Male Catheterisation Procedure Walkthrough - Clinical Skills - Dr Gill

Hello and welcome back to the channel. Today I've joined myself and Dr James Gill for a tutorial video on how to insert a catheter. Crucially, the catheter that we're going to be using here is a male catheter. There are female catheters which are a little bit shorter. However, some trusts have now moved over to only using male catheters. The reason why that's important is a female catheter, what we're being shorter, can potentially end up in the prostate or the urethra and when you expand the balloon to keep the catheter in place can result in serious harm to the male patient. So it may be that you're only going to find one size of catheter. In this examination I'm going to be using a different style of a trainer compared to those which we'll use in the labs. This trainer particularly has a cutout so you can see the passage of the catheter through both the prostate and into the bladder. And to reiterate, we'll see the effect of what would happen if we insert the balloon when it's located in the wrong position and thus the potential harms that we get with that. Now one final thing to highlight is you shouldn't be doing what I'm doing and handling the catheter. Even with sterile gloves we want to try to avoid as much contact with the catheter as we can. Why? Because this is a procedure which is highly invasive. Obviously we're going to insert this into a patient's urethra but also that in itself is a potential for infection to be inserted into the body and patients that are in need of a catheter likely have significant medical problems. Therefore an additional infection into that mix could make things very very serious for that patient. So ordinarily you'll find these catheters covered in a sheath which you can slowly tear off as you insert the catheter into the patient, avoiding you touching the tube as much as is possible. So to start off with our procedure, we want to prepare our sterile field. So that would routinely be cleaning down at the surface of your trolley or area that you're going to be having your equipment on. I would actually recommend that you wipe down the trolley twice because again reducing infections in this procedure is incredibly important. With the sterile field prepared we then want to gain the consent from our patient and make sure that they are happy with what we're going to do. Hello, my name is Dr Gill. I've been asked to perform a catheter insertion on yourself. Before we get any further, could I please confirm your name and date of birth? Hi, James Gill, 1st of the 2nd, 1985. Thank you. So in terms of doing this, have you ever had a catheter inserted before? No, I haven't had anything like this before. Okay, so what we're going to be doing is we're going to be taking a catheter, flexible piece of silicon and we're going to be inserting it into your penis to try and help drain some of the urine from your bladder. Now this can be uncomfortable but it shouldn't be painful, particularly because we're using a topical anaesthetic lubricant to help A, the catheter pass and B, to help any discomfort as that catheter is moving through your urethra, so your urine pipe. So before we go ahead with that, do you have any questions for myself? Sure, yeah, we can carry on. It sounds like I need it. Okay, so if I can get you to climb up onto the bed and then we can start to prepare you, which is going to involve me holding your penis and cleaning around it to try and make as sterile environment as possible. Are you happy to proceed? So when we're doing the catheter insertion, the first thing we need to do is make sure we've got the appropriate kit and crucially is that kit within date, so this is incredibly important. Obviously here we're using some equipment because this is a demonstration that is slightly out of date. In terms of what we're after, we're needing the sterile catheter itself, we're needing the catheter insertion kit and crucially the instiller gel, our topical anaesthetic agent. It's going to help smooth the insertion of the catheter. So the crucial thing to keep in mind with regards to the catheter packs and things like that is they are sterile, i.e. we need to make sure that our surrounding area has been made or cleaned at least. So for example, using the MediWipes and things like that. With that in mind, we're then going to open the catheter pack and inside we've got the large gloves which are themselves sterile, so we can take that out for a second and then inside we have the sterile catheter preparation. We can actually open this out, creating a sterile field at which point we can get out the gown, preparing our bag for disposal. So each of these should contain all the equipment you need for the catheter. Again, we've got the sterile surgical gloves, we've got a drape for the patient and another set of sterile gloves along with pads and cotton swabs. In addition, we can open up our sterile lubricating jelly. The instiller gel is perhaps one of the more important parts of the equipment because it provides both a local anaesthetic effect but also provides a lubricating function to allow us to insert the catheter, crucially whilst minimising discomfort with that local anaesthetic function as well. We'll then want to take the catheter and catheter bag. The standard metal catheter is between 40 and 45 centimetres in length. This is very important because we need to make sure the catheter is long enough to pass through the prostate and the urethra to be situated within the bladder when we expand the catheter balloon. If that balloon is inflated in the urethra or potentially in the prostate, not only would it cause severe pain but is likely to cause damage, maybe even rupture of these structures. So that is one thing that's vitally important to ensure that you've got the right length catheter for the patient. Also when selecting our catheter, we want to pay attention to the French or the catheter diameter. So here we've got an 18 French catheter. That's slightly larger than normal diameters but will be useful for trying to prevent things such as haematuria. Now this is important because a smaller catheter may be much easier to pass and have much less discomfort. However, it's also more likely that a smaller catheter will result in bypasses. And if we're dealing with surgical problems, we may end up with even larger catheters. When it comes to selecting the catheter, it's important to consider the number of lumens you've got and what's the purpose. Here we've got a dual lumen catheter. So we've got one lumen for the saline to be inserted to blow up the catheter balloon and then a lumen for the urine to pass through. Other catheters, for example, may have three lumens to allow for the balloon inflation, urine to pass through, and