Ospe for urinary catheterization
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CDC CAUTI guideline urinary catheter insertion aseptic technique indications 2024
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male urethral catheterization technique diagram Foley catheter insertion
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OSPE: Urethral urinary catheterization (Foley catheter)
Station objective: Perform aseptic urethral catheterization safely, demonstrate correct communication, and state key precautions.
Equipment
- Catheterization kit with sterile gloves and drapes
- Appropriate Foley catheter, commonly 14-16 Fr adult female, 16-18 Fr adult male, as per local protocol
- Sterile lubricant or lidocaine jelly
- Antiseptic solution and swabs
- Sterile water syringe for balloon inflation, using the volume printed on the catheter
- Closed urinary drainage bag and securement device
- Disposable underpad, gauze, specimen container if needed
OSPE checklist
| Step | What to do / say | Marks |
|---|---|---|
| 1 | Verify patient identity, prescription/indication, allergies including latex or antiseptic, and explain the procedure. Obtain consent and offer a chaperone. | 1 |
| 2 | Check for contraindications: suspected urethral injury, especially pelvic trauma, blood at meatus, perineal/scrotal hematoma, high-riding prostate, or inability to pass urine after trauma. Do not catheterize if suspected. | 1 |
| 3 | Ensure privacy. Perform hand hygiene, use appropriate PPE, position patient, and place waterproof pad. | 1 |
| 4 | Prepare equipment. Select the correct catheter. Attach drainage bag without breaking sterility. Check balloon integrity only if local policy requires it. | 1 |
| 5 | Wash hands again and create a sterile field. Put on sterile gloves and drape genital area. | 1 |
| 6 | Clean the urethral meatus with antiseptic using sterile swabs. Maintain asepsis. | 1 |
| 7 | Lubricate catheter generously. Instill anesthetic gel if prescribed/available and allow time to act. | 1 |
| 8 | Insert catheter gently with the correct sex-specific technique. Never force against resistance. | 2 |
| 9 | Confirm urine drainage, advance further before balloon inflation, then inflate balloon with the stated volume of sterile water. | 2 |
| 10 | Gently withdraw until resistance is felt. Connect and position drainage bag below bladder, ensure free dependent drainage, and secure catheter. | 1 |
| 11 | Make patient comfortable, remove equipment, hand hygiene, document indication, catheter type/size, balloon volume, urine characteristics, date/time, and any difficulty. | 1 |
Total: 13 marks
Female catheterization technique
- Position supine with knees flexed and hips abducted, or frog-leg position.
- With your non-dominant hand, separate the labia and keep this hand in place. It is now considered contaminated.
- Clean from anterior to posterior, using a separate swab for each stroke.
- Identify the urethral meatus, located above the vaginal opening.
- Insert lubricated catheter gently until urine appears.
- Advance another 2-3 cm before inflating the balloon.
- If the catheter enters the vagina, leave it there as a landmark, use a new sterile catheter, and reattempt.
Male catheterization technique
- Position supine.
- If uncircumcised, gently retract foreskin. Clean glans and meatus using aseptic technique.
- Hold penis upright, about 60-90 degrees to the body, to straighten the urethra.
- Instill lubricant or anesthetic gel.
- Advance the catheter slowly and gently until urine returns, then advance it to the bifurcation/Y-port before balloon inflation.
- Inflate balloon only after confirming catheter is fully in the bladder.
- Gently withdraw until resistance is felt.
- Replace the foreskin after the procedure to prevent paraphimosis.
Failure to advance a male Foley fully before balloon inflation can inflate the balloon in the urethra and cause serious injury. Pfenninger and Fowler's Procedures for Primary Care, p. 795.
Indications to state in viva
- Acute urinary retention
- Accurate urine-output monitoring in critically ill patients
- Sterile urine specimen when necessary
- Perioperative bladder drainage for selected procedures
- Neurogenic bladder requiring intermittent catheterization
- Bladder outlet obstruction with renal compromise
Roberts and Hedges’ Clinical Procedures in Emergency, p. 1323.
Contraindications and red flags
Do not pass a urethral catheter if urethral injury is suspected
- Blood at urethral meatus
- Pelvic fracture or major perineal trauma
- Perineal, scrotal, or penile hematoma
- High-riding/non-palpable prostate
- Known urethral disruption
Request senior/urology review and consider retrograde urethrogram or suprapubic drainage as appropriate.
Other cautions:
- Known urethral stricture
- Recent urethral surgery
- Artificial urinary sphincter
- Previous difficult catheterization
Campbell-Walsh-Wein Urology, p. 197.
Common OSPE errors
- Not checking indication or allergy
- Breaking sterile technique
- Inflating balloon before urine return or before full advancement
- Forcing the catheter when resistance occurs
- Forgetting to replace foreskin
- Leaving drainage bag above bladder level or on the floor
- Not securing catheter
- Failing to document the procedure
- Using an indwelling catheter for convenience or uncomplicated incontinence
CDC guidance recommends insertion only for appropriate indications, aseptic insertion with sterile equipment, maintenance of a closed drainage system, and removal as soon as it is no longer needed. See the CDC CAUTI recommendations.
One-line OSPE closing statement
“The catheter is draining freely into a closed system below bladder level. The patient is comfortable, the catheter is secured, and I will document the indication, catheter size, balloon volume, urine output and characteristics, and plan for daily review of removal.”
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