Urine catheter procedure: Urinary catheterisation – Tests & treatments
Urinary catheterisation – Tests & treatments
It’s possible to live a relatively normal life with a long-term urinary catheter, although it may take some getting used to at first.
Before being discharged from hospital, a specialist nurse will give you detailed advice about looking after your catheter.
You will be given a supply of equipment to take with you when leaving hospital, and told where to get further supplies in the future. In most cases, catheter equipment is available on prescription from pharmacies.
You will also be shown how to empty and change your equipment.
If you have been taught to use intermittent catheters, you should insert them several times a day to drain urine into a toilet or bag. These catheters are usually designed to be used once and then thrown away.
How often intermittent catheters need to be used differs from person to person. You may be advised to use them at regular intervals spaced evenly throughout the day, or only when you feel you need the toilet.
Indwelling catheters can either drain into a bag attached to your leg, which has a tap on the bottom so it can be emptied, or they can be emptied into the toilet or suitable receptacle directly using a valve.
Bags should be emptied before they become completely full (around half to three-quarters full). Valves should be used to drain urine at regular intervals throughout the day to prevent urine building up in the bladder.
Both bags and valves should be replaced and thrown away about every 5 to 7 days.
At night, you will need to attach a larger bag to your valve or regular bag. This should be placed on a stand next to your bed, near the floor, to collect urine as you sleep. Depending on the type of night bag you have, it may need to be thrown away in the morning or it may be emptied, cleaned and reused for up to a week.
The catheter itself will need to be removed and replaced at least every 3 months. This will usually be done by a doctor or nurse, although sometimes it may be possible to teach you or your carer to do it.
Preventing infections and other complications
Having a long-term urinary catheter increases your risk of developing urinary tract infections (UTIs), and can also lead to other problems, such as blockages.
You will be advised about measures to take to minimise these risks, such as:
- regularly washing your hands, body and catheter with warm water and soap – it’s particularly important to clean your hands before and after touching your equipment
- ensuring you stay well hydrated – you should aim to drink enough fluids so that your urine stays pale
- preventing constipation – staying hydrated can help with this, as can eating high-fibre foods such as fruits, vegetables and wholegrain foods
- avoiding kinks in the catheter and making sure any urine collection bags are kept below the level of your bladder at all times
Read more about the risks of urinary catheterisation.
Your regular activities
Having a urinary catheter shouldn’t stop you from doing most of your normal activities. You will be advised about when it is safe for you to go to work, exercise, go swimming, go on holidays, and have sex.
If you have an intermittent or suprapubic (inserted through your tummy) catheter, you should be able to have sex as normal.
Indwelling catheters can be more problematic, but it’s still usually possible to have sex with them in place. For example, men can fold the catheter along the base of their penis and cover them both with a condom.
In some cases, you may be taught how to remove and replace the catheter so you can have sex more easily.
When to seek medical advice
You should contact a district nurse or nurse practitioner (you may be given a phone number to call before discharge from hospital) or your GP if:
- you develop severe or persistent bladder spasms (similar to stomach cramps)
- your catheter is blocked, or urine is leaking around the edges
- you have persistent blood in your urine, or are passing large clots
- you have symptoms of a UTI, such as pain, a high temperature (fever) and chills
- your catheter falls out (if it’s indwelling and you haven’t been taught how to replace it)
If your catheter falls out and you can’t contact a doctor or nurse immediately, go to your nearest accident and emergency (A&E) department.
Support groups and further information
Living with a catheter can be a challenge and you may find it useful to seek more information and advice from support groups and other organisations.
Bladder Catheterization – StatPearls – NCBI Bookshelf
Continuing Education Activity
Bladder catheterization is a commonly performed procedure in all hospitals. It can be performed by external, urethral, and suprapubic techniques. It is associated with complications including but not limited to urinary tract infection which is the most common hospital-acquired infection. This activity describes in detail the working knowledge for urethral catheterization, which is the most commonly used method worldwide and highlights the role of an interprofessional healthcare team in improving care for patients who undergo urethral catheterization.
Describe the process involved in bladder catheterization
Identify the indications for bladder catheterization.
Outlines the complications associated with bladder catheterization.
Explain the importance of improving care coordination amongst the interprofessional team to improve outcomes for patients with bladder catheters.
