I.

ELIMINATION

URINARY CATHETERIZATION

DEFINITION: It is the insertion of a catheter thru the urethra to the urinary bladder.

PURPOSES:

1. To allow emptying of urinary bladder.

2. To obtain sterile urine specimens.
3. To determine amount of residual urine.
4. To provide accurate monitoring of urine output.
5. To provide an avenue for bladder irrigation.

ASSESSMENT:

2. Determine when the client last voided or was last catheterized.

3. Percuss the bladder to check for fullness or distention.
4. Use a straight catheter if only spot urine specimen is needed.
5. Use an indwelling catheter if the bladder must remain empty or continuous urine
collection is needed.

SPECIAL CONSIDERATION:

1. Observe sterile technique at all times.

2. Perineal care must be performed before catheterization.
3. If there is not an immediate flow of urine after the catheter has been inserted,
several measure may prove helpful;
a. Have the patient take a deep breath, which helps to relax the perineal and
abdominal muscles.
b. Rotate the catheter slightly, because a drainage hole may be resting against the
bladder wall.
c. Raise the head of the patient’s bed to increase pressure in the bladder area.

EQUIPMENT/SUPPLIES:

1. Sterile catheter kit that contains:

a. gloves
b. drapes (one of which is fenestrated)
c. Antiseptic solution
d. Lubricant
e. Cotton balls or gauze squares
f. Prefilled syringe(with 10 ml of NSS)
g. Basin(usually base of kits serves as this)
h. Specimen container
2. Catheter
3. Flashlight
4. Waterproof disposable pad
5. Disposable urine collection bag and drainage tubing (may be connected to sterile
indwelling catheter if a closed drainage system is used)
6. Velcro leg strap or tape
7. Disposable gloves
8. Sterile gloves(extra)
9. Pick-up forceps

IMPLEMENTATION:

Suggested Action Rationale

1. Check physician’s orders. Ensures accuracy and prevents errors.

2. Review chart for patient’s limitations Ensures accuracy and prevents mistakes on
in physical activity. mobility.

3. Introduce yourself to the client. Introducing yourself could alleviate the fear
of the patient and gain cooperation from the
client.

4. Identify the client by asking for the Confirms identity of client.

name or checking the identification
band.

5. Introduce yourself to the client. Introducing yourself could alleviate the fear
of the patient and gain cooperation from the
client.

6. Explain the procedure to the client. Explaining the procedure could alleviate the
fear of the patient and gain cooperation
from the client.

Suggested Action Rationale

6. Assess client’s status. Care is always individualized according to a

client’s needs.

8. Prepare the materials needed. Saves time and effort.

9. Perform hand hygiene. This prevents cross contamination and

further spread of infection.

10.Adjust the bed to the appropriate Make the client feel at ease.
height.

11.11. Provide privacy. This is basic to human dignity, and provision

of privacy demonstrates respect.

12.Place the client in the appropriate Good visualization of the meatus is

12.position: important.

13.Female: Dorsal Recumbent position

14. Male: Supine, legs slightly

abducted
15.13. Drape accordingly. Embarassment, chillness, and tension can
interfere with catheter insertion. The drape
 will protect bed linens from moisture.

16.14. Provide adequate lighting. Good lighting is necessary to see the

meatus clearly.

Suggested Action Rationale

15.Using clean gloves, perform Gloves reduce the risk of exposure to blood
perineal flushing. and body fluids. Clean technique decreases
the possibility of introducing microorganisms
into the bladder.

16.Open the drainage package. Gloves reduce the risk of exposure to blood
Remove gloves. and body fluids

17.Place the end of the tubing within This facilitates connection of the catheter to
reach, in case the collecting bag the drainage system and provides for easy
used is not contained within the access.
catheterized kit.

18.Open the catheterization kit on the Placement of equipment near worksite

side table using sterile technique. increases efficiency. Sterile technique
protects patient and prevents spread of
microorganisms.

19.Apply sterile gloves.

20.Place a sterile water proof drape

without touching the unsterile area:

Female: by sliding it under the

buttocks

Male: patient’s thigh or under

penis

21.Organize the remaining supplies by It is necessary to prepare all supplies for the
putting them next to client’s legs. procedure while both hands are sterile.

a. Saturate the fluff cleansing balls

with the antiseptic solution.
b. Open the lubricant package.

c. Remove the specimen container,

 and place it nearby with lid

loosely open on top.

