118 Section IV ■ Miscellaneous Sampling

A B

Fig. 20.4. A: Cystogram shows dilated posterior urethra (arrows) secondary to posterior urethral valves.

B: Subsequent film shows perforation of the bladder, with free contrast material in the peritoneal cavity.

F. Complications

1. Infection (23–26)

a. Urethritis

b. Epididymitis

c. Cystitis

d. Pyelonephritis

e. Sepsis

 The most common complication of bladder catheterization is the introduction of bacteria into the urinary

tract and potentially into the bloodstream.

Catheterization is the leading cause of nosocomial urinary tract infection and gram-negative sepsis in adult

patients (24). The risk of bacteriuria from straight (“inand-out”) catheterization is 1% to 5% in this population

(23,24). The risk of infection is related directly to the

duration of catheterization. In infants and children,

approximately 50% to 75% of hospital-acquired urinary

tract infections occur in catheterized patients, the highest rate being in neonates (25,26). Urinary tract infection developed in 10.8% of catheterized pediatric

patients (25), and secondary bacteremia in 2.9% (26).

Risk of infection is decreased by adhering to strict aseptic technique during catheter placement, maintaining

a closed sterile collection system, and removing the

catheter as soon as possible.

2. Trauma

a. Hematuria

b. Urethral erosion or tear (27)

c. Urethral false passage (27,28)

d. Perforation of the urethra or bladder (Fig. 20.4)

(27,29,30)

e. Tear of the fourchette (27)

f. Meatal stenosis (20)

g. Urethral stricture (31)

h. Urinary retention secondary to urethral edema (27)

3. The risk of trauma is reduced by using the smallestdiameter catheter with ample lubrication, advancing

the catheter only as far as necessary to obtain urine, and

never forcing a catheter through an obstruction.

Erosion and perforation are associated with longindwelling catheters. This risk is reduced by removing

the catheter as soon as possible.

4. Mechanical

a. Catheter malposition (27)

b. Catheter knot (32–36)

 The risk of knotting is reduced by using the minimal

length of catheter insertion. Standard insertion lengths

of 6 cm for male and 5 cm for female term newborns

have been suggested (36). Shorter lengths would be

appropriate for preterm infants. A more general standard is to insert the catheter only as far as needed to

obtain urine. Using a feeding tube as a urinary catheter

may also increase the risk of knotting, because these

tubes are softer and more likely to coil.

Chapter 20 ■ Bladder Catheterization 119

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