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Urinary bladder catheterization is performed for both therapeutic and diagnostic purposes.. Based on the dwell time, the urinary catheter can be either intermittent (short-term) or indwelling (long-term).
There are three types of urinary catheters based on the approach of insertion.
External catheters adhere to the external genitalia in men or pubic area in women and collect the urine. They are useful for the management of urinary incontinence.
Urethral catheters are inserted through the urethra, with the tip advanced into the base of the bladder.
Suprapubic catheters are inserted into the bladder surgically via a suprapubic approach.
Urethral catheterization is most commonly performed in routine clinical practice and is discussed in this article.
Anatomy and Physiology
The urinary system comprising of kidneys, ureter, bladder, and urethra is involved in the production, storage, and excretion of urine. Under normal conditions, in an adult, the kidneys produce approximately 1500 ml of urine in a day. After passing through the ureters, the urine is stored in the bladder. The capacity of the bladder can vary between 350 ml – 500 ml. Three sets of muscles control urinary drainage from the bladder into the urethra. The internal sphincter located at the base of the bladder is an involuntary smooth muscle. The voluntary striated external sphincter muscles encompass the proximal part of the urethra. Lastly, the pelvic floor muscles support and provide additional control.
The indications for bladder catheterization are:
Urinary retention can be acute or chronic. The causes of urinary retention can be:
Obstructive: Urinary obstruction can be intrinsic (within the urinary system) or extrinsic. Benign prostatic hyperplasia (BPH), stones, strictures, stenosis, or a tumor can cause intrinsic obstruction. BPH is the most common cause of urinary retention. If the blockage is from a pathology outside the bladder, it is classified as extrinsic. An enlarged abdominal or pelvic organ can compress on the bladder neck resulting in extrinsic obstruction.
Infectious & Inflammatory: Cystitis, urethritis, prostatitis (common infectious etiology in men), and vulvovaginitis in the woman can cause urinary retention.
Pharmacologic: Drugs with anticholinergic or alpha-adrenergic agonist properties.
Neurologic: Brain or spinal cord injury, cerebrovascular accident, multiple sclerosis, Parkinson disease, and dementia can lead to urinary retention.
Others: Trauma, psychogenic, Fowler syndrome in women. 
Bladder catheterization is performed perioperatively in most abdominopelvic surgeries, such as urological and gynecological procedures. In cases of surgery on structures adjacent to the genitourinary tract, sheath catheters are recommended. Bladder catheterization is also useful in surgical patients who require strict intraoperative urine output. Besides, it is helpful for the management of postoperative urinary retention due to anesthesia, and to achieve better postoperative pain control.
Neurogenic bladder dysfunction
Social and hygiene reasons
Acutely ill patients requiring close urinary output measurement
Chemotherapy drug delivery
Measurement of urodynamics
Sample collection for urinalysis
Radiographic studies (cystogram)
Indications for Removal
The need for a bladder catheter should be assessed daily and must be removed when the purpose of the catheter insertion is served.  For intraperitoneal colorectal surgeries, the catheter can be removed on postoperative day 1. In the case of mid to low rectal operations, the catheter can be removed between postoperative days 3-6 based on the risk of urinary retention.
Early removal of urinary catheters helps with ambulation and better post-op recovery. For patients with chronic urinary retention and incomplete bladder evacuation, intermittent catheterization is useful.
Contraindications to bladder catheterization include:
Blood at the meatus. Insertion of the catheter can worsen an underlying injury.
Evidence of urethral infection
Urethral pain or discomfort
Low bladder volume/compliance
Patient refusal 
Bladder catheterization requires the following equipment:
Single-use lubricant and anesthetic gel
Waterproof pad (disposable)
Type and Choice of Catheter
The catheters can vary with the composition and coating material.
Composition: Silicone, latex, and PVC.
Coating: Teflon, hydrogel, and antimicrobial or latex with a silicone elastomer coat.
The selection of a catheter type depends upon the clinical indication, dwell time, and individual patient’s risks. A trained physician must perform catheterization with a Coude or suprapubic catheter in cases where standard catheterization is unsuccessful. Silver alloy impregnated catheters are preferred for short term catheterization(≤14 days) as they reduce the incidence of UTI and bacteremia.
Preparing for a catheterization involves the following steps:
Review indications and contraindications for the procedure. A careful history can help to assess the need for urological referral.
