The complete guide to placing and caring for urinary catheters
A key part of nursing patients with renal and urinary tract disease is the successful placement and management of indwelling urinary catheters.
They’re used both as a diagnostic tool - for the collection of urine samples, prostatic washes and suction biopsy samples - and therapeutically, in the management of patients with urine retention, obstruction and where urine output needs to be closely monitored.
We should absolutely be placing these in our patients as nurses - and not just in male dogs, there is no reason why we can’t be placing catheters in cats, and female dogs too!
In today’s post, I’m going to talk you exactly through how to place and maintain urinary catheters in dogs and cats, so you can perform this skill more in your clinic.
And once that catheter’s in, don’t forget to measure urine output, too! I have a free fluid output monitoring tool in my free resource library that will really help with this. Grab your copy here.
Urinary Catheters
An appropriate catheter type should be selected based on the individual patient, the anticipated duration of catheterisation and the purpose of catheterisation (e.g. is this to collect a sample or to leave indwelling?).
Ideally, a softer, silicone, flexible catheter should be selected for indwelling use, whereas a more rigid catheter may be used for unblocking or for collecting diagnostic samples only.
The smallest catheter size should be selected in order to minimise urethral trauma, whilst also being large enough to minimise leakage of urine around the catheter.
Equipment
The equipment needed to place a urinary catheter will vary depending on the reason for placing it, the species, whether the catheter is being left indwelling, and whether sedation or anaesthesia will be required for placement.
You will need:
Clippers
Nonirritating antimicrobial skin solution, diluted
Gauze swabs
Syringes for flushing
Sterile, water-based lubricant sachet
Sterile urinary catheter of appropriate type and size
Sterile closed collection system
Sterile gloves (for individual placing catheter)
Disposable examination gloves (for assistant)
Fenestrated drape
Plain drape or glove wrapper (for table)
Sterile syringe and universal container (for urine sample collection)
Sterile vaginal speculum or otoscope (for female catheterisation)
Equipment for sedation or anaesthesia where required
For indwelling catheterisation:
Sterile 0.9% saline
Syringe corresponding with Foley balloon size
Needle, or needle-free bag spike (for preparing saline)
Non-absorbable suture material
Needle holders
Thumb forceps
Scissors
Method of preventing patient interference where required (e.g., Elizabethan collar)
Patient Preparation
Once the equipment has been prepared, we also need to talk about preparing our patients.
In order to minimise contamination from the patient’s skin/hair and risk ascending urinary tract infection, excess fur from around the prepuce/vulva should be trimmed, and the area cleaned with a diluted antimicrobial skin solution.
The inside of the prepuce/vulva should also be flushed with a diluted antimicrobial skin solution before the catheter is placed.
Catheter Placement
So you’ve selected your equipment and prepared your patient. Next up, we need to talk about placing the catheter itself - and the way we do this varies depending on species and gender.
Male Dogs
To place a urinary catheter in a male dog:
The dog is restrained in lateral recumbency and the site prepared.
The catheter is measured from the bladder neck to the prepuce.
An assistant grasps the os penis and retracts the prepuce caudally to expose the glans penis.
The catheter is lubricated and inserted aseptically into the urethra.
The assistant relaxes their grasp on the penis once the catheter reaches the level of the os penis, to facilitate insertion of the catheter.
The catheter is advanced until it enters the bladder and urine emerges from the catheter hub.
If an indwelling catheter is being placed, the Foley balloon is inflated with an appropriate volume of 0.9% saline, and the catheter is withdrawn gradually until the balloon sits in the bladder neck.
Female Dogs
Placing urinary catheters in female dogs is a little more complex, but there’s no reason why we can’t be doing this as nurses!
There are two ways of catheterising a female dog - blindly and via visualisation:
The patient may be positioned in lateral or dorsal recumbency with the hindlimbs extended cranially, or in sternal recumbency with the hindlimbs hanging from the end of the table (depending on your preference). The site is then prepared for catheterisation.
The catheter is measured from the bladder neck to the vulva.
A vaginal speculum may be used to facilitate direct visualization of the urethral orifice. This is lubricated and inserted with the slit directed ventrally.