22. Test the balloon. A balloon that does not inflate or that leaks
needs to be replaced before insertion.

a. Remove protective cap on tip of

syringe, prefilled with sterile

water.

a. Attach the prefilled syringe to the

indwelling catheter inflation hub.

b. Inject appropriate amount of

fluid.

c. If balloon inflates properly,

withdraw fluid and leave syringe
attached to port (if needleless).

Suggested Action Rationale

Note: If the balloon malfunctions,

it is important to replace it prior to

use.

1. Place it with the drainage end inside

the collection chamber.

2. Place the fenestrated drape with

opening over the meatus.
3. Cleanse the meatus:

FEMALE

1. Establish a firm gentle position.

2. Use your nondominant hand to

spread the labia.
3. Pick up a cleansing ball with the
sterile forceps in your dominant
hand.
4. Wipe one side of the labia
majora in an anteroposterior
direction
5. Use a new ball for the opposite
side.
 6. Repeat for the labia minora.

7. Use the last ball to cleanse

directly over the meatus.
MALE:

1. Use your nondominant hand to

grasp the penis just below the
glans.
2. Hold the penis firmly upright,
with slight tension. If necessary
retract the foreskin.

3. Pick up a cleansing ball with

sterile forceps in your dominant
hand.

4. Wipe the center of the meatus

in a circular motion around the
glans.

Repeat this for three times.

4. Use sterile lubricant. Lubrication facilitates catheter insertion and

reduces tissue trauma.

Female: lubricate 1 to 2 inch of the

catheter tip.

Suggested Action Rationale

Male: Lubricate 6 to 7 inches of the

catheter tip

5. Insert the catheter. Advancing an indwelling catheter an

additional 1.3 to 2.5 cm (1/2” to 1”)
ensures placement in the bladder and
facilitates inflation of the balloon without
damaging the urethra.

1. Grasp the catheter firmly 2-3

inches from the tip.

2. Ask the client to take a slow deep The balloon anchors the catheter in
breath. place in the bladder. Sterile water is
used to inflate the balloon as a
precaution in case the balloon ruptures.
 3. Insert the catheter as the client
exhales.

1. Attach the syringe(if not left attached

earlier when testing the balloon) and
inflate with your dominant hand.
2. If the client complains of discomfort,
immediately withdraw the instilled fluid.
3. Advance the catheter further and
attempt to inflate the balloon again.
4. Tug gently on the catheter until Improper inflation can cause patient
resistance is felt. discomfort and malpositioning of
catheter.

28. Collect a urine specimen if needed.

1. Allow 20-30 ml to flow into bottle

without touching the catheter to the
bottle.
Note: Allow the straight catheter to
continue draining, if necessary, attach
the drainage end of an indwelling
catheter to the collecting tubing and
bag.

2. Measure the urine.

Note: In some cases, only 75-100ml of
urine are to be drained from the bladder
at one time. Check agency policy.
Note: Remove the straight catheter
when urine flow stops.

Suggested Action Rationale

29. Secure the bag accordingly(for indwelling Proper attachment prevents trauma to
the urethra and meatus from tension on
catheter.
the tubing. Whether to take the
Female: inner thigh drainage tubing over or under the leg
depends on gravity flow, patient’s
Male: Upper thigh/abdomen mobility and comfort of the patient.

30. Secure the collecting bag:

a. Attach it to the linen.

b. Secure the collecting tubing to the bed

linens.
c. Hang the bag below the level of the
bladder.
Note: No tubing should fall below the
 top of the bag.

31. Place patient in a comfortable position. A comfortable position improves well

being.

32. Raise the side rails up and lower the bed Prevent accidental falls.
to the lowest position.

33. Discard all used supplies in appropriate Promotes clean environment with
container/receptacles. necessary equipment ready for future
use.

34. Perform hand hygiene. Reduces spread of microorganism

DOCUMENTATION

1. Record the time of A careful record is important for planning

catheterization, type and size the patient’s care.
of catheter, amount of fluid
instilled, amount and
appearance of urine and
client’s reaction.

II. ELIMINATION
 URINARY CATHETERIZATION

Suggested Action Correctly Partially Not Remarks

Done Done Done

1. Check physician’s orders.

2. Review chart for patient’s limitations

in physical activity.

3. Introduce yourself to the client.

4. Identify the client by asking for the

name or checking the identification
band.

5. Introduce yourself to the client.

6. Explain the procedure to the client.

7. Assess client’s status.

8. Prepare the materials needed.

9. Perform hand hygiene.

10.Adjust the bed to the appropriate

height.

11. Provide privacy.

12.Place the client in the appropriate

position:

Female: Dorsal Recumbent position

Male: Supine, legs slightly abducted

13. Drape accordingly.

14. Provide adequate lighting.

15.Using clean gloves, perform

perineal flushing.

