CATHETERIZATION

Definition: Introduction of a tube catheter through the urethra into the bladder to remove the urine.
Purpose:
1. To relieve discomfort due to bladder distention or to provide gradual decompression of a distended
bladder.
2. To assess the amount of urine if the bladder empties incompletely.
3. To obtain a urine specimen.
4. To empty the bladder completely prior to surgery.
5. To facilitate accurate measurement of urinary output for critically ill patients whose output needs
to be monitored hourly.
6. To provide for intermittent or continuous bladder drainage and irrigation.
7. To prevent urine from contacting an incision after perineal surgery.
8. To manage incontinence when other measures have failed.
Side Effects:
● DISCOMFORT: Usually prelubricated to reduce discomfort during insertion.
● UTI: Urinary tract infections (UTIs) are a common potential side effect of using an intermittent
catheter. The risk of developing a UTI increases with longer-term use of the catheter.
● HEMATURIA: This is the presence of red blood cells in the urine, which can cause the urine to
appear red or brown. Hematuria is common when a person first starts using an intermittent catheter,
but persistent hematuria may indicate a UTI.
● BLADDER STONES: These are common in people who use an intermittent catheter on a long-
term basis.
● URETHRAL STRICTURES: This is a narrowing of the urethra that can result from repeated
trauma. People who insert their own intermittent catheters repeatedly over many months have a
higher risk of urethral strictures.
TYPES OF URINARY CATHETER
1. The intermittent catheter, standard catheter or it is called Straight Catheter
● Is a thin, flexible tube that a person temporarily inserts into their bladder through the
urethra.
● The external end of the tube may be left open, allowing the urine to drain into a receptacle.
Another option is to attach the tube to an external drainage bag, which collects the urine.
2. Indwelling catheter or Foley Catheter
● Is similar to an intermittent catheter but remains in place for a period of days or weeks.
● One end of the indwelling catheter has a deflated balloon attached. A healthcare provider
will insert this end into the bladder and then inflate the balloon with sterile water to hold
the catheter in place.
● Indwelling catheters typically drain into a collection bag. A person can strap the bag to the
inner thigh or attach it to a stand in a position lower than the bladder.
● It is important to empty a drainage bag before it becomes full. For most people, this will
mean emptying the bag every 2–4 hours. A person should also attach a clean, unused
drainage bag twice per day and attach a larger bag at night.
● Some indwelling catheters use a valve instead of a bag. Keeping the valve closed allows
the bladder to fill up.
● A person can then open the valve to empty their bladder and drain the urine out into a
receptacle. Some people find this more convenient than using a drainage bag.
External catheters
● Some males have the option of using an external catheter. This is a condom-like device that fits
over the penis. A tube attached to the catheter collects urine into a drainage bag.
● Doctors usually recommend external catheters for males with incontinence who do not experience
urinary blockages or retention and can use the catheter themselves.
EQUIPMENT
1. Cherry balls soaked in betadine
2. Picking forceps
3. Lubricating jelly
4. Waterproof drape
5. Urobag
 6. Sharps bin
7. Clean gloves
8. Sterile gloves
9. Foley Catheter
10. Yellow Trash bag
11. Sterile Water
12. 10cc Syringe
13. Plaster
14. Bandage Scissors
FEMALE CATHETERIZATION
● Because the female urethra is only a few inches in length compared to the male urethra, female
length catheters are typically around 6 inches long, although there are smaller pocket catheter
options.
PROCEDURE:
FEMALE CATHETERIZATION (Indwelling)

1. Introduced self and verified the client’s identity.

2. Explained procedure to client and discussed how results will be used.
3. Gathered appropriate equipment.
4. Performed hand hygiene and observed other appropriate infection control procedures.
5. Provided for client privacy.
Prepared equipment:
6. Opened 10cc syringe and filled with 10cc sterile water
7. Opened drainage bag package and placed end of tubing within reach.
8. Opened Sterile Catheter:
a. Opened outer package of sterile catheter half way.
b. Opened top part of inner package and exposed the balloon and urine drainage tube, making sure
not to touch with unsterile hand the part of inner package with the catheter tube.
9. Pretested the balloon applying agency policy and/or manufacturer recommendations.
a. Attached syringe.
If using needle-access catheter:
i. Held inflation valve between two fingers of nondominant hand.
ii. Using dominant hand, insert needle parallel to the balloon tube,
making sure not to injure self.
b. Injected 10cc of sterile water.
c. Observed for leaks or any damages in the balloon.
d. If none, aspirated sterile water.
e. Removed syringe and recap.
If using syringe with needle,
i. Recap safely using one-hand scoop method. Do not use other hand to hold cap in the process.
f. Placed syringe within reach.
10. Attach end of tubing of the drainage bag at the urine drainage port ofthecatheter
11. Prepare Sterile field using the inner package of sterile gloves:
a. Opened sterile gloves.
b. Poured lubricating jelly
Prepared client:
12. Placed client in appropriate position: supine with knees flexed, feet about 2 feet apart, and hips slightly,
externally rotated.
13. Draped all areas except perineum.
14. Established adequate lighting.
15. Stood on client’s right if nurse was right-handed and on left if nurse was left-handed
16. Placed a water proof drape under the buttocks without contaminating the center of the drape.
17. Open container of cherry balls soaked in betadine
18 . Don Clean Gloves
19. Cleansed the meatus.
a. With thumb and one finger of nondominant hand, spread labia and identified meatus. Did not allow
the labia to close over cleaned meatus.
b. Use the dominant hand to handle picking forceps.
c. Pick up a cherry ball using picking forceps:
d. Cleansed in anteroposterior direction using one cherry ball for each wipe.

a. Wipe the farther labia and discard cherry ball.