Give clear instructions to the patient about the procedure. Allow appropriate time to respond to the queries of the patient.
A proper light source should be present. 
Maintain patient’s privacy during the procedure.
The patient should lie down on a firm flat surface with the head resting on a pillow.
Appropriate positioning of the patient. Supine position for men and frog-leg position for women is recommended.
Place a disposable pad beneath the patient’s buttocks.
Perform hand hygiene.
Wear sterile gloves.
Appropriately drape the patient.
Prepare the glans penis and the urethral meatus using a sterile technique. In women use the non-dominant hand to expose the urethral meatus by separating the labia and prepare the meatus with an antiseptic solution.
Technique or Treatment
Local anesthesia and the lubricant must be generously used. The lubricant gel should be milked proximally with the distal urethra compressed to occlusion. The penis is held using the nondominant hand directed towards the ceiling or the umbilicus. The catheter is inserted into the urethral meatus with the dominant hand until the Y of the catheter is at the urethral meatus. The return of urine in the attached bag is a sign of correct placement into the bladder. The catheter balloon is then inflated using sterile water. The amount of water used for inflation varies with the manufacturer’s recommendations.
After exposing the urethral meatus, a lubricated catheter tip is advanced in the meatus until there is a spontaneous return of urine. The catheter balloon is then inflated as per the manufacturer’s recommendations. In morbidly obese patients, exposing the meatus may require help from a second person or placing the patient in a Trendelenburg position. Adequate swabbing with povidone-iodine helps with visualizing the meatus. In the event a catheter is inserted in the vagina, it should be left there until a new sterile catheter is successfully inserted into the meatus. Analgesia is of no proven clinical use in women.  Lubrication jelly should be applied to the tip of the catheter. The application of lubricant to the urethral meatus is associated with difficulty in catheter insertion.
Complications of urethral catheterization include:
Urinary tract infection (UTI) is the most common complication that occurs as a result of long term catheterization. The normal urinary flow prevents the ascension of microbes from the periurethral skin avoiding the infection. Alteration of the defensive mechanism from the catheter results in an increased risk of UTIs. Escherichia coil and Klebsiella pneumonia are the most common organisms implicated in UTIs. Recurrent UTIs are associated with increased antibiotic resistance.
A chronic bladder infection can occur from urinary (10-100 ml) stasis at the base of the bladder, which is obstructed by the balloon of the catheter.
Pain due to traction on the drainage bag.
A transitory stinging sensation is common in men that often occurs during lubrication and can be minimized by cooling the gel to 4°C. 
Catheter obstruction can occur due to the sediment buildup in patients with subclinical bacteriuria. Flushing can often relieve the blockage. If unsuccessful catheter replacement may be required.
Urine leakage from the urethral meatus extrinsic to the catheter may occur as a result of bladder spasms. These spasms can be painful and can be alleviated with anticholinergic medications like oxybutynin.
A negative effect on the quality of life, especially for patients with longterm indwelling catheters.
Due to these complications, indications for the bladder catheterization must be carefully reviewed before the procedure.
Bladder catheterization is a commonly performed hospital procedure. Therefore physicians and nurses must be aware of its indications, contraindications, and be familiar with the scenarios where a urology consultation is warranted.  The need for a bladder catheter should be evaluated daily. Prompt removal of the catheter decreases the risk of urinary tract infection.
Catheter-associated urinary tract infection (CAUTI) is the most common healthcare-associated infection and accounts for more than $131 million of medical expenditure annually. 70% of healthcare-associated UTIs are attributed to catheters. The risk of bacterial colonization of the catheter increases with the duration ranging from 3-10% per day to 100% in long term indwelling catheters. According to the National Healthcare Safety Network (NHSN), a diagnosis of CAUTI is considered in a patient with fever and bacteriuria, who has an indwelling catheter for at least two days. The IDSA (Infectious Diseases Society of America) recommends considering CAUTI as a diagnosis of exclusion in a febrile patient. Antibiotic therapy for asymptomatic bacteriuria is inappropriate and is associated with drug resistance and increased risk of Clostridium difficile infection.  When treating a catheter-associated UTI, indwelling catheters for greater than two weeks must be removed. CAUTI prevention is possible by avoiding unnecessary catheter insertion and by frequently assessing the need and aiming for early removal.
