Pediatric urinary catheterizations

Pediatric Critical Care Columnist · Aug 18, 2010

Have somebody help you... these are little people who don't usually cooperate that well. You could need your helper to hold their legs down or to hold a flashlight so that you can see what you're looking for.

Baby boys are usually a simple, straight-forward non-event. It's possible to cath them without retracting their foreskin, but you do have to move it around a bit so that you can see the urinary meatus. Put some sterile gauze on your field so that you can use it to grasp the slippery bits... once you povidone them up they're going to be slippery. For little girls, have two catheters handy because you might need two and your helper can open the second one without leaving the legs free. Aim a little more anteriorly than you might think. Your helper (or a rolled up cloth diaper) should elevate the baby's hips a bit so that you have a better view. Again, that gauze will be useful because you're going to have a lot of povidone and sterile lubricant in a very small area. You can tuck a 2x2 under your fingers with your other hand if you're careful and that'll give you a better grip. If you miss, leave the catheter where it is and aim higher with the second one. One giveaway that you're not in the urethra is if after you've filled the balloon and give it a little tug, oops look there it is!

I usually leave the diaper underneath their little bums so that if they do pee while I'm getting things going, the bed may be spared. Term babies may have large enough urethras for an 8Fr. If you have the silastic catheters with stylets in them, you may find the stylet is really hard to remove. I like to partially remove it (about 1/2 cm) just to satisfy myself that it will come out. It's not a good thing if it breaks off in the patient. It won't float into the baby's bladder but it could cause urethral damage and it may impede the flow of urine. ANother possibility is that you accidentally pull out the catheter while trying to get the stylet out. I've been able to insert them without the stylet, but it is a bit more of a challenge.

back2bRN · Aug 20, 2010

Timely and could you elaborate on the differences in anatomy adult female to infant. Our docs are going to alot of in and out caths in infants with fever of unknown origin and well I need a refresher! I heard something about a "flower" and where the betadine pools.... but still I'd like a lesson from someone who does this alot. Boys, easy peasy. Thanks in advance.

Pediatric Critical Care Columnist · Aug 20, 2010

The distance from the hood of the privy parts to the urethra is much shorter proportionally in infants than in adults. It may amount to only 3-5 mm. There's also much less tissue colour differentiation in infants so the meatus is a bit harder to spot. It looks like a very small slit. Because their anatomy is so small, exposure can be more difficult. That's where those 2x2s will come in handy. And once again, have at least 2 catheters at the bedside just in case you miss.

Something I meant to mention is that your basin from your cath kit needs to be as close to the baby's crotch as you can get it and still have room to manoeuvre. The catheter is going to be short and you want to catch the pee in the basin and not get it all over your bed. The second pair of hands can help you avoid having it tip over. (When I'm the second pair of hands I stabilize it from underneath the sterile drape.)

rnsrgr8t · Aug 20, 2010

I work in pediatric urology so I cath the young ones a lot.

For infant girls, you need a good helper with strong hands. Have them bend their knees and spread the legs open and back towards the head and keep their bums are a little off of the bed. When you clean with the betadine, start at the clitoral hood and go down with a little pressure, normally the meatus is just above the lady parts and it is a little slit. If you use pressure when you clean, it will often "wink" at you. As said by PP, it is a much smaller area than you may be used to if you are used to cathing adults.... the rare times I cath post-pubertal teenagers, etc... It always amazes me how much "space" is there from what I am used to with the little ones.

I normally keep "cleaning" with the betadine until I am able to identify the anatomy. Identify the lady partsl opening and look up to 12 o'clock,it is normallythere. They make infant cath kits that have a 5 or 8 french catheter connected to a small tube that you can send to the lab. Comes with betadine sticks, gloves and lubricant all in a sterile packet. I like the betadine swabs better, easier to clean a smaller area.

Little boys can be a little more tricky believe it or not.... there sphincters can tend to be really tight, especially if they are crying. I find it easier to hold the member with my dominate hand (they will be very slippery with the betadine) and advance the catheter with my nondominate hand. Make sure you have a good grip at the base of the member. If you initially meet resistance, hold steady pressure with the catheter...you are normally up agains the sphincter. Often times it will just "give" and pass with a little pressure. If you pull the catheter back and forth, the sphincter gets even tighter...the trick is to hold steady pressure. Also, boys urethra's are much longer than you would think.

The more your do, the better you get. When I was inexperienced, I was the "holder" and used the time to see if I could identify the anatomy each time. It was good practice! Good Luck!

RN1298 · Aug 20, 2010

Thank you so much for the advice everyone!! janfrn, I really like your advice about the 2x2s... that seems to be my mine problem, that my fingers are constantly slipping... but I'm having a hard time visualizing what you're saying. are you saying use 2, one on either side? Or just use one and kind of hold it across the top so you aren't blocking your view..?

Pediatric Critical Care Columnist · Aug 20, 2010

The package holds 2 separate pieces of gauze. I separate them onto my field while I'm setting up. I wrap one around my index finger before I clean, and then tuck the second one under my thumb once everything is cleaned, but you can tuck it in there before you clean if you're really careful not to contaminate your dominant hand. It gives you a better grip when you separate the labia although they sometimes let you down and your fingers slip anyway. Try it a few times and see how it works for you. I learned it from a neonatal resus nurse who did a lot of sepsis workups and it really makes a difference.

back2bRN · Aug 21, 2010

Thank you for the tips...the 2x2s, I already knew about they work well . And boys, yes it is amazing how much you do advance the cath, also the resistance and holding steady pressure is very important.(Going up against an enlarged prostate teaches you all sorts of tricks). The anatomy is most crucial to me,3-5 mm away, yes there is not much space! Thank you janfrn and rnsrgr8t for the tips.