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required for a short period of time and free drainage is the preferred method.) As catheter valves preclude free drainage, they are unlikely to be appropriate for patients with uncontrolled detrusor overactivity, ureteric reflux or renal impairment (Fader et al. 1997). Catheter valves are designed to fit with linked systems so it is possible for patients to connect to a drainage bag. This may be necessary when access to toilets may be limited, for example overnight or on long journeys.

Catheter valves are licensed by the Department of Health to remain in situ for 5–7 days, and this corresponds with most manufacturers’ recommendations (Pomfret 1996). Little research into the advantages and disadvantages of catheter valves has been completed.

Pharmacological support

Anaesthetic lubricating gel

The use of anaesthetic lubricating gels is well recognized for male catheterization, but there is some controversy over their use for female catheterization. In male patients the gel is instilled directly into the urethra and then external massage is used to move the gel down its length, unless a conforming gel such as Instillagel is used and then this is not necessary. In female patients the anaesthetic lubricating gel or plain lubricating gel is applied to the tip of the catheter only, if it is used at all. It has been suggested that most of the lubricant is wiped off the catheter at the urethral introitus so therefore it fails to reach the urethral tissue (Muctar 1991).

These differences in practice imply that catheterization is a painful procedure for men but is not so for women. This assumption is not based on any empirical or biological evidence. Other than the differences in length and route, the male and female urethra are very similar except for the presence of lubricating glands in the male urethra (Tortora and Derrickson 2009). The absence of these lubricating glands in the female urethra suggests that there is perhaps a greater need for the introduction of a lubricant (Wilson 2008). Women have complained of pain and discomfort during catheterization procedures (Mackenzie and Webb 1995), suggesting that the use of anaesthetic lubricating gels must be reconsidered (BAUN 2000, 2009, Woodward 2005). The literature does highlight a couple of issues on the use of lidocaine gel. If it is not instilled far enough in advance, that is, more than 4 minutes, it will have only a lubricating effect (Association for Continence Advice 2003/2008, Tanabe et al. 2004) and if the gel is not instilled up the urethra, it will not dilate or anaesthetize it (Bardsley 2005, NICE 2003). There is a need for caution with the use of lidocaine in the elderly, those with cardiac dysrhythmias and those with sensitivity to the drug, as there is a danger of injury to the urothelial lining of the urethra during the procedure, allowing systemic absorption of the drug (BNF 2011).

Trauma can occur during catheterization, which in turn can increase the risk of infection. Using single-use lubrication gels with antiseptic properties can reduce these risks (BNF 2011, Pratt et al. 2007). Since there is a lack of research to clarify the efficacy of lubricating gels, practice must be based on the research evidence that is available and the physiology and anatomy of the urethra.

Procedure guideline 6.4 Urinary catheterization: male

Essential equipment

Sterile catheterization pack containing gallipots, receiver, low-linting swabs, disposable towels

Disposable pad

Sterile gloves

Selection of appropriate catheters

Sterile anaesthetic lubricating jelly

Universal specimen container

0.9% sodium chloride

Bactericidal alcohol handrub

Hypoallergenic tape or leg strap for tethering

Sterile water

Syringe and needle

Disposable plastic apron

Drainage bag and stand or holder

Preprocedure

Action Rationale

1 Explain and discuss the procedure with the patient. To ensure that the patient understands the procedure and gives his valid consent (NMC 2008a, C).

2 Screen the bed. To ensure patient’s privacy (Fraise and Bradley 2009, E).

3 Assist the patient to get