Acute urinary retention is an emergency that requires urinary catheterization. Urethral strictures are one of the leading causes of urinary retention in patients younger than fifty years. Urethral catheterization can be challenging in the presence of urethral strictures and must be attempted with a 14 French catheter. If an obstruction is encountered, the catheter should not be forced into the urethra. Blood at the meatus can be due to urethral trauma. Repeated attempts of catheter insertion may further increase the risk of injury and the creation of a false passage. Urology must be promptly consulted in challenging cases of urinary catheterization.
Asymptomatic bacteriuria (ASB) is defined by at least ≥ 100,000 colony-forming units [CFU]/mL or ≥100,000,000 CFU/L of a bacteria isolated from a voided urine specimen without any signs or symptoms of UTI. Antimicrobial therapy should not be prescribed for ASB due to an increased risk of antimicrobial resistance and adverse effects. Screening and treatment of asymptomatic bacteriuria are indicated in pregnant women and in patients expected to have a urologic endoscopic procedure that is associated with mucosal trauma.
Enhancing Healthcare Team Outcomes
A myriad of clinical conditions may require bladder catheterization. While a physician or a nurse can place the catheter in most cases, consultation with urology is necessary for specific patients. The nurses are essential members of the interprofessional group, as they will predominantly perform the procedure. They also monitor the catheter and assist with the education of the patient and family as needed. The pharmacist will ensure that the patient is not on any medication that can precipitate urinary retention. The physical therapist also plays a role in early mobilization, voiding exercises, and rehabilitation. Interprofessional communication and care coordination among health professionals are vital to enhancing patient-centered care and improve outcomes.
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Disclosure: Mobeen Haider declares no relevant financial relationships with ineligible companies.
Disclosure: Pavan Annamaraju declares no relevant financial relationships with ineligible companies.
Bladder catheterization for women (without the cost of anesthesia)
Urological manipulation, which consists in placing a catheter through the urethra directly into the bladder. Manipulation is carried out in order to ensure unhindered outflow of urine when it is difficult due to any pathology. Catheterization is necessary in the treatment and diagnosis of diseases of the urinary system.
Catheterization is the process of inserting a urological catheter, a thin, flexible tube connected to a reservoir. The tube allows urine to drain from the urinary tract. The device is inserted through the urethra into the bladder.
Please note that the price of the service does not include the cost of anesthesia.
Manipulation may be performed for diagnostic reasons, such as to check diuresis, inject contrast media or saline. For therapeutic purposes, the procedure is necessary when the natural flow of urine is not possible. Its accumulation in the bladder leads to organ damage and increases the risk of urinary tract infection.
Many people are afraid of pain during catheterization, but currently the process of inserting the device is quick and painless, anesthetics are used for such procedures.
Advantages of this procedure
Catheterization is carried out by qualified specialists. Due to this, high efficiency of manipulation is achieved, and there are no side effects and complications.
The procedure allows you to empty the bladder when the patient is unable to do so naturally, such as after surgery. Also, with the help of this manipulation, you can enter drugs, which will significantly increase their effectiveness and speed up recovery.
Before catheterization, the patient must be psychologically prepared. Before inserting the catheter, the nurse or doctor performs appropriate hygiene procedures.
The catheter is inserted in the supine position, the patient bends her knees, spreading them apart. Under the pelvis, you need to put a diaper with oilcloth, install the vessel. Before the procedure, the genital organs are treated with a dilute solution of furacilin. A nurse or doctor, using sterile wipes, pushes the labia apart, treating the urethra with a cotton swab dipped in furacilin.
The end of the catheter is moistened with Vaseline and inserted into the urinary tract to the required depth using sterile forceps. Upon reaching the bladder, urine will appear from the outer end of the tube, after which it is sent to a previously prepared container. Outside, the catheter is attached to the skin of the thigh.
If the purpose of the procedure is to flush or administer medication to the bladder, then it is performed after the end of urine output.
After completion of this manipulation, the catheter is gently withdrawn. Before removing the tube to protect against infection, an antiseptic is introduced into its cavity. The external opening of the urethra is treated with a cotton ball moistened with a solution of furacilin, and the remaining moisture is removed with a napkin.
