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Use of lubricants for male and female catheterization

There is clear consensus that a lubricant should be used for both male and female urinary catheterisation (NICE 2012), but this is another area of practice which requires further research to inform clinical decision making.

Task 2

1
What is the purpose of using a lubricant prior to catheter insertion?

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Using an appropriate, sterile, single use lubricant to lubricate the urethra prior to catheterisation will reduce trauma on insertion (NICE, 2012), thereby reducing damage to the urethral lining and reducing pain on catheter insertion.Check your answer

There is a general consensus that sterile, anaesthetic based gel, is used for male catheterisation, with most Trusts now using Instillagel(r).

There have been a number of different practices in relation to female urethral catheterisation over the years and still a wide variation in practice today.

Task 3

2
Reflect on different practices in relation to lubrication for female urethral catheterisation that you have either heard of or witnessed in practice.

Record your thoughts in the box and then check your answer and see which of the methods cited you have come across.

1. No lubricant - "women don't need a lubricant as the urethra is only 3cm long"

2. Lubricating the catheter - dipping the catheter tip into either water or into a blob of lubricating gel that has been put onto the sterile field on top of the trolley (Insert photo 2 - catheter rubbed through sterile gel: copyright Sue Woodward)

3. Lubricating the urethra - inserting sterile, single use lubricating gel into the urethra using a pre-filled syringe

Check your answer

Task 4

3
Which of the three methods identified above is acceptable practice?

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3 - the female urethra should be lubricated. Gel applied to a catheter will often wipe off at the urethral meatus and not enter the urethra. The female urethra is a flattened, convoluted tube and inserting a gel into the urethra will perform and dilate the urethra making it easier to insert a catheter (Woodward, 2005).

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Figure 3 - female urethra in cross section

Some products, such as Instillagel(r), are available in two sizes, i.e. an 11ml syringe for use with males and a 6ml syringe for use with females. The correct size should be selected and the full amount used. However many nurses are not aware of the smaller size product for female use, or this is not stocked in a clinical area, so the larger size is used and part of the contents wasted.

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LU361_kg_c12_lo27 image 3.JPG

Figure 4: Instillagel 11ml and 6ml.

(CliniMed)

More recently a debate has begun regarding whether a local anaesthetic based gel is needed or whether a plain gel is sufficient for catheterisation, given the evidence supporting the use of plain gels for flexible cystoscopy (Kyle, 2009). You must ensure you follow local Trust guidance.

Task 5

4
Access and read the short practice question paper by Kyle (2009). Do you think practice should be changed to the use of plain gel?

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At the moment we have insufficient evidence on which to base this decision and further research is required. There are currently two studies, both conducted within emergency departments, investigating the use of local anaesthetic or plain gel for procedural pain in female urethral catheterisation (Tanabe et al, 2004; Chung et al, 2007). These are small scale studies, with methodological flaws and have produced conflicting results.Check your answer