Types of Urinary Catheters

Understanding the three main catheter types, their structure, and when each is clinically appropriate.

What is Urinary Catheterisation?

Urinary catheterisation is the insertion of a thin, flexible hollow tube (catheter) into the bladder via the urethra — or, in some cases, through the abdominal wall — to drain urine. It is a clinical procedure requiring training, consent, and aseptic technique.

Urinary catheter care in a clinical setting

Sterile catheterisation equipment

1. Intermittent Catheter

Inserted to drain the bladder, then immediately removed. Not left in place.

• For patients with incomplete bladder emptying or retention who can manage regular catheterisation
• Can be self-catheterised by the patient (ISC — Intermittent Self-Catheterisation)
• Significantly lower CAUTI risk than indwelling catheters
• Typically used every 4–6 hours based on clinical need
• Single-use only — never re-use a standard intermittent catheter

2. Foley Catheter (Indwelling)

Left in place in the bladder, draining continuously into a collection bag. The most commonly used catheter in UK healthcare settings.

Structure:

• Drainage lumen — hollow tube through which urine flows out
• Balloon lumen — filled with sterile water (typically 10ml) to retain the catheter in the bladder
• Drainage port — connects to the collection bag

Materials & Duration:

3. Suprapubic Catheter

Inserted through the abdominal wall, directly into the bladder above the pubic bone. This is a surgical procedure performed under local or general anaesthetic.

• Used when urethral access is not possible (stricture, trauma, prostate obstruction)
• Preferred for long-term catheterisation in some patients — less urethral trauma
• Insertion site requires specific care: stoma-type cleaning, monitoring for granulation tissue
• Changed by trained clinical staff — typically every 4–12 weeks

Quick Comparison

Indications & Contraindications

When catheterisation is clinically appropriate — and critically, when it isn't.

Indications — When Catheterisation Is Appropriate

• Urinary retention — acute inability to void; the most common indication
• Accurate urine output measurement — critical illness, post-operative monitoring, sepsis
• Peri-operative use — prolonged surgery, urological or abdominal procedures
• Prolonged immobilisation — spinal injury, complex fractures
• Bladder irrigation — post-prostate surgery, haematuria management
• Neurogenic bladder — bladder dysfunction due to spinal cord or neurological conditions
• End of life care — where catheterisation improves comfort and dignity

Contraindications — When NOT to Catheterise

• Suspected urethral injury — blood at meatus, perineal bruising; urgent urology referral required
• Acute prostatitis — risk of bacteraemia and sepsis; suprapubic route may be considered
• Urethral stricture — specialist assessment first
• Known allergy to catheter material — check and use appropriate alternative
• Patient refusal — valid, informed refusal must be respected absolutely

Consider Alternatives First

Penile Sheath (Conveen) Application & Care

A catheter-free alternative for managing male urinary incontinence — when and how to use it correctly.

What Is a Penile Sheath?

A penile sheath (Conveen, external catheter, or condom catheter) is a soft sheath fitting over the penis, connecting to a urine drainage bag. Nothing enters the urethra — significantly reducing infection risk compared to an indwelling catheter.

Is It Suitable?

✅ Suitable for:

• Male patients with urinary incontinence where other measures are not practical
• Patients who cannot tolerate an indwelling catheter
• Where skin integrity is at risk from moisture/incontinence

❌ Not suitable for:

• Small or significantly retracted penis — sheath will not stay in place
• Urinary retention — the issue is inability to void, not incontinence
• Existing skin breakdown or sensitivity in the area
• Known latex allergy (latex-free alternatives available)

Step-by-Step Application

1. Preparation

   Gather equipment: correct-size sheath, drainage bag and tubing, leg bag strap, wipes or soap and water, non-sterile gloves, apron. Wash hands. Explain procedure and obtain consent.
2. Skin Assessment & Cleaning

   Wash penis and surrounding area with soap and water. Pat dry — moisture underneath causes skin breakdown. Inspect carefully: redness, breakdown, or irritation should be documented before proceeding.
3. Sizing & Application

   Use the manufacturer's sizing card. Leave 1–2cm space between penis tip and connector end to allow urine to pool before draining. Roll sheath smoothly down the shaft without twisting. Secure with adhesive strip.
4. Connect to Drainage Bag

   Attach drainage tubing to sheath connector. Secure leg bag to thigh using straps — never tape to skin. Ensure tubing runs downwards without kinks. Bag must remain below bladder level at all times.
5. Check & Document

   Confirm urine draining freely. Check patient comfort and no constriction. Document: date applied, size used, skin condition, any concerns. Wash hands.

