In your article on "Inserting an Indwelling Urinary Catheter in a Male Patient" (Clinical Do's and Don'ts, July 2004), you say "Advance [the catheter] 7 to 9 inches or until urine starts draining, then advance it another inch." This isn't far enough. In a male patient, you should always insert an indwelling catheter up to the catheter's Y bifurcation before you inflate the balloon. This ensures that the balloon isn't inflated while in the prostatic urethra, which would cause pain and bleeding.

JEANNE HELD-WARMKESSEL, RN, AOCN(R), APRN,BC, MSN

Philadelphia, Pa.

Richard L. Pullen, Jr., RN, EdD, responds: Your point is well taken, but I think the literature is still split on this issue. Both methods seem to meet the standard of practice. Perhaps it would have been better to say, "Advance the catheter 7 to 9 inches or until urine starts draining, then advance it another inch, or advance it to the Y bifurcation, depending on your institution's policies and procedures."