You’re preparing for urinary catheterization of a trauma patient and you observe bleeding at the urethral meatus. Which action has priority?
A. Irrigate and clean the meatus before catheterization.
B. Check the discharge for occult blood before catheterization.
C. Heavily lubricate the catheter before insertion.
D. Delay catheterization and notify the doctor.
Correct Answer: D. Delay catheterization and notify the doctor.
Bleeding at the urethral meatus is evidence that the urethra is injured. Because catheterization can cause further harm, consult with the doctor. Urethral trauma can occur due to pelvic and perineal injuries or iatrogenic trauma to the urethra. Urethral bleeding as one of the complications of urethral trauma is not usually life-threatening, nevertheless it can be very embarrassing.
Option A: Traditionally, direct pressure on the bleeding site is the standard way to control hemorrhage. Putting pressure on the perineum is the only way we can reach this goal. In the perineum, applying a pressure dressing over a solid object which is fixed with adhesive bands to the lower abdomen is the conventional method.
Option B: The second method to control traumatic or non-traumatic urethral bleeding is to apply intermittent penile ligation. This intervention does not permit bleeding through the urethra, increases pressure at the bleeding site and helps homeostasis.
Option C: Intermittent penile and continuous perineal compression are methods that are taught but not mentioned in the literature directly. Sometimes these methods are ineffective and difficult to tolerate. In applying this method, providing direct pressure on the distal end of the urethra and also corpus spongiosum and urethral arteries ceases the bleeding.
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