Synopsis
Insert, confirm, secure, maintain and remove urinary catheters and nasogastric tubes safely, preventing urethral trauma, infection and catastrophic respiratory placement.
- Use an invasive tube only for a clear indication, document it and review daily; alternatives may meet the goal with less harm.
- Urinary catheterisation uses aseptic technique, single-use lubricant, the smallest gauge that permits drainage and a sterile closed system.
- Never inflate a urinary balloon until urine flows and the catheter is advanced appropriately into the bladder; pain or resistance is a stop signal.
Key red flags
Meatal blood, pelvic trauma or perineal bruising requires urological assessment before blind catheterisation.
Pain during balloon inflation, failure to drain or new bleeding requires immediate stopping, complete balloon deflation and senior review before any further catheter manipulation.
Cough, cyanosis, breathlessness, voice change or falling saturation during insertion requires immediate withdrawal.
Acute cough, desaturation, fever or respiratory distress during feeding requires stopping feed and urgent assessment.
Reasoning priorities
Confirm retention and guide whether catheterisation is needed.
Device and timing limitations apply; severe symptoms or acute renal risk may still require urgent action.
Worked reasoning
A newly inserted NG tube yields no aspirate and the patient needs time-critical medication.
- Do not flush, medicate or feed; reassess patient, respiratory symptoms, external length, fixation and insertion events.
- Reason that absence of distress or a plausible tube length cannot confirm gastric position and that flushing could deliver fluid into lung.
- Use manoeuvres allowed by local policy to obtain aspirate, then arrange an appropriate placement X-ray if pH confirmation remains unavailable; use an alternative medicine route meanwhile.
- Verify trained X-ray interpretation and documented authorisation, record external length and communicate confirmation before first use.