b. Wipe the nearer labia and discard cherry ball.
c. Last wipe over the meatus and discard cherry ball.
2. Remove clean gloves
Inserted catheter:
20. Don Sterile gloves
21. Inserted the catheter.
a. Removed catheter from package holding the sterile catheter tube.
b. Grasped catheter firmly 2 to 3 in. from tip.
c. Lubricated the tip (1-2 inches)
d. Asked client to take a slow deep breath and inserted catheter approximately 2 to 3 in. as client
exhaled.
e. After urine begins to flow through it, advanced catheter another 2-3 in. farther.
f. If catheter became contaminated by touching labia or other tissue before entering meatus,
performed catheterization with a new sterile catheter.
g. Held catheter with nondominant hand.
22. Inflated retention balloon with designated volume.
a. Without releasing catheter, held inflation valve between two fingers of nondominant hand while
nurse inflated with dominant hand.
b. If patient complains pain, it could indicate the catheter is not in the bladder. Deflate the balloon and
insert the catheter further into the bladder. ALWAYS ensure urine is flowing before inflating the
balloon.
c. Pulled gently on catheter until resistance was felt.
23. Secured an indwelling catheter to client’s inner thigh.
24. Secured collecting tubing and hung bag below bladder level.
25. Wiped the perineal area of any remaining antiseptic or lubricant.
26. Returned client to comfortable position. Instructed client on positioning and moving with catheter in
place.
27. Discarded all used supplies in appropriate receptacles.
28. Removed and discarded gloves.
29. Performed hand hygiene.
30. Documented procedure and all relevant information.
 MALE CATHETERIZATION (Indwelling)

1. Introduced self and verified the client’s identity.

2. Explained procedure to client and discussed how results will be used.
3. Gathered appropriate equipment.
4. Performed hand hygiene and observe other appropriate infection control procedures.
5. Provided for client privacy.
Prepared equipment:
6. Opened 10cc syringe and filled with 10cc sterile water
7. Opened drainage bag package and placed end of tubing within reach.
8. Opened Sterile Catheter:
a. Opened outer package of sterile catheter half way.
b. Opened top part of inner package and exposed the balloon and urine drainage tube, making sure
not to touch with unsterile hand the part of inner package with the catheter tube.
9. Pretested the balloon applying agency policy and/or manufacturer recommendations.
a. Attached syringe.
If using needle-access catheter:
i. Held inflation valve between two fingers of nondominant hand.
ii. Using dominant hand, insert needle parallel to the balloon tube,
making sure not to injure self.
b. Injected 10cc of sterile water.
c. Observed for leaks or any damages in the balloon.
d. If none, aspirated sterile water.
e. Removed syringe and recap.
If using syringe with needle:
i. Recap safely using one-hand scoop method. Do not use other hand to hold cap in the process.
f. Placed syringe within reach.
10. Attach end of tubing of the drainage bag at the urine drainage port of the catheter
11. Prepare Sterile field using the inner package of sterile gloves:
h. Opened sterile gloves.
i. Poured lubricating jelly
Prepared client:
12. Placed client inappropriate position: supine, thighs slightly abducted or apart.
13. Draped all areas except perineum.
14. Established adequate lighting.
15. Stood on client’s right if nurse was right-handed and on left if nurse was left-handed.
16. Placed a waterproof drape under the penis without contaminating the center of the drape.
17. Applied sterile gloves.
18. Cleansed the meatus.
a. Grasped penis just below glans with nondominant hand. Retracted foreskin if necessary.
b. Using dominant hand, picked up a cherry ball. Cleansed in circular moving from the meatus down
the glans of the penis. Used a new cherry ball each time for three more wipes.
c. Discarded each cherry ball after one use.
Inserted catheter:
19. Inserted the catheter.
a. Removed catheter from package holding the sterile catheter tube.
b. Lubricated the tip (6-7 inches)
c. Held catheter an inch or two from the tip.
d. Ask the patient to take deep breaths.
e. Advance the catheter to the bifurcation or “Y” level of the ports. Do not use force to introduce the
catheter.
f. If the catheter resists entry, ask patient to breathe deeply and rotate catheter slightly.
g. Hold the catheter securely at the meatus with your nondominant hand
20. Inflated retention balloon with designated volume.
a. Without releasing catheter, held inflation valve between two fingers of nondominant hand while
nurse inflated with dominant hand. (ALWAYS ensure urine is flowing before inflating the balloon.)
b. Replace foreskin over catheter.
c. Lower penis.
d. Pulled gently on catheter until resistance was felt.
21. Secured an indwelling catheter to client’s abdomen or anterior thigh.
22. Secured collecting tubing and hung bag below bladder level.
23. Wiped the perineal area of any remaining antiseptic or lubricant. Replaced foreskin if retracted earlier.
24. Returned client to comfortable position. Instructed client on positioning and moving with catheter in
place.
25. Discarded all used supplies in appropriate receptacles.
26. Removed and discarded gloves.
27. Performed hand hygiene.
28. Documented procedure and all relevant information.

References:
1. Potter, P.A., Perry, A.G., Stockert, P.A., & Hall, A.M. (2017). Fundamentals of Nursing (9th
ed.). Elsevier Inc.

2. Berman, A., Snyder, S.J., & Frandsen, G. (2022). Kozier & Erb’s Fundamentals of Nursing
(11th ed.). Pearson Education Limited.

3. Dougherty, L., & Lister, S. (2015). The Royal Marsden Manual of Clinical Nursing
Procedures (9th ed.). The Royal Marsden NHS Foundation Trust.

4. Hinkle, J. L., & Cheever, K. H. (2014). Brunner & Suddarth's Textbook of Medical-Surgical
Nursing (14th ed.). Wolters Kluwer Health/Lippincott Williams & Wilkins.