483

STUDENT: ________________________________________________________________ INSTRUCTOR: _____________________________________________________________

DATE: _________________________ DATE: _________________________

Skill 442 Inserting a Straight or In-Dwelling Catheter S

1. 2. 3. Review the clients medical record, including physicians order and nurses notes. Close bedside curtain or door. Assess the status of the client: A. Urinary status: Ask the client when he or she last voided, or check intake and output flow sheet, or palpate bladder B. Level of awareness or developmental stage C. Mobility and physical limitations of the client D. The clients gender and age E. Bladder distension F. Perineum, for erythema, drainage, and odour: Perform hand hygiene, put on clean gloves, and inspect perineum G. Any pathological condition that may impair passage of catheter (e.g., enlarged prostate in men) H. Allergies Assess the clients knowledge of the purpose of catheterization. Explain the procedure to the client. Arrange for extra nursing assistance if necessary. Perform hand hygiene. Raise the bed to an appropriate working height. Facing the client, stand on the left side of the bed if you are righthanded (on the right side if you are left-handed). Clear the bedside table, and arrange equipment. Raise the side rail on the opposite side of the bed, and put the side rail down on the working side. Place a waterproof pad under the client. Position the client. A. Female client: (1) Assist the client to the dorsal recumbent position. Ask the client to relax her thighs so that the hips can be rotated externally. (2) Assist the client to a side-lying (Sims) position with the upper leg flexed at the hip if the client is unable to assume the dorsal recumbent position. If this position is used, you must take extra precautions to cover the rectal area with a drape to reduce chance of cross-contamination. B. Male client: (1) Assist the client to a supine position with thighs slightly abducted. Drape client. A. Female client: (1) Drape with a bath blanket. Place the blanket in a diamond shape over the client, with one corner at the clients midsection, side corners over each thigh and the abdomen, and the last corner over the perineum. B. Male client: (1) Drape the clients upper trunk with a bath blanket and cover the lower extremities with bedsheets so that only genitalia are exposed. Wearing disposable gloves, wash the perineal area with soap and water as needed; dry thoroughly. Remove and discard gloves; perform hand hygiene. Position a lamp to illuminate the perineal area. (If you use a flashlight, have an assistant hold it.) Open the package containing the drainage system. Place the drainage bag over the edge of the bottom bed frame, and bring the drainage tube up between side rail and mattress. Open the catheterization kit according to directions, keeping the bottom of the container sterile. ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____

U
____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____

NP
____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____

Comments
____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________

4. 5. 6. 7. 8. 9. 10. 11. 12.

____

____

____

____________________

13.

____

____

____

____________________

____ ____ ____ ____ ____

____ ____ ____ ____ ____

____ ____ ____ ____ ____

____________________ ____________________ ____________________ ____________________ ____________________ Continued

14. 15. 16. 17.

Copyright 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

484

S
18. 19. 20. Place the plastic bag that contained the kit within reach of the work area to use as a waterproof bag in which used supplies can be disposed. Put on sterile gloves. Organize supplies on a sterile field. Open the inner sterile package containing the catheter. Pour sterile antiseptic solution into the correct compartment containing sterile cotton balls. Open the packet containing lubricant. Remove the specimen container (the lid should be placed loosely on top) and the prefilled syringe from the collection compartment of the tray, and set them aside on the sterile field. Before inserting an in-dwelling catheter, test the balloon by injecting fluid from the prefilled syringe into the balloon port. Lubricate 2.55 cm of the catheter for female clients and 12.5 17.5 cm for male clients. Apply the sterile drape: A. Female client: (1) Allow the top edge of the drape to form a cuff over both gloved hands. Place the drape on the bed between the clients thighs. Slip the cuffed edge just under the clients buttocks, taking care not to touch the contaminated surface with gloves. (2) Pick up the fenestrated sterile drape and allow it to unfold without touching any unsterile objects. Apply the drape over the clients perineum, exposing labia, taking care not to touch the contaminated surface with gloves. B. Male client: (1) Two methods are used for draping, depending on preference. First method: Apply the drape over the thighs and under the penis without completely opening fenestrated drape. Second method: Apply the drape over the thighs just below the penis. Pick up the fenestrated sterile drape, allow it to unfold without touching any unsterile objects, and drape it over the penis, with the fenestrated slit resting over the penis. Place the sterile tray and contents on the sterile drape. Open the specimen container. Cleanse the urethral meatus. A. Female client: (1) With your nondominant hand, carefully retract the labia to fully expose the urethral meatus. Maintain position of your nondominant hand throughout the procedure. (2) Holding forceps in your sterile dominant hand, pick up a cotton ball saturated with antiseptic solution and clean the clients perineal area, wiping from clitoris toward anus (front to back). Using a new cotton ball for each area, wipe along the far labial fold, the near labial fold, and directly over the centre of the urethral meatus. B. Male client: (1) If the client is not circumcised, retract the foreskin with your nondominant hand. Grasp the penis at the shaft, just below the glans. Retract the urethral meatus between your thumb and forefinger. Maintain your nondominant hand in this position throughout the procedure. (2) With your sterile dominant hand, use forceps to pick up a cotton ball saturated with antiseptic solution, and clean the penis. Move the cotton ball in circular motion from the urethral meatus down to the base of the glans. Repeat cleansing three more times, using a clean cotton ball each time. Pick up the catheter with your gloved dominant hand, 7.510 cm from the catheter tip. Hold the end of the catheter loosely coiled in the palm of your dominant hand. (Optional: Grasp the catheter with forceps.) Insert the catheter. A. Female client: (1) Ask the client to bear down gently as if to void urine, and slowly insert the catheter through the urethral meatus. ____ ____ ____

