St.

Paul University Surigao

St. Paul University System
8400 Surigao City, Philippines
Name of Date:
Student:
Year Level:

PROCEDURE CHECKLIST
Intermittent Female Urethral Catheterization

ILO: The student will practice beginning nursing skills in promoting healthy physiologic responses to health / illness.

Key:
3 : Correctly and confidently performed the skill
2 : Able to perform skill; requires moderate reinforcement
1 : Skill not preformed correctly; needs re-demonstration

3 2 1
1. Check the medical record for the order for intermittent urethral
catheterization. Review the patient’s chart for any limitations in physical
activity. Bring the catheter kit and other necessary equipment to the
bedside. Obtain assistance from another staff member, if necessary.
Perform hand hygiene. Put on PPE, as indicated, based on transmission
precautions.
2. Identify the patient. Discuss the procedure with the patient and assess the
patient’s ability to assist with the procedure. Ask the patient if she has any
allergies, especially to latex or iodine.
3. Close curtains around bed and close the door to the room, if
possible.
4. Provide good lighting. Artificial light is recommended (use of a flashlight
requires an assistant to hold and position it). Place a trash receptacle within
easy reach.
5. Raise the bed to a comfortable working height. Stand on the patient’s
right side if you are right-handed, patient’s left side if you
are left-handed.
6. Put on disposable gloves. Assist the patient to dorsal recumbent position with
knees flexed, feet about 2 feet apart, with her legs abducted. Drape patient.

7. Put on clean gloves. Clean the perineal area with washcloth, skin cleanser,
and warm water, using a different corner of the washcloth with each
stroke. Wipe from above the orifice downward toward the sacrum (front
to back). Rinse and dry. Remove gloves. Perform
hand hygiene again.
8. Open sterile catheterization tray on a clean over-bed table using sterile
technique.
9. Put on sterile gloves. Grasp upper corners of drape and unfold drape
without touching unsterile areas. Fold back a corner on each side to make
a cuff over gloved hands. Ask patient to lift her buttocks and slide sterile
drape under her with gloves protected by
cuff.
10. Place a fenestrated sterile drape over the perineal area, exposing the labia,
if appropriate.
11. Open all the supplies. Fluff cotton balls in tray before pouring antiseptic
solution over them. Alternately, open package of antiseptic swabs. Open
specimen container if specimen is to be
obtained.
12. Lubricate 1 to 2 inches of catheter tip.
13. With thumb and one finger of nondominant hand, spread labia and
identify meatus. If the patient is in the side-lying position, lift the upper
buttock and labia to expose the urinary meatus. Be prepared to maintain
separation of labia with one hand until catheter is
inserted and urine is flowing well and continuously.
14. Use the dominant hand to pick up a cotton ball. Clean one labial fold, top
to bottom (from above the meatus down toward the rectum), then discard
the cotton ball. Using a new cotton ball for each stroke, continue to clean
the other labial fold, then directly over the meatus.
15. With the uncontaminated, dominant hand, place drainage end of
 St. Paul University Surigao
St. Paul University System
8400 Surigao City, Philippines
catheter in receptacle. If a specimen is required, place the end into
the specimen container in the receptacle.
16. Using the dominant hand, hold the catheter 2 to 3 inches from the tip and
insert slowly into the urethra. Advance the catheter until there is a return of
urine (approximately 2 to 3 inches [4.8 to 7.2 cm]). Do not force the
catheter through the urethra into the bladder. Ask the patient to breathe
deeply, and rotate the catheter gently if slight resistance is met as the
catheter reaches external sphincter.
17. Hold the catheter securely at the meatus with the nondominant hand while
the bladder empties. If a specimen is being collected, remove the drainage
end of the tubing from the specimen container after required amount is
obtained and allow urine to flow into receptacle. Set specimen container
aside and place lid on container.
18. Allow the bladder to empty. Withdraw catheter slowly and smoothly after
urine has stopped flowing. Remove equipment and dispose of it
according to facility policy. Discard syringe in sharps container to
prevent reuse. Wash and dry the perineal area, as needed.
19. Remove gloves. Remove gloves and additional PPE, if used. Assist the
patient to a comfortable position. Perform hand hygiene.

( x 3) + ( x 2) + ( x 1)
X 100 =
(Total # of items x 3)

References
Lynn, P. (2011). Taylor’s Clinical Nursing Skills: A Nursing Process Approach 3rd edition. PA: Wolters Kluwer Health |
Lippincott Williams & Wilkins.

Student shall be graded based on the following observations.

Fullname and
signature of
Qualitative description of student’s performance Grade/Remarks
clinical
instructor/Date
Very satisfactory performance. Student showed basic competency
in performing the procedure, showed mastery in understanding the
Competen t
rationale behind all the actions, and was able to execute all the 90-99
steps on his/her first attempt of return
demonstration.
Satisfactory performance. Student showed basic competency in
Partially performing the procedure, showed mastery in understanding the
Competen rationale behind all the actions, and was able to execute 80% of all 80-89
t the steps on his/her first attempt of return demonstration.

Performance that needs improvement. Student failed to show basic No grade. Student shall
competency in performing the procedure, showed less mastery in be given another chance
Not yet
understanding the rationale behind all the actions and was only able until he/she shows
Competen
to execute less than 80% of all the steps on his/her first attempt of competency and
t
return demonstration. mastery in skills and
knowledge.
2nd attempt 90
3rd attempt 85
4th attempt 80
5th attempt 75

Remarks:

STRENGTHS AREAS FOR IMPROVEMENT

 St. Paul University Surigao
St. Paul University System
8400 Surigao City, Philippines
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