INSERTION OF A STRAIGHT OR INDWELLING CATHETER
PROCEDURE
ASSESSMENT
1. Identify the patient using 2 identifiers.
2. Review patient’s medical record, note previous
catheterization.
3. Review medical record for any pathological
condition that may impair passage of catheter.
4. Perform hand hygiene, ask patient and check for
allergies.
5. Assess patient’s weight, LOC, developmental level,  Determines positioning for catheterization and
ability to cooperate, and mobility.
6. Assess patient’s gender and age.
7. Assess patient’s knowledge, prior experience with
catheterization and feelings about procedure.
8. Assess for pain and bladder fullness.
9. Perform hand hygiene, apply gloves, perform hand  Assessment of female perineum landmarks
hygiene.
PLANNING
1. Identify expected outcomes.
2. Explain procedure to patient.
3. Arrange for extra personnel to assist as necessary;  More than one person is needed to help position
organize supplies at the bedside.
IMPLEMENTATION
1. Check the patient’s plan of care for size and type of
catheter, use smallest size possible.
2. Perform hand hygiene.
3. Provide privacy.
4. Raise bed to appropriate height, raise side rail on
opposite side, lower side rail on working side.
5. Place waterproof pad under patient.
6. Apply clean gloves; clean, rinse, and dry perineal
area, examine patient and identify urinary meatus,
remove and discard gloves, perform hand hygiene.
7. Position patient appropriately.
8. Drape patient appropriately.
9. Position light to illuminate genitals or have assistant  Adequate visualization of urinary meatus helps
hold light.
RATIONALE
 Ensures correct patient. Complies with the Joint
Commission standards and improves patient’s
safety.
 Identifies purpose of inserting catheter such as for
measurement of residual urine or specimen
collection, previous catheter size, and potential
difficulty with catheter insertion.
 Obstruction of urethra may prevent passage of
catheter into bladder. Men with enlarged prostates
may require the use of condé-tip catheter.
 Identifies allergies to components of
catheterization kit and/or catheter (antiseptic, tape,
latex).
indicates how much help is needed to properly
position patient, ability of patient to cooperate
during procedure and level of explanation needed.
 Determines catheter size.
 Reveals extent of instruction or support needed by
the patient.
 Palpation of full bladder
improves accuracy and speed of catheter
insertion.
 Promotes cooperation and facilitates anxiety
reduction.
patients who are weak, frail, obese or confused.
 Reduces transmission of microorganisms.
 Protects patient confidentiality.
 Promotes good body mechanisms. Use of side
rails in this manner promotes patient safety.
 Prevents soiling of bed linen.
 Hygiene before catheter insertion removes
secretions, urine, feces that could contaminate the
sterile field and increase risk for catheter-
associated urinary tract infection.
 Provides good visualization of structures of
perineum (female) and penis (male), and
decreases risk for fecal contamination. Alternate
position is more comfortable if patient can’t abduct
leg at hip joint.
 Protects patient dignity by avoiding unnecessary
exposure of body parts.
with speed and accuracy of catheter insertion.
10. Open outer wrapping of catheterization kit, place
inner wrapped kit on a appropriate clean surface.
11. Open inner sterile wrap using sterile technique.
12. Apply sterile gloves.
13. Drape perineum, keep gloves sterile:
a. Drape female patient:
(1) Unfold square drape without touching
unsterile surfaces, allow top edge to form cuff over
both hands, place drape shiny side down between
patient’s thighs, ask patient to lift hips, slip cuffed
edge just under buttocks, apply new gloves if old
gloves are contaminated.
(2) Unfold fenestrated sterile drape without
touching unsterile surfaces, allow top edge to form
cuff over both hands, drape over perineum, expose
labia.
b. Drape male patient:
(1) Unfold square drape without touching
unsterile surfaces, place over thighs just below penis,
place fenestrated drape with opening centered over
penis.
14. Arrange supplies on sterile field, maintain sterility
of gloves, place loaded sterile tray on sterile drape:
a. Pour antiseptic solution over cotton balls if
necessary.
b. Open sterile specimen container if specimen was to
be obtained.
c. Open inner sterile wrapper of catheter, attach
drainage bag if part of a closed system, ensure clamp
on drainage port of bag was closed, attach catheter to
drainage tubing if part of sterile tray.
d. Open lubricant, squeeze onto sterile field, lubricate
catheter in gel appropriately.
15. Cleanse urethral meatus:
a. For female patient:
(1) Separate labia with fingers of nondominant hand.
(2) Maintain position of nondominant hand throughout
procedure.
(3) Cleanse labia with one cotton ball using forceps,
cleaned labia and urinary meatus appropriately.
 Provides easy access to supplies during catheter
insertion.
 Inner sterile wrap serves as sterile field. Straight
catheterization trays do not routinely come with
double wrapping.
 Sterile drapes provide sterile field over which
nurse will work during catheterization.
Sterile drape female:
 When creating cuff over sterile glove hands,
sterility of gloves and workspace is maintained. If
gloves are contaminated, remove and apply new
pair.
 Opening in drape creates sterile field around labia.
Sterile drape male:
 Sequence of supplies in kit varies. Use supplies in
order to prevent contamination of underlying
supplies.
 Provides easy access to supplies during catheter
insertion and helps to maintain aseptic technique.
Appropriate placement is determined by size of
patient and position during catheterization.
 Use of sterile supplies and antiseptic solution will
reduce risk of CAUTI.
 Makes container accessible to receive urine from
catheter if specimen is needed.
 Lubrication minimizes trauma to urethra and
discomfort during catheter insertion. Male catheter
needs enough lubricant to cover length of catheter
inserted.
