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NICU guideline identifier

Urine measurement, urinary catheterisation and urinalysis in newborns

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Urine measurements

The following infants should have urine output monitored in the NICU:

  • All babies admitted to Level 3 in their first 5 days of life. 
  • All babies who suffered intrauterine or intrapartum asphyxia. 
  • Infants with cardiac anomalies including symptomatic PDA. 
  • Infants with any renal impairment/anomaly identified on ultrasound e.g. reflux. 
  • Hydropic/oedematous infants. 
  • Muscle relaxed infants. 
  • Infants with renal failure. 
  • Babies receiving the following medications:
        Diuretics 
        Indomethacin 
        Steroids 
        Inotropes

Urine testing

The following infants should have regular daily urine testing unless requested more frequently on ward round:

  • Infants less than 1000g 
  • Infants less than 28 weeks gestation. 
  • Infants with suspected or confirmed infection, i.e, septicaemia or meningitis 
  • Infants receiving:
        Steroids 
        Insulin 
        Indomethacin 

Urinary catheterisation

Considerations

  • Time the procedure when the infant has not recently voided (1 to 2 hours after the last wet nappy) to reduce the chance of an unsuccessful attempt.
  • Use the smallest-diameter catheter to avoid traumatic complications.
  • The use of infant feeding tube as urinary catheters is not recommended.
  • Do not use a catheter with a balloon and/or a guidewire

Equipment

  • Sterile gloves
  • Dressing pack
  • Sterile guard
  • Lubricant
  • Antiseptic liquid
  • Urinary catheter
  • Sterile container for specimen collection or collection burette for continuous closed drainage

Catheterisation of male infant

Follow the steps below to catheterise a male infant. This would normally be performed by Medical or NS-ANP staff.

  1. Use strict aseptic technique
  2. Gather equipment. Set-up sterile field. Squeeze a small amount of lubricant on to the sterile field.
  3. Place infant supine, with the thighs abducted (frog-like position).
  4. Wash hands thoroughly and put on sterile gloves.
  5. Stabilise the shaft of the penis with non-dominant hand, perpendicular to the body. This hand is now considered contaminated.
  6. Apply gentle pressure at the base of the penis to avoid reflex urination.
  7. Clean the penis with antiseptic solution starting at meatus and moving down the shaft of the penis. Allow the antiseptic to dry.
  8. Drape sterile guards across the lower abdomen and across the infant's legs.
  9. Apply sterile lubricant to catheter tip.
  10. Gently insert the catheter into the meatus until urine is seen in the catheter.
  11. Slight resistance may be felt as the catheter passes through the external sphincter. Hold the catheter in place with minimal pressure - generally spasm will relax after several minutes allowing easy passage. NEVER FORCE THE CATHETER.
  12. Collect specimen for culture.
  13. If the catheter is to remain indwelling, immediately connect the catheter to closed urinary collection system.
  14. To prevent dislodgement, tape catheter securely to lower abdomen, rather than the leg to help decrease stricture formation caused by pressure on the posterior urethra. Place duoderm on lower abdomen underneath catheter taping to protect skin.

Catheterisation of female infant

Follow the steps below to catheterise a female infant

  1. Use strict aseptic technique
  2. Gather equipment. Set-up sterile field. Squeeze a small amount of lubricant on to the sterile field.
  3. Place infant supine, with the thighs abducted (frog-like position).
  4. Wash hands thoroughly and put on sterile gloves.
  5. With the non-dominant hand separate the labia and using sterile gauze
  6. Using the free hand for the rest of the procedure, clean the area around the meatus with antiseptic solution using anterior-to-posterior strokes to prevent drawing faecal material in to the field. Allow the antiseptic to dry.
  7. Drape sterile guards across the lower abdomen and across the infant's legs.
  8. Apply sterile lubricant to catheter tip.
  9. Gently insert catheter until urine is visible in catheter tubing. Do not insert extra tubing.
  10. If catheter is accidentally inserted into vagina, leave in place and insert new catheter anterior to the first catheter.
  11. Collect specimen for culture.
  12. Connect to closed urinary collection system.
  13. Secure the catheter by taping to infant's leg, apply duoderm to leg where catheter is to be taped to protect the skin.

Nursing documentation/Care post insertion

Document the size, type of catheter used and the time and date of insertion in multidisciplinary notes.

Removal of Urinary Catheter

Follow the steps below to remove a urinary catheter

  1. The catheter is removed as soon as possible as requested by medical staff/NS-ANP.
  2. If it is a surgically placed catheter, check if the catheter has a balloon. If so, empty the balloon before withdrawing the catheter. The volume in the balloon should be noted on the anaesthetic list.
  3. Gently withdraw catheter.
  4. Document in multidisciplinary notes and on nursing chart time and date catheter removed.
  5. Observe and document urine output accurately after removing catheter.
  6. Every 24hrs record urine output in ml/kg/hr.

Minimisation of trauma

  1. Feeding tubes should not be used as urinary catheters. Their rigid material and longer lengths (as compared to urethral catheters), increase the risk of trauma and knotting.
  2. Do not use a catheter with a balloon and/or a guidewire.
  3. Do not force catheter.
  4. Do not insert extra tubing length in an attempt to stabilize a catheter to be left indwelling as this will increase the risk of trauma and knotting.
  5. Do not move the catheter in and out as this will increase the risk of urethral damage.
  6. Secure the catheter to prevent pulling.

Associated documents

  • Evaluating the Kidney and Renal Function. In: Rudolph's Pediatrics (20th Ed). Rudolph AM, Hoffman JIE, Rudolph CD (Eds). Appleton and Lange, Conn, 1996. (p.1331-1335).
  • Atlas of Procedures in Neonatology, 4th edn. MacDonald and Ramasethu (Ed). (2007).

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Document Control

  • Date last published: 19 September 2018
  • Document type: Clinical Guideline
  • Services responsible: Neonatology
  • Owner: Newborn Services Clinical Practice Committee
  • Editor: Sarah Bellhouse
  • Review frequency: 2 years