Cover Image
close this bookMinor Surgical Procedures in Remote Areas (MSF, 1989, 172 p.)
View the document(introduction...)
View the documentNotice
close this folderChapter 1: Wounds - Burns
View the documentDressings
View the documentWounds
View the documentBurns
close this folderChapter 2: Infection of soft tissues
View the documentAbscess
View the documentTreatment of tropical myositis
View the documentInfections of the hand and fingers
close this folderChapter 3: Catheterisation and drainage
View the documentCatheterisation of large veins
View the documentLumbar puncture
View the documentPleural puncture
View the documentThoracic drainage
View the documentPericardial puncture
View the documentDrainage of ascites and intra-peritoneal perfusion
View the documentPuncture and drainage of the knee
close this folderChapter 4: ent procedures
View the documentEpistaxis
View the documentEar drainage
View the documentDental extraction
close this folderChapter 5: uro-genital procedures
View the documentUrinary catheterisation
View the documentReduction of a paraphymosis
View the documentEpisiotomy
View the documentSuturing episiotomies or perineal tears
View the documentIntra-uterine procedures
View the documentTreatment of a bartholin abscess
close this folderChapter 6: treatment of trauma
View the documentFractures and disIocations: the basics
View the documentShoulder and arm trauma
View the documentTrauma of the lower limb
View the documentPeriod of immobilization for major fractures
close this folderAppendix
View the documentList of essential supplies (absolutely necessary)
View the documentDisinfection and Sterilization of medical equipment and supplies
View the documentBibliography

Urinary catheterisation

Drainage of urine


Acute retention of urine

Urgent procedure is necessary for:

· Narrowing of the urethra
· Adenoma or cancer of the prostate
· Pelvic tumor
· Pelvis trauma
· Paraplegia

Urethral catheterisation

(for men)


· Sterilised gloves and drapes

· Sterile catheters, generally Foleys n° 12,14,18 for example

· Lubrification with chlorhexidine (+ cetrimide) (see table page 7)

· Sterile compresses

· 10 ml syringe

(Figures 88, 89)

· Careful disinfection of the meatus, the glan and the prepuce, through the hole in the drapes.

· Coat the catheter with chlorhexidine (+ cetrimide) (see table page 7)

· The left hand holds the penis vertically

· The right hand carefully introduces the catheter through the meatus.

· Change the size of the catheter if introduction is difficult.

· When the catheter reaches the bulbar angle (13 to 15 cm), direct it towards the base.

· NEVER FORCE THE CATHETER, it is better to use a suprapubic catheter than to traumatise the urethra.

· Advance the catheter to the hilt before inflating the balloon (5 to 10 ml of liquid).

· Next, gently pull the catheter until the balloon abuts on the bladder neck.

· Always replace the prepuce around the glans, to prevent a paraphymosis.

· If the catheter is to remain in place, connect it to a sterile urine container, otherwise to a perfusion tube attached to a short necked bottle.

· Clean the meatus each day, and eventually, depending on the clinical context, institute antibiotic treatment (cotrimoxazole: 1,600 mg de SMX/day in 2 divided doses x 5 days for an adult.




Suprapubic catheterisation


When urethral catheterisation presents difficulties, and when there is a risk of damage to the urethra with the catheter (trauma to the bladder, trauma to the urethra, and urethral stenosis, etc.).

The bladder must be dilated: A DISTENDED BLADER IS OBLIGATORY.


· A prepared pack exists with a unique "cystocath". If not available, a large trochar and long catheter perforated at one end (at least 14G), can be used.

· Drapes with a hole, and sterile gloves

· Suture material

· Local anesthetic


· Shave and then disinfect the suprapubic region with polyvidone iodine (see table page 7).

· Make a bubble in the skin with lidocaine a finger breadth above the symphysis pubis in the median line. Anesthetise the deep tissue planes (Figure 91).

· With the same syringe ensure that aspiration produces urine.

· Puncture through the anesthetised bubble, asking the patient to cough.

· Introduce the perforated drain: advance 10 to 15 cm of the catheter, remove the trocar and attach the catheter to a sterile urine container.

· Fix the drain to the skin with a non resorbable suture and a dressing.

· Clean the drain at least once a day and institute urinary antibiotic treatment (cotrimoxazo/e: 1,600 mg of SMX/day in 2 doses for adults x 5 days) (Figures 92, 93, 94).