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Devices and appliances

New guidance on how to avoid inserting female-length urinary catheters into men


The National Patient Safety Agency has issued new guidance on the importance of selecting catheters of the correct length to avoid adverse incidents


Key points

  • Nurses must select the correct catheter for each patient. There are three lengths: female (20–26cm), standard (40–45cm) and paediatric (30–31cm).
  • Men should always receive standard catheters. If they receive a female-length catheter, the ‘balloon’ in the urethra can cause potentially serious complications, including haematuria, penile swelling or urinary retention. There is a theoretical risk that similar trauma could occur if older boys receive a paediatric catheter. However, the NPSA did not identify any cases where this had occurred.
  • A lack of urine flow following catheter insertion may suggest balloon misplacement. Some healthcare professionals assumed that patients who received an incorrect catheter and showed low urine flow had poor output.
  • Trusts should review their supply systems for female catheters, limit access where appropriate and prominently display warning notices in settings where teenage or adult males are treated.
  • Whenever possible, trusts should attach additional warning labels to each catheter before distribution. Staff responsible for over-labelling should check the label adhesive is compatible withthe packaging and will notcompromise sterility. If in doubt, the warning label should be attached to atransparent over-wrapper. The labelshould not obscure safety and other information.
  • The NPSA recommends purchasing urinary catheters that are labelled to avoid selection errors. Training for urinary catheter insertion should cover selecting catheters of the correct length.

Trusts should review the supply and access to female-length urinary catheters, following the National PatientSafety Agency’s (2009) rapid response report. This identified incidents where male patients were catheterised with female catheters.

Female-length urinary catheters (20–26cm) allow women to hide their catheter drainage bag more discreetly than is possible with standard-length catheters (40–45cm), especially when wearing skirts. Certain women prefer standard-length catheters, such as some who are confined to bed, those who are obese or those who always wear trousers. These catheters pose no safety issues in female patients. However, a standard catheter must be used with male patients. If men wrongly receive a female device, the ‘balloon’ – which should be in the bladder to maintain the catheter in position – will lie in the urethra, potentially causing serious complications.

Reported incidents

The NPSA recently analysed 114 incidents reported between 1 January 2006 and 17 December 2008 in which healthcare staff inserted female catheters into men. Nurses in hospitals were responsible for 65 incorrect insertions and those in the community were responsible for 15 during this period. In all cases, the insertions caused significant pain. Some men experienced penile swelling or urinary retention.

In 29 cases, the incorrect insertion produced ‘moderate frank bleeding’, while seven men experienced ‘significant haemorrhages’. Two cases resulted in acute kidney failure and two in impaired renal function. The Medicines andHealthcare products Regulatory Agency also received a report of a death that was related partly to haemorrhage after staff inserted a female catheter into a seriously ill man.

Although the 114 incidents represent a very small proportion of catheterisations, the NPSA suggests that simple measures could prevent such errors from occurring. 


The rapid response report wants trusts to review their supply systems and limit access to female catheters where appropriate. For example, the NPSA suggests that specialist wards or specialist nurses in hospitals could become the sole source of female catheters. Other wards would not routinely stock them.

Trusts should prominently display warning notices close to stocks of female catheters in settings where teenage or adult males are treated. Whenever possible, they should attach additional warning labels to each catheter before distribution to settings that treat teenage or adult males. Downloadable warning notices and labels are available from the NPSA and can be printed on standard address label sheets.

Staff responsible for over-labelling should contact the catheter manufacturer to ensure the adhesive is compatible with the packaging and will not compromise sterility. If in doubt, the warning label should be attached to a transparent over-wrapper, such as a plastic sleeve or bag. The label must not obscure safety and other information, such as warnings about latex.

The NPSA also recommends purchasing urinary catheters that are clearly labelled to avoid selection errors. Finally, trusts should ensure that local competency-based training for urinary catheter insertion includes advice on selecting correct-length catheters.

Healthcare organisations must implement these recommendations by 1 September 2009.

Mark Greener, BSc, is a freelance medical writer


Readers' comments (2)

  • I would suggest that this issue has deeper implications for both NHS managers and patients. It is clear that all the checks that are required to be made prior to the insertion of a urinary catheter, usually in a policy document, are not being followed. This not only increases the risk of the wrong length being used but also those that are out of date or damaged. Continence and urology specialist nurses have for many years zealously warned of the dangers of failing to systematically check these high risk products. The collaboration between manufacturers and clinicians has ensured that labelling assists not only these checks but documenting the procedure. Standard length catheters are not only uncomfortable for independant females but also increase the risk of pulling and consequent trauma. My main concern is that due to bad practice, catheter care for women may well be compromised as we implement defensive procedures. The last time this issue arose nurses refused to undertake catheterisation in males for fear of incidents and patients were forced to attend hospital instead. I would hope that commissioners keep their eye on this ball.

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  • Number 1 - I applaud the National Patients Safety Agency (NPSA) for taking this position and Belinda in her comment above is absolutely correct. This has far, far reaching implications. As an author of many Trust policies in the past relating to continence (& catheters) even I as a fairly independently minded individual found it difficult to complete a policy in Plain English. There were so many "required elements" to be added that made a simple policy 20 pages long and as Belinda implies such wordy documents allow the danger of staff not really reading, checking and complying. This is a fairly simple problem that has a very simple solution - FEMALE CATHETERS ARE ONLY FOR FEMALES! Nurses should not refuse to catheterise men per sae, if you are trained and follow basic good practice then you are safe, naturally I would always say remember the first rule of catheterisation - DON'T DO IT! Then if you MUST, do it properly. With knowledge, developed skills and awareness of your client/patient group you must of course consider a female catheter as an option and discuss this, issues of dignity etc., with the client/patient. Even with all the good things manufacturers do, the excellent services provided by manufacturers and clinicians, the risks of catheterisation remains high so my final word on this matter must be; Let US the clinician, the provider of care most excellent not be stupid and careless, read the label and follow manufacturers instructions. This process will take ONE MINUTE more and save everyone hours, days and weeks of pain and aggravation. Well it works for me!

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