U
____ ____ ____

NP
____ ____ ____

Comments
____________________ ____________________ ____________________

21. 22. 23.

____ ____

____ ____

____ ____

____________________ ____________________

____

____

____

____________________

____

____

____

____________________

____

____

____

____________________

24. 25.

____

____

____

____________________

____ ____

____ ____

____ ____

____________________ ____________________

____

____

____

____________________

____

____

____

____________________

26.

____

____

____

____________________

27.

____

____

____

____________________

Continued

Copyright 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

485

S
Advance the catheter a total of 57.5 cm in an adult or until urine flows out the catheters end. When urine appears, advance the catheter another 2.55 cm. Do not use force against resistance. (3) Release the labia and hold the catheter securely with your nondominant hand. Slowly inflate the balloon if the indwelling catheter is being used. B. Male client: (1) Lift the clients penis to position perpendicular to the clients body, and apply light traction. (2) Ask the client to bear down gently as if to void urine, and slowly insert the catheter through the urethral meatus. (3) Advance the catheter 1722.5 cm (79 inches) in an adult or until urine flows out the catheters end. If resistance is felt, withdraw the catheter; do not force it through the urethra. When urine appears, advance the catheter another 2.55 cm. Do not use force against resistance. (4) Lower the clients penis and hold the catheter securely in your nondominant hand. Place the end of the catheter in the urine tray. Inflate the balloon if an in-dwelling catheter is being used. (5) Reduce (or reposition) the foreskin. Collect the urine specimen as needed. Fill the specimen cup or jar to the desired level (2030 mL) by holding the end of the catheter over the cup with your dominant hand. Allow the clients bladder to empty fully (about 8001000 mL) unless institution policy restricts the maximal volume of urine to drain with each catheterization. Check institution policy before beginning catheterization. Inflate the balloon fully per manufacturers recommendation, and then release the catheter with your nondominant hand and pull gently. Attach the end of the in-dwelling catheter to the collecting tube of the drainage system. The drainage bag must be below the level of the bladder. Attach the bag to the bed frame; do not place the bag on the beds side rails. Anchor the catheter. A. Female client: (1) Secure the catheter tubing to the clients inner thigh or abdomen with a strip of nonallergenic tape (or multipurpose tube holders with a Velcro strap). Allow for slack so that movement of the thigh does not create tension on the catheter. B. Male client: (1) Secure the catheter tubing to the top of the thigh or lower abdomen (with the penis directed toward the chest). Allow for slack so that movement does not create tension on the catheter. Assist the client to a comfortable position. Wash and dry the perineal area as needed. Remove gloves and dispose of equipment, drapes, and urine in proper receptacles. Perform hand hygiene. Palpate the clients bladder. Ask whether the client is comfortable. Observe the character and amount of urine in the drainage system. Ensure that no urine is leaking from the catheter or tubing connections. Record and report catheterization, characteristics and amount of urine, specimen collection (if performed), and clients response to procedure and teaching concepts. Initiate intake and output records. (2) ____

U
____

NP
____

Comments
____________________

____

____

____

____________________

____ ____ ____

____ ____ ____

____ ____ ____

____________________ ____________________ ____________________

____

____

____

____________________

28. 29.

____ ____ ____

____ ____ ____

____ ____ ____

____________________ ____________________ ____________________

30. 31.

____ ____

____ ____

____ ____

____________________ ____________________

32.

____

____

____

____________________

____

____

____

____________________

33. 34. 35. 36. 37. 38. 39. 40. 41.

____ ____ ____ ____ ____ ____ ____ ____ ____

____ ____ ____ ____ ____ ____ ____ ____ ____

____ ____ ____ ____ ____ ____ ____ ____ ____

____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________

Copyright 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.