the drainage bag should be replaced every 5-7 days according to the manufacturer’s instructions. If the bag is damaged or visually dirty, it should be replaced.

    DISPOSAL.The bag should be tied up and discarded with general trash.

    Care of the bladder and suprapubic catheter (cystostomy).

    HYGIENE is the most important element of life with a suprapubic catheter (epicystostomy).

    The most common problem with cystostomy is a urinary tract infection that enters the bladder through or around the catheter.

    • Always wash your hands before and after manipulating the catheter, before and after emptying your bladder if you are using an accumulation technique.
    • Empty the leg bag when it is half full.
    • Do not let the urine bag come into contact with the toilet when you are flushing urine down the toilet, wipe the valve after flushing.
    • Wash around the site where the tube enters your skin with warm water and soap 1-2 times a day, or wipe with a damp cloth.
    • It is not necessary to apply a dressing around the catheter after the wound has healed, although some people prefer to wear it all the time.
    • In rare cases, the skin around the catheter may overgrow.Don’t worry about this. If this creates problems (bleeding, pain), see your doctor.
    • Showers are preferred over prolonged baths when possible. Avoid scented products, talcum powder, creams as they can cause irritation.
    • Whenever possible, shower daily, leaving all tubing in place.
    • Wash the catheter gently using a longitudinal motion.
    • You should drink at least 2 liters of fluid daily to flush your kidneys and bladder and to prevent urinary tract infections.
    • Minimize irritating liquids (tea, coffee, soda).
    • Try to avoid constipation by eating wholemeal bread and 5 servings of fruit or vegetables daily.
    • Use hip straps to prevent yanking of the catheter.
    • Alternate legs (right-left) during the day that you wear the bag to prevent the catheter from slipping.
    • It is best to always have a spare catheter of similar size with you. If the catheter falls out, you can put it back in for a short time (60 minutes) until the opening is closed.Seek medical attention as soon as possible.
    • Drugs may be needed to relieve bladder and urethral spasms. Please consult about it.

    Can I have sex with an existing cystostomy?
    Yes. The suprapubic catheter does not decrease sexual performance.

    Can I go to the pool (swim) with a cystostomy?
    Yes, you can. After the wound has healed, you can go to the pool where the water is clean and treated.Then make sure the catheter site is clean and dry. Good hygiene is paramount to prevent infection. There are smaller swimming pool bags available.

    Possible problems:
    • The catheter fell out.
    • There is no urine flow through the catheter
    • You feel pain, fever, abdominal discomfort.
    • Urine flows along the catheter — this may be normal after you change the catheter.
    • The area around the catheter becomes red and inflamed
    • Bleeding

    You should see a doctor if you see a disruption in the normal operation of the catheter.

    cystoma, cystoma care, folley catheters, urine bags

    Cystoma (Cystostomy) is an artificial opening in the abdominal wall into the bladder created by the surgeon to drain urine. Cystoma is also called suprapubic drainage, suprapubic fistula, epicystostomy. The surgical method is called Cystostomy.

    A cystoma is created to drain urine if it does not pass naturally for various reasons – injuries of the bladder, urethra, benign formations, prostate adenoma, malignant tumors, in bedridden patients (spinal cord injury), etc.d.

    Accessories for the patient with cystostomy.

    To drain urine, a cystomy drainage is created, which most often consists of a Foley catheter and a urine collection bag (urine collection bag).

    The Folley catheter has a balloon that inflates the field of introduction into the catheter and therefore is kept in the bladder. One port of the catheter is used to divert urine, the other to inflate the balloon (two-way catheter). There are also three-way Foley catheters (third port for flushing and administering drugs into the bladder).

    Recommendations for the care of cystoma:

    • Care should be taken to ensure that the catheter and urine collection tube are not twisted or pinched, as a constant outflow of urine is required.
    • On the recommendation of the attending physician, training of the bladder and prevention of its shrinkage is necessary. To do this, the catheter tube is clamped several times a day for several hours to simulate the act of urination.You cannot pinch the tube at night.
    • It is important to maintain cleanliness around the cystoma, for this you need simple baby soap, antiseptics and ointments as recommended by a doctor. The skin around the cystoma is washed with running water.
    • For hygiene of the whole body, the patient with cystoma is advised to use a shower and refuse to take a bath.
    • It is impossible to flush the catheter on your own, as it is possible for fluid to enter the lumen of the bladder under pressure, which can provoke the development of an infection.
    • It is necessary to drink more than 2 liters of water per day, then the system will be flushed naturally.
    • The urine collection bag must be secured below the bladder, both day and night. At night, it is recommended to secure the bag on the bed, below the level of the bladder.
    • The bag should be replaced before it reaches the maximum level. The large (night bag) 1.5 – 2 liters should be replaced every 8 hours, the small bags (up to 1 liter) every 4 hours.
    • Urine is drained from the urine bag and only through a special valve.
    • It is recommended to change the catheter once a week (self-replacement is possible only by agreement with the attending physician after training). If necessary, replace the catheter (cystostomy drain) more often, or less often with the permission of the doctor.