potentially also for irrigation of the bladder. Ultimately, you're going to choose the right tool for the right job. So when you're asked to catheterize somebody, the question I would ask is not only how many lumens do we need but what are those lumens so we can cross-reference that we've got the correct tool. Another aspect that we need to be aware of when we're preparing is the position of the catheter tap. We don't want the catheter tap open, which would allow free passage of the urine, frankly, all over the floor, the patient and potentially yourself. So we want to make sure that we're starting off with the catheter in the closed position. That way we know we're not going to have any accidents. The other end of the catheter bag that we'll insert into the catheter is another lock which can be rolled into place. So that way we've got an inability for urine to flow into the catheter bag as well, doubling the risk to ourselves and the patient. Once the catheter is in place and the bag is attached, then we can release the valve and allow urine to flow into the bag. We'd also look to source our saline that we're going to use for the balloon. So then we've got the sodium chloride flush that we're going to be using to inflate the catheter balloon and keep everything in place. You can see throughout how we've collected the equipment. I'm trying to make sure that I'm not touching it as I'm taking it out of the sterile packs and having it land on our sterile field. Once our equipment is ready, we need to get our apron and a simple trick I would recommend is screwing up the apron. That should allow you to open it with much more ease. It's going to be much easier to put your gown on when you're not wearing surgical gloves because your skin will move more easily over the plastic. For clarification, we should be wearing the gown throughout the catheter insertion procedure but I've got a sneaking suspicion it's going to irritate the microphone throughout, which is why I'm not going to be wearing it. But once more clarification, once you're finished, you can pull at the top, pull behind and wrap up and take off your gloves at the same time and then deposit in the bin. From there, we're going to ask the patient to climb onto the examination couch and disrobe from the waist downwards. At this point, we're going to put a dressing underneath the patient and begin to clean the penis. Now, I would recommend wearing two pairs of gloves. We have a dirty pair on the outside for when we're cleaning the patient and then we can remove those for a clean pair underneath as we move towards the sterile field and inserting the catheter. To actually clean the patient, we can use a hammock technique where we take the swab, hold the penis with the swab and then using cotton balls soaked in saline to clean from the urethra backwards covering all of the meatus. At that point, we want to make sure we're using all of the cotton wool balls. They're there for a reason and the more of them we use, the greater the probability that we're going to be removing anything from around the patient's urethra which could potentially provide a source of infection being pushed deeper into the patient. Once we've cleaned the area, we want to put a sterile drape around the patient and that would normally have a hole to it where the penis can come through. Now, whilst the sterile field is obviously incredibly important for the procedure, I'm actually going to remove it in this case so that we can see the workings as we go through with the catheterization process. At which point, we can again use the hammock technique and hold the patient's penis and insert the instiller gel. It's very important this instiller gel is kept within the bladder, the prostate and the urethra for between three to five minutes to properly anesthetize this area to reduce the discomfort of having a large catheter inserted into the urethra. Our catheter should not be exposed like this. It should be within a sterile plastic sheath, again to minimize risk of infection. I'm going to use a little bit of the instiller gel that I have on the sterile field to coat the end of the catheter. I'm then going to feed the catheter into the meatus. That's passing down the urethra and we're making very clear to pause if the patient is in any discomfort. We're going to insert the entirety of the catheter all the way up to the bifurcation whereby we can insert the balloon. Now, that is quite important because it means that we know the catheter has gone into the correct location. And here we can see the catheters actually come out of the model, which is fine. We want to carefully thread the entirety of the catheter into the patient's penis until we get to the bifurcation of the catheter port and the balloon port. At that point, we've got the maximum insertion of the catheter. That's very important. It significantly reduces the risk of the catheter tip and the balloon being within the bladder wall, being within the prostate and being within the urethra. All three of those areas, if the balloon was expanded, could cause serious harm. We're then going to take the saline flush and we're going to simply holding the port, screw the flush in place. And that will allow the balloon to inflate. We would immediately pause the saline infusion if the patient experienced any pain, even if we were convinced that the catheter had been correctly sited. There's always the possibility for kinks and the catheter to be ending up in a position where it could cause pain. So I really want to highlight that. If there's discomfort with the saline infusion, stop and get a senior review. Before the catheter is inserted, there can be a benefit to placing the spigot into the catheter tube. That way, we will collect the urine into here. That should allow urine to flow into the bag, which we then must make sure we're positioning below the position of the patient so that gravity can work with the flow of urine, pulling it out of the bladder. Having completed the procedure, we want to remove the sterile drapes from the patient and clear away our equipment and allow the patient to dress themselves once again. We also want to confirm that there's no discomfort with the patient after the catheter has been put in and is flowing and have them highlight that if there are any problems, if the catheter gets blocked, then they should call for assistance straight away. Hopefully this video has been useful for you in terms of walking through the catheter insertion in a male patient, highlighting some of the risks and also visualising the issues with where the balloon can be inflated. If you've got any questions or comments, please put them in the box below and hopefully we'll be able to help you out with further videos. Take care and we'll see you in the next one. Cheerio.