In the case of flushing, a syringe with a solution of furacilin heated to a temperature of +38 ° C is attached to the catheter, which is slowly introduced into the bladder. After that, the outer end of the tube is directed into the vessel to remove the solution from the bladder. This procedure is repeated until the liquid is clear.
Indications for examination
- Urinary tract edema.
- Interstitial cystitis.
- Injuries of the genitals.
- Cysts in the bladder or urethra.
- Constriction, spasms of the urethra.
- Acute urinary retention.
- Tumors of the urinary ducts.
- Blockage of bladder outlet with stones.
- Urinary diverticulosis.
- Bladder flushing.
- Injection of drugs into the bladder.
- Urine collection for laboratory testing.
No special training required.
Bladder catheterization | Dobromed
Quite often, in pathological processes in the human body, more often of a urological nature, it becomes necessary to drain the bladder, that is, to create an artificial outflow of urine from the bladder reservoir cavity. In modern medical practice, this process is carried out using a whole set of modified devices (catheters) made of various materials. Bladder catheterization is used for both diagnostic and therapeutic purposes.
What causes the need for catheterization MP
Indications for the drainage procedure are individual and depend on many reasons. Usually, these are patients with urological problems. The drainage system is necessary:
- when examining the urethral tract for the presence of obstruction in patients who have lost the ability to perform independent micturition, which led to their long delay (more than 12 hours) and the development of an acute pain syndrome, which may be due to dysfunction of the bladder innervation, a strong inflammatory the process in the urethra, the presence of calculi or tumor formations in the organs of the urinary system themselves and in the tissues adjacent to it;
- for laboratory monitoring of urine for microflora – for greater reliability of the results, sterile urine is taken directly from the reservoir bladder cavity;
- if necessary, a cystourethrographic examination – diagnostics with a contrast agent;
- for washing the bladder cavity from stagnant urine, pus, or blood clots formed as a result of infectious and inflammatory processes, or surgical interventions;
- indications for catheterization are patients who have undergone surgical interventions on the organs of the urinary system, which contributes to the processes of complete regeneration and recovery;
- and finally, patients who are in a state of coma and have lost the ability to independently mict;
- the patient has infectious urethritis;
- pathological disorders that prevent the flow of urine into the bladder cavity;
- injury to the bladder organ and urethral tract;
- presence of blood in the urethra and scrotum;
- signs of urinary reflux;
- potential complications in the form of acute prostatitis or penile fracture;
- a real risk of infection of the MP from the outside.
Bladder drainage methods
Depending on the condition of patients and the purpose of drainage, bladder catheterization in women and other patients of various ages can be one-time, performed periodically (intermittent catheterization) or installed for a permanent period. For each specific case, its own drainage system is selected.
- if it is necessary to withdraw urine from the reservoir bladder cavity for diagnostic assessment of the urinary tract condition and collection of urine for laboratory monitoring;
- in pregnant women with urological problems, to stabilize the condition just before childbirth;
- if necessary, medicinal irrigation of the MP reservoir tissues.
Disposable catheters are used for this purpose. The duration of the procedure does not exceed 2 minutes, and the minimal presence of a drainage tube in the body minimizes the risks of additional infection and the development of other complications.
The permanent catheterization procedure has been used since the middle of the last century for chronic urinary problems. The drain is left in the bladder reservoir for a long time. It is installed by the urethral route, or by means of a cystostomy (an incision in the pubic area of the abdomen). But, as studies show, prolonged drainage contributes to the formation of calculi (stones) in the urinary excretion system and increases the risk of malignant tumors in the bladder.
According to international studies and the recommendations of the Urological Association, indwelling catheters should not be placed for more than 2 weeks.
The method of intermittent drainage has been widely used since the end of the 20th century to replace permanent drainage. The method is based on 4, 6 single catheterization during the day, which imitates the normal processes of urine excretion by single drainage. This technique represents the lowest risk of developing functional disorders in the kidneys, infectious and other disorders. It can be used for many months and years without causing any harm to health.