    Cases when you need to urgently contact a urologist with a cystostomy:

    1. Catheter prolapse. If you cannot replace it yourself, you should consult a doctor within 2-3 hours.Late presentation increases the likelihood that it will be necessary to undergo surgery to create a new opening (cystostomy fistula).
    2. Appearance of blood in the urine (urine becomes red, brown)
    3. Increase in body temperature above 38 degrees.
    4. Inflammation, maceration of the skin around the fistula is a sign of infection that requires treatment.
    5. Severe pain in the lower back, in the side, as well as nausea, vomiting and fever.
    6. Reduction of urine flow or complete cessation of its flow through the catheter.
    7. Leakage of urine past the catheter, through a cystomic fistula.

    90,000 Urinary catheter care – Vera Hospice Charitable Foundation

    You can download the memo here .


    The portal “About palliative” contains all reminders about caring for a seriously ill person .

    When a patient has a catheter in place, a bladder infection may not always be prevented, but it can be less likely to occur.

    Please note that all manipulations are carried out after thorough washing of hands and preferably with gloves .

    Wash the area around the catheter with soap and water twice a day to avoid irritation and infection. Also, wash the person after each bowel movement. After washing thoroughly, lightly dry the skin.

    When wiping after bowel movement, washing and drying the perineum, women should move from front to back to prevent bacteria from the rectum from entering the catheter and urinary tract.

    Rinse the bag with water daily. You can add a 3% solution of table vinegar to the water at the rate of 1: 7.
    Empty the bag every 3-4 hours.
    Always keep the bag below the level of the bladder.

    Tell your doctor immediately if urine leaks from under the catheter, abdominal pain, bloating, blood or flakes in the urine. If the catheter becomes clogged or painful, it must be replaced immediately.
    Never pull on the catheter.Disconnect the catheter only to flush or replace it, or empty the drainage bag.

    Reasons for leaking urine: catheter too thin, balloon not inflated enough, catheter or urine collection tube kinked, catheter blockage.
    If the outflow of urine has ceased to take place, the reasons may be:

    • Kinked catheter or urine collection tube,
    • insufficient intake of fluid in the body (increase the amount of fluid consumed),
    • the urinal is fixed too high (lower it below the level of the bladder),
    • catheter blockade,
    • impaired renal function (anuria) with deterioration of the patient’s condition.

    The catheter installed in the bladder can be washed by the patient himself or his family. A warm saline solution is used for rinsing. If sediment or flocs appear in the urine, flush the catheter with furacilin solution. At home, you can prepare a solution of two furacilin tablets dissolved in 400 ml of boiled water. Strain the solution through a double layer of cheesecloth. You can buy a ready-made solution at a pharmacy. Also suitable are 3% boric acid solution, dioxidine diluted in a ratio of 1:40, miramistin, 2% chlorhexidine solution.

    Flush the catheter with a 50 or 100 milligram syringe (Janet’s syringe). Rinse the syringe with boiling water before use, and in between store in a disinfectant solution: 3% chloramine or 2% chlorhexidine. The solutions are sold at the pharmacy. Having disconnected the tube from the urine bag, treat its end from the outside with a solution of furacilin or any antiseptic solution. Then draw the solution into the syringe, insert the cannula of the syringe into the opening of the tube and slowly inject the solution, starting in small portions (20-30 ml). After the introduction of portions of the solution, remove the syringe from the catheter.The solution will flow freely.
    If a therapeutic effect on the mucous membrane of the bladder is required, washing can be daily. In other cases – as needed.

    We hope that our recommendations will help you.

    And remember that you can always contact the hotline for the terminally ill people :

    8 800 700 84 36

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    How to support hospice patients?

    It is very easy to support hospice patients. You can subscribe to monthly donations (by checking the box in front of “I want to donate monthly” ) or make a one-time donation :

    Thank you always.