GENITOURINARY DISORDERS - Medicine for Mountaineering and Other Wilderness Activities - page 295

Urethral catheterization is rarely required for females, whose much shorter urethra of-
fers far less resistance to voiding. If urethral catheterization is needed for a female, it must
be carried out by someone with enough knowledge of female anatomy to correctly identify
the urethral opening.
Rarely,anindividual withadistended bladder repeatedly voidsasmall amount butdoes
not completely empty the bladder. For such individuals distension requires longer to de-
velop but can become much more severe because it is less obvious. Since the individual is
voiding, the primary symptom is the severe discomfort from the distended bladder.
Usually about eight to ten hours are required for the bladder to become distended.
Urethral catheterization can often be avoided if the person can be induced to void before
that much time has elapsed. Having the person walk around for a few minutes or placing
the person's hand in warm water is frequently helpful in achieving that goal.
The greatest risk from urethral catheterization is infection, but meticulous care to avoid
contamination of the catheter reduces this hazard.
The following procedure should be followed for urethral catheterization:
1. Everything needed must be assembled before the procedure is begun. Any break to ob-
tain a forgotten item invites contamination and infection. The required supplies consist
of a sterile urinary catheter, size 16 or 18 French, sterile rubber or plastic gloves or
sterile instruments to handle the catheter, sterile lubricating ointment, and Betadine®
or soap and water. A sterile towel on which to place the items is a great convenience
andhelpspreventcontamination.Thesterilewrapperfromtheglovesmaybeanappro-
priate substitute. A receptacle to collect the urine should also be on hand, particularly
if the volume of urine must be measured.
2.TheglansmustbecleanedwithBetadine®orjustsoapandwater,andthecathetermust
be removed from its container without being contaminated. The circumstances and as-
sistance available should determine which is done first, but the glans should not touch
any nonsterile objects after it has been cleaned. For women, the labia should be spread
and the opening of the urethra and surrounding mucosa should be cleansed in a similar
manner. The labia must not be allowed to close until the catheter has been inserted into
the bladder.
3. A small amount of a sterile lubricant should be applied to the catheter tip, and, with the
individual in the supine position, the catheter should be inserted into the urethra and
gentlythreadedupwarduntilurinebeginstoflowfromtheopenend.Inmen,thisman-
euver is facilitated if the penis is pulled upward to straighten the urethra and eliminate
anyfoldsinthemucosaliningthispassage.Aftertheurinehasceasedtoflow,thecath-
eter should be gently withdrawn.
Some individuals require only a single catheterization and are subsequently able to void
without difficulty, but in the wilderness most individuals require multiple catheterizations