The external urethral orifice can be visualised along the ventral aspect of the cranial vestibule.
NB. If using the blind method, the external urethral orifice can be palpated as a small, round, firm mass around 2.5-5cm from the vulva, along the ventral aspect of the vestibule. Using their index finger, the nurse guides the catheter tip into the urethral orifice.
The urinary catheter is lubricated and inserted into the urethra aseptically.
The catheter is advanced until it enters the bladder and urine emerges from the catheter hub.
If an indwelling catheter is being placed, the Foley balloon is inflated with an appropriate volume of 0.9% saline, and the catheter is withdrawn gradually until the balloon sits in the bladder neck.
Male Cats
To place a urethral catheter in a male cat, deep sedation or general anaesthesia is typically required. Here’s how to do it:
Following sedation or anaesthetic induction, the patient is positioned in lateral recumbency and the site prepared.
The catheter is measured from the bladder neck to the prepuce.
The thumb and index finger are used to push the prepuce cranially, exposing the glans penis.
The catheter is lubricated and advanced into the urethra aseptically.
Once the catheter is advanced into the penile urethra, the prepuce can be grasped and pulled caudally. This straightens the urethra, facilitating the passage of the catheter.
The catheter is advanced until it enters the bladder and urine emerges from the catheter hub.
The catheter, if remaining in situ, is secured to the prepuce with sutures.
Female Cats
Though we don’t place them as frequently, urinary catheters are actually easier to place in female cats than we think!
Here’s how to do it:
Following sedation or anaesthetic induction, the patient is positioned either in lateral or dorsal recumbency, depending on individual preference, and the site prepared.
The catheter is measured from the bladder neck to the vulva.
The catheter is lubricated.
The vulval lips are grasped and extended ventrally, whilst the catheter is inserted along the ventral midline of the vestibule.
The catheter should advance into the external urethral orifice (which lies on the ventral floor of the vestibule) without the need for visualisation.
The catheter is advanced until it enters the bladder and urine emerges from the catheter hub.
The catheter, if remaining in situ, is secured to the vulva with sutures.
Urinary Catheter Care
Urinary catheter infections are one of the most common hospital-acquired infections we encounter in practice.
Ascending infection via the catheter into the urinary tract is very common, and therefore performing thorough and regular catheter care is vital to minimise the risk of infection.
We can do this by:
Considering the catheter type we use - place a Foley where possible as these can be secured in place without the need for sutures, which can pull on the patient, be uncomfortable, and risk interference.
Always using a closed collection system on the end of every indwelling catheter, and never leaving any open to the environment.
Wearing gloves whenever handling the urinary catheter, bag and lines, in conjunction with performing hand hygiene.
Cleaning the prepuce/vulva, the external portion of the catheter, collection system and all connections with a diluted antimicrobial skin solution every 4-6 hours.
Storing the collection system away from contaminated surfaces, such as the floor. Popping the urine bag in a clear ziplock bag, or in a clean litter tray used only for catheter bag storage is a good alternative.
Prophylactic antibiotics should not be routinely administered to patients with indwelling urinary catheters, owing to the risk of developing a resistant UTI. Instead, in patients where the risk of UTI is considered high, a urine sample is collected via cystocentesis after the urinary catheter is removed. This sample is submitted for bacterial culture, and appropriate treatment is administered if required.
Whilst the catheter is in situ, it is also a good idea to perform sediment analysis every 48 hours in patients with indwelling urinary catheters - to identify signs of infection at an early stage. This is another skill we can build into the nursing care of these patients!
So that’s an overview of how to place and manage urinary catheters in your small animal patients! How often do you place urinary catheters in your patients? DM me on Instagram and let me know! And don’t forget to grab your free fluid output monitoring sheet here!
References
Hackett TB and Mazzaferro EM. 2013. Veterinary emergency and critical care procedures. 2nd ed. Iowa: Wiley-Blackwell.
Bubenik LJ, Hosgood GL, Waldron DR et al. 2007. Frequency of urinary tract infection in catheterized dogs and comparison of bacterial culture and susceptibility testing results for catheterized and noncatheterized dogs with urinary tract infections. J Am Vet Med Assoc, 31, pp. 893-899.