 Optimal visualization of urethral meatus is
possible. Closure of labia during cleansing means
that area is now contaminated and requires
cleaning procedure to be repeated.
 Front-to-back cleansing is cleaning from area of
least contamination toward highly contaminated
area. Dominant gloved hand remains sterile.
b. For male patient:
(1) Retract foreskin if present with nondominant hand,
hold penis appropriately.
(2) Use uncontaminated hand to appropriately
cleanse meatus.
(3) Repeat cleaning three times using clean cotton
ball each time.
16. Hold catheter properly away from catheter tip with
catheter coiled in hand, position urine tray
appropriately if necessary.
17. Insert catheter, explain to patient that feeling for
burning or pressure is normal and will go away:
a. For female patient:
(1) Ask patient to bear down, insert catheter slowly
through urethral meatus.
(2) Advance catheter appropriately or until urine flows
out end.
(3) Release labia, hold catheter securely with non
dominant hand.
b. For male patient:
(1) Apply upward traction to penis as it was held at 90
degree angle from the body.
(2) Ask patient to bear down, slowly insert catheter
through urethral meatus.
(3) Advance catheter appropriately or until urine flows
out end.
(4) When urine appears in indwelling catheter,
advances to bifurcation.
(5) Lower penis, hold catheter securely.
18. Allow bladder to empty fully unless volume is
restricted.
19. Collect urine specimen as needed, label and bag
specimen in front of patient according to agency
policy, send to laboratory as soon as possible
20. If straight catheterization, withdraw catheter slowly
until removed.
21. Inflate catheter balloon with designated amount of
fluid:
a.) Continue to hold catheter with non dominant
hand.
b.) Connect prefilled syringe to injection port with
free dominant hand.
 When grasping shaft of penis, avoid pressure on
dorsal surface to prevent compression of urethra.
Positioning penis at this 90-degree angle to
patient straightens out curvature of male urethra
and eases insertion.
 Circular cleansing pattern follows principles of
medical asepsis
 Holding catheter near tip allows for easier
manipulation of catheter during insertion. Coiling
catheter in palm prevents distal end from striking
non-sterile surface.
 Bearing down may help visualize urinary meatus
and promotes relaxation of external urinary
sphincter, aiding in catheter insertion.
 Urine flow indicates that catheter tip is in bladder.
Prevents accidental dislodgement of catheter.
 Straightens urethra to ease catheter insertion.
 Relaxation of external sphincter aids in insertion of
catheter.
 Length of male urethra varies. Flow of urine
indicates that tip of catheter is in bladder but not
necessarily the balloon part of an indwelling
catheter.
 Prevents accidental dislodgement of catheter.
 There is no definitive evidence regarding whether
there is benefit in limiting maximal volume drained.
 A sterile specimen for culture analysis can be
obtained. Fresh urine specimen ensures more
accurate findings
 Prevents accidental removal.
 Indwelling catheter balloons should not be
overinflated or underinflated to prevent occlusion

c.) Inject total amount of solution.
d.) Release catheter after inflating balloon, pull
catheter until resistance is felt, advance catheter
slightly
e.) Connect drainage tubing to catheter if not
preconnected.
22. Secure indwelling catheter with securement
device, leave enough slack to allow leg movement,
attach device just at the catheter bifurcation:
a.) For female patient, secure tubing to inner thigh,
allow enough slack.
b.) For male patient, secure catheter to upper thigh
or lower abdomen, allow enough slack, replace
foreskin if retracted.
23. Clip drainage tubing to edge of mattress, position
bag lower than bladder, do not attach side rails of
bed.
24. Ensure there is no obstruction to urine flow, coil
excess tubing on fed, fasten to bottom sheet with
securement device.
25. Provide hygiene as needed, assist patient to
comfortable position.
26. Dispose of supplies in appropriate receptacles.
27. Measure urine and record the amount.
28. Remove gloves, perform hand hygiene.
EVALUATION
1. Palpate bladder for distention or used bladder scan.
2. Ask patient to describe level of comfort.
3. Observe character and amount of urine in drainage
system for indwelling catheter.
4. Ensure there is no urine leaking from catheter or
tubing connections for indwelling catheter.
5. Ask patient to describe how to keep urine flowing
out of catheter.
6. Identify unexpected outcomes.
RECORDING AND REPORTING
1. Record and report all pertinent information in the
appropriate log.
2. Record amount of urine in I&O flow sheet record.
3. Report persistent catheter-related pain, inadequate
urine output, and discomfort to health care provider.
of catheter drainage holes, balloon distortion, and
bladder irritation.
 Catheter balloons are only filled with sterile water.
Other solutions might precipitate and occlude the
fill tubing and catheter balloon fill valve.
 Withdrawing catheter places catheter balloon at
base of bladder; slight advancement reduces risk
of excessive pressure
 Ensures proper drainage by gravity. Placement on
side rails increases risk for tension applied to
catheter, and bag can be raised above level of
bladder
 Securing indwelling catheters reduces risk of
urethral trauma, urethral erosion, CAUTI or
accidental removal.
 Drainage bags that are below level of bladder
ensure free flow of urine, thus decreasing risk for
CAUTI. Bags attached to movable objects such as
a side rail increase the risk for urethral trauma
because of pulling or accidental dislodgement.
 Obstructions prevents free flow of urine and
increases risk for CAUTI.
 Reduces transmission of microorganisms.
 Determines if distention is relieved.
 Determines if patient’s sensation of discomfort or
bladder fullness has been relieved.
 Determines if urine is flowing adequately.
 Prevents injury to patient’s skin and ensures
closed sterile system.
 Evaluates what patient and family are able to
explain or demonstrate.