Video Guidance

Catheter Insertion — ANTT & Procedure

Safe, aseptic catheter insertion technique for female and male patients.

Before You Start

• Confirm clinical indication — is the catheter genuinely needed?
• Obtain informed consent — explain procedure, answer questions
• Check allergy status — latex, anaesthetic gel, antiseptic
• Select appropriate catheter: correct type, size (French gauge), material
• Gather equipment: catheterisation pack, sterile gloves, catheter, 10ml sterile water, Instillagel, drainage bag, good lighting

French Gauge — Choosing the Right Size

Always use the smallest size that will drain effectively.

Female Catheterisation — Key Steps

1. Position & expose

   Supine, knees bent and apart. Good lighting essential. The urethral meatus is between the clitoris and vaginal opening — take time to identify it clearly before proceeding.
2. Cleanse

   Cleanse with sterile saline, front-to-back strokes only. One swab per stroke. Never move back towards the vagina.
3. Insert catheter

   Advance gently into meatus until urine flows (~4–6cm). Never force. Resistance — stop and reassess.
4. Inflate balloon

   ONLY after urine has drained — confirms catheter is in bladder, not urethra. Inflate with correct sterile water volume (check packaging — usually 10ml).
5. Withdraw & secure

   Gently withdraw until resistance felt (balloon at bladder neck). Connect drainage bag. Secure to inner thigh with catheter support strap.

Male Catheterisation — Additional Points

• Instil Instillagel into urethra — wait 3–5 minutes before inserting catheter
• Hold penis at 90° to body to straighten urethra during insertion
• Advance catheter its full length before inflating balloon (male urethra ~20cm)
• Resistance at prostate — do NOT force. Try gentle rotation and slow breathing. If persists, stop and refer to urology
• Retract foreskin for insertion, replace immediately after — prevent paraphimosis

Catheter Maintenance & Complications

Daily care routines and how to recognise and respond to the most common problems.

Daily Catheter Care

• Clean urethral meatus and catheter externally with soap and water — antiseptics not recommended routinely
• Wash from meatus outward along catheter — never towards the bladder
• Inspect insertion site: redness, discharge, encrustation, trauma
• Ensure catheter support strap in place — traction injury is preventable
• Check and document urine: colour, clarity, odour, volume

Drainage Bag Management

• Always below bladder level — never on the floor, never lifted above bladder
• Empty when two-thirds full
• Leg bag: day use, change every 5–7 days
• Overnight bag: connected to leg bag tap using a link system — avoid breaking the closed system
• Never disconnect unnecessarily — every disconnection is an infection risk

Common Complications

🦠 CAUTI — Catheter-Associated Urinary Tract Infection

Most common complication. Signs: cloudy/offensive urine, fever, rigors, confusion (in elderly), haematuria, suprapubic pain. Action: take CSU for MC&S. Treat only if symptomatic — do not treat asymptomatic bacteriuria routinely. Escalate if systemically unwell — consider sepsis pathway.

🚫 Blockage

Signs: reduced or absent drainage despite adequate hydration, discomfort, bypassing. Causes: encrustation, kinking, clots, constipation. Action: check for kinks, ensure bag below bladder, encourage fluids, consider washout if indicated, change catheter if blocked.

💧 Bypassing (Leakage Around Catheter)

Causes: catheter too small, blockage, bladder spasm, constipation. Common mistake: inflating balloon further — this causes trauma and does not help. Address the underlying cause.

Change Frequency

Monitoring, Documentation & Prevention

What to observe, what to record, and how to prevent complications before they happen.

Urine Monitoring

What Must Be Documented

• Catheter type, brand, and batch number
• Size (French gauge) and balloon volume inflated
• Date, time, and name of person who inserted
• Clinical reason for catheterisation
• Next planned review/change date
• Patient tolerance and any complications
• Volume of urine drained immediately post-insertion

CAUTI Prevention Bundle (NHS England)

1. Only insert when essential — confirm clinical indication
2. Use ANTT — at insertion and every access to the closed system
3. Maintain closed drainage system — avoid unnecessary disconnections
4. Bag always below bladder — no exceptions
5. Daily necessity review — remove at earliest clinically safe opportunity

Top 5 Catheter Care Tips

Case Studies

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Knowledge Assessment

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