Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Routine urinary catheter placement may cause trauma and poses a risk of infection. Male catheterization, in particular, can be difficult, especially in patients with enlarged prostate glands orother potentially obstructive conditions in the lower urinary tract. Solutions to problematic urinary catheterization are not well known and when difficult catheterization occurs, the risk of failedcatheterization and concomitant complications increase. Repeated and unsuccessful attempts aturinary catheterization induce stress and pain for the patient, injury to the urethra, potential urethralstricture requiring surgical reconstruction, and problematic subsequent catheterization. Improperinsertion of catheters also can significantly increase healthcare costs due to added days ofhospitalization, increased interventions, and increased complexity of follow-up evaluations. Improved techniques for catheter placement are essential for all healthcare personnel involved in themanagement of the patient with acute urinary retention, including attending emergency physicians whooften are the first physicians to encounter such patients. Best practice methods for blind catheter placement are summarized in this review. In addition, for progressive clinical practice, an algorithm forthe management of difficult urinary catheterizations that incorporates technology enabling directvisualization of the urethra during catheter insertion is presented. This algorithm will aid healthcare personnel in decision making and has the potential to improve quality of care of patients. [West J EmergMed. 2012;13(6):472–478.]