How to insert a urinary catheter to a newborn girl

Urinary Catheterization in a Newborn

Newborn infants may sometimes need a urinary catheter and as sensitive as it may sound, you might need to insert a urinary catheter to an newborn. Infants with an indwelling catheter shall have catheter care performed daily by licensed nursing personnel.

Purpose

1.     To obtain a urine specimen for diagnostics purposes.

2.     To relieve urinary retention.

3.     To determine the existence of residual urine.

4.     To provide continuous bladder drainage.

5.     To monitor urinary output accurately.

6.     To perform cystography.

7.     To provide continuous bladder irrigation in the case of bleeding to prevent clot formation and retention.

Equipment needed for newborn catheterization.

1.     Sterile gloves

2.     Urine catheter – (use smallest diameter catheter to avoid complications; A 3.5 Fr catheter is recommended for infant< 1000 grams and 5 Fr catheter for larger infants)

3.     Urinary drainage collection system

4.     Povidone-iodine swabs

5.     Water-soluble lubricant

6.     Sterile gauze

7.     Sterile towel

8.     Sterile container

Baby soap and water

 

For female infant:

1.     Retract the labia minora using sterile gauze with your non-dominant hand.

2.     Using the free hand for the rest of the procedure, cleanse the area between the labia minora 3 times with povidone-iodine swabs in an anterior to posterior direction. Cleanse once with each swab and discard.

3.     Blot dry with sterile gauze if necessary.

4.     Place the sterile container between the infant’s legs.

5.     Place end of the catheter in the sterile container to avoid contaminating the catheter.

6.     Generously lubricate the tip of the catheter in the water-soluble lubricant.

7.     Gently insert catheter into the urethra only until urine appears in the catheter. If the meatus is obscured by the introital fold, gently push the fold down with a cotton-tipped applicator prior to insertion of the catheter. The urethral length from the smallest preterm to the largest term newborn ranges from approximately 1-2 cm for the female infant.

For male infant:

1.     Gently retract the foreskin just enough to expose the meatus.

2.     Apply gentle pressure at the base of the penis to avoid reflex voiding.

3.     Using the free hand for the rest of the procedure, clean the glans meatus 3 times in a circular motion washing outward with the povidone-iodine swabs. Cleanse once with each swab and discard.

4.     Place the sterile container between the infant’s legs.

5.     Place end of the catheter in the sterile container to avoid contaminating the catheter.

6.      Lubricate the tip of the catheter in the water-soluble lubricant copiously..

7.     Gently insert catheter into the glans meatus until urine is seen in the tube:

8.     During insertion, apply gentle upward traction on the penile shaft to prevent kinking of the urethra.

9.     If the meatus cannot be visualized, insert the catheter through the preputial ring in a slightly inferior direction.

10. If resistance is met at the external sphincter, hold the catheter in place, applying minimal pressure. Generally, spasm will relax after several minutes, allowing easy passage of catheter. Of not suspect obstruction and stop the procedure.

11. Do not move the catheter in and out. This will increase the risk of urethral trauma.

12. Do not insert extra tubing length in an attempt to stabilize a catheter to be left indwelling. This will increase the risk of knotting. The urethral length from the smallest preterm to the largest term newborn ranges from approximately 3.5-7cm in the male infant.

13. Collect specimen.

14. If the catheter is to be removed, gently withdraw it when urine flow ceases. If the catheter is to remain indwelling, secure tube to the inner thigh with tape or opposite.

15. Connect the catheter to the urinary drainage system.

16. Remove povidone-iodine from skin with soap and water. On the male infant reposition the foreskin.

17. Remove soiled towels and make infant comfortable.

18. Dispose of equipment.

19. Document procedure in nurse’s notes to include:

  • Size of catheter
  • Success or unsuccessful attempt
  • Amount and color of urine

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