Types of urinary drainage systems
There are different types of bladder catheters, differing in material, size and modification, for women, men and children, soft (rubber), hard or rigid (metal) and semi-soft (synthetic), equipped with additional internal channels (from 1 to 3), for permanent and temporary drainage. Consider some of them used in medical practice:
- Nelaton (Robinson) drainage system – the simplest version of a rubber or polymer catheter. Designed for intermittent drainage in uncomplicated cases. Made from polyvinyl. Under the influence of body temperature becomes soft. Equipped with two side openings and a closed rounded end. They are used for both men and women, they differ only in length – for women from 12 cm to 15, for men, up to 40 cm. Sizes are marked with different color coding. A special hydrophilic coating, when interacting with moisture, makes it slippery, which does not require additional lubrication, and minimizes the risk of additional infection;
- Mercier (Timman) system – equipped with an elastic curved tip, two holes and one outlet channel. It is used in complex infectious and inflammatory processes against the background of adenomatous growths in the prostate, or stenosis of the urethral tract;
- Nelaton system with Timman tip – has the characteristics of a basic system, but the curved tip of the above device helps to drain patients with a prostate;
- catheter for long-term use of the Pezzer system. It has the form of a conventional rubber tube, equipped with two output channels and a retainer in the form of a thickening of the tube;
- Foley drainage catheter is the most popular type of drainage in urology. It is an excellent option for long-term use. Equipped with a special balloon (filled with sterile liquid) holding the device inside the MP. Through this catheter, the bladder is washed, drugs are administered, or urine is removed into the urinal attached to the end of the tube;
- two-channel with a common stroke for the outflow of urine and washing the MP and the channel through which balloon liquid is introduced;
- three-channel with an additional channel for the introduction of drugs, made of silicone-coated latex (cheap option), which eliminates the deposition of salts inside the catheter, or silver-coated silicone (expensive option), which inhibits bacterial replication and reduces the risk of infection;
- two-channel with a coraco-curved tip of Timman, which is the most convenient option for catheterization against the background of the prostate and its hyperplasia;
- with women’s and children’s versions (shorter in length and with a smaller diameter).
Drainage with rigid (metal) systems is rare today. In normal practice, catheterization with a soft catheter is used, which minimizes the risk of injury to the urethra.
In each case, the drainage system is selected by a doctor and installed by medical personnel. Self-drainage is fraught with serious consequences, additional infection and the development of dangerous complications, since the procedure requires special preparation and knowledge of certain rules of the installation algorithm.
Self-catheterization is performed only in emergency cases, when there is no way to call a doctor, or medical help is too late.
Preparation for drainage manipulation
The preparatory period for catheterization of patients consists of several stages, including:
- a preliminary examination by a doctor to clarify the absence of contraindications;
- adherence to a certain nutritious diet (no fried and spicy foods, alcohol and sweet drinks with gas) a couple of days before the procedure;
- careful preparation of the patient by a specialist (treatment of the genital organs with an antiseptic, familiarization with the technique of catheterization).
At the next stage, a special kit for catheterization is selected, including:
- A set of sterile improvised materials necessary for the procedure – gauze, cotton swabs and napkins;
- Disposable medical gloves;
- Pain medications and sterile solutions to facilitate insertion of the catheter tube;
- Sterile plastic tweezers and Janet syringe cone configuration;
- Antiseptic solution and genital preparations;
- Urine tray.
Peculiarities of bladder drainage in adults
Drainage of the bladder organ in men is associated with peculiarities of the anatomical configuration of the urethra (long and curved) and different structure of its sections – prostatic, membranous and cavernous, which makes it quite vulnerable and sensitive to various types of damage .The algorithm for performing bladder catheterization in men is determined by a certain, consistent technique for introducing a drainage device.
- the introduction of a drain for men can be in a standing position and lying down. The classic method is lying on couches with legs bent at the knees;
- the procedure begins with the treatment of the head of the penis with an antiseptic, instillation of sterile glycerin into the urethral fissure and treatment with it, the end of the catheter tube;
- The urine collection vessel is placed between the patient’s legs. If a permanent system is installed, the patient is given recommendations for its care in parallel. Sometimes a patient who has undergone surgery is offered an operation to remove the stoma;
- the next stage is the introduction of the system. With an antiseptic-treated tweezers, the doctor, at a distance of 6 centimeters from the edge, grabs the catheter tube and gradually immerses it into the urethra. To prevent uncontrolled micturition, the head of the penis is slightly squeezed.
- reaching the cavity of the urinary reservoir with a catheter is marked by the release of urine;
- after the release of urine, the tube of the system is attached to a syringe with sterile furatsilin, for subsequent rinsing of the bladder reservoir.