16.Open the drainage package.

Remove gloves.

17.Place the end of the tubing within

reach, in case the collecting bag
used is not contained within the
catheterized kit.

18.Open the catheterization kit on the

side table using sterile technique.

19.Apply sterile gloves.

20.Place a sterile water proof drape
without touching the unsterile area:

Female: by sliding it under the

buttocks

Male: patient’s thigh or under

penis

Suggested Action Correctly Partially Not Remarks

Done Done Done

21.Organize the remaining supplies by

putting them next to client’s legs.

a. Saturate the fluff cleansing balls

with the antiseptic solution.
b. Open the lubricant package.

c. Remove the specimen container,

and place it nearby with lid

loosely open on top.

22. Test the balloon.

a. Remove protective cap on tip of

syringe, prefilled with sterile

water.

b. Attach the prefilled syringe to the

indwelling catheter inflation hub.

c. Inject appropriate amount of

d. fluid.
e. If balloon inflates properly,
withdraw fluid and leave syringe
attached to port (if needleless).
Note: If the balloon

malfunctions, it is important to

replace it prior to use.

23.Place it with the drainage end inside

the collection chamber.

24.Place the fenestrated drape with

opening over the meatus.
25. Cleanse the meatus:

FEMALE
 a. Establish a firm gentle position.

b. Use your nondominant hand to

spread the labia.
c. Pick up a cleansing ball with the
sterile forceps in your dominant
hand.
d. Wipe one side of the labia
majora in an anteroposterior
direction
e. Use a new ball for the opposite
side.

f. Repeat for the labia minora.

Suggested Action Correctly Partially Not Remarks

Done Done Done

g. Use the last ball to cleanse

directly over the meatus.
MALE:

a. Use your nondominant hand to

grasp the penis just below the
glans.
b. Hold the penis firmly upright,
with slight tension. If necessary

retract the foreskin.

c. Pick up a cleansing ball with

sterile forceps in your dominant

hand.

d. Wipe the center of the meatus

in a circular motion around the

glans.

Repeat this for three times.

26. Use sterile lubricant.

Female: lubricate 1 to 2 inch of the

catheter tip.

Male: Lubricate 6 to 7 inches of

the

catheter tip
27.Insert the catheter.

a. Grasp the catheter firmly 2-3

inches from the tip.

b. Ask the client to take a slow

deep breath.
c. Insert the catheter as the client
exhales.

d. Attach the syringe(if not left

attached earlier when testing
the balloon) and inflate with
your dominant hand.
e. If the client complains of
discomfort, immediately
withdraw the instilled fluid.
f. Advance the catheter further
and attempt to inflate the
balloon again.
g. Tug gently on the catheter until
resistance is felt.
28. Collect a urine specimen if needed.

Suggested Action Correctly Partially Not Remarks

Done Done Done

a. Allow 20-30 ml to flow into bottle

without touching the catheter to
the bottle.
Note: Allow the straight catheter
to continue draining, if
necessary, attach the drainage
end of an indwelling catheter to
the collecting tubing and bag.

b. Measure the urine.

Note: In some cases, only 75-
100ml of urine are to be drained
from the bladder at one time.
Check agency policy.
Note: Remove the straight
catheter when urine flow stops.

29.Secure the bag accordingly(for

indwelling catheter.

Female: inner thigh

Male: Upper thigh/abdomen

30. Secure the collecting bag:

 a. Attach it to the linen.

b. Secure the collecting tubing to

the bed linens.
c. Hang the bag below the level
of the bladder.
Note: No tubing should fall
below the top of the bag.

31. Place patient in a comfortable

position.
32. Raise the side rails up and lower
the bed to the lowest position.
33.Discard all used supplies in
appropriate container/receptacles.
34. Perform hand hygiene.

DOCUMENTATION

Record the time of catheterization, type

and size of catheter, amount of fluid
instilled, amount and appearance of
urine and client’s reaction.

ATTITUDE CRITERION

SHOWN NOT SHOWN REMARKS

1. Accepts criticisms well and

shows effort to improve
performance.

2. Answers the question politely.

3. Observes proper decorum.

4. Behave as a mature student

Score: 3 x ______ = ________ Total Weight/_______ = __________

2 x ______ = ________ (no. of items)

1 x ______ = ________ SCORE : _________

EQUIVALENT: __________

K(__%) = _________%

S(__%) = _________%

A(__%) = _________%

Total = _________%
______________________________________________ _______________

Signature of Student Over Printed Name Date

______________________________________________ _______________

Signature of Clinical Instructor Over Printed Name Date