Performing a Urinary Catheterization

Definition:
Introducing a catheter into the urinary bladder through urethra using aseptic technique for
the purpose of emptying the bladder.

Types:

1. Intermittent catheterization
2. Indwelling catheterization

Intermittent catheterization

Purposes:

1. To relieve bladder distension.

2. To assess for residual urine after voiding
3. To obtain a sterile specimen.
4. To empty bladder prior to delivery or abdominal surgery.

Indwelling Catheterizaton:

Purposes:

1. To facilitate urinary elimination in incontinent patient.

2. To facilitate continuous bladder drainage after injury/ surgery on urinary tract or other
major surgeries.
3. To splint urethra to promote healing after urological survey.
4. To relieve acute or chronic urinary retention.
5. To prevent urine from contacting an incision after perineal surgery.

Equipments:
A clean tray containing:

1. Flash light
2. Basin with warm water, soap, washcloth, bedpan, towel, etc.
3. Disposable gloves.
4. Kidney tray
5. Antiseptic solution
6. Sterile saline.
7. Adhesive tape or scissors (in case of retention catheter).
8. Specimen container
9. Water soluble lubricant.
A sterile tray with:

1. Sterile gloves
2. Sterile drape/ fenestrated towel
3. Small bowl
4. Cotton swabs
5. Catheter (indwelling / straight of appropriate size)
6. Kidney tray
7. Artery forceps
8. Dissecting forceps.
9. Sterile syringe- 20ml and distilled water ( in the case of retention catheter)

Procedure:
Sr no Nursing Procedure
1. Review physician’s order and nursing
care plan.
2. Identify patient and assess patient for
time of last voiding, level of awareness,
mobility, physical limitation, and
pathological condition, e.g. prostate
enlargement, bladder distension, etc
3. Explain procedure to patient
emphasizing how he/she has to
cooperate.
4 Arrange for help if needed for
. maintaining position of patient
5. Provide privacy
6. Wash hands
7. Raise bed to appropriate working level.
Stand on right side of patient and shift
patient and shift patient closer to you.
8. Position patient
a. Female: Dorsal recumbent with knees
flexed, and thighs externally rotated.
b. Male: Supine position with thighs
slightly abducted.
Rationale
Help in identifying the reason for
catheterization.
Proper assessment helps in identifying
patient’s ability to cooperate during
procedure and any possible obstruction in
passing catheter.
Reduces anxiety and promotes cooperates
which ensures smooth insertion of the
catheter.
Promotes use of correct body mechanics.
Reduces embarrassment to patient
Reduces risk of transmission of
microorganisms.
Promotes use of correct body mechanics.
Provides good view of perineal area.

9. Wash perineal area/ genital with soap Cleaning reduces the number of
and water microorganisms around urinary meatus
and possibility of introducing
microorganisms with the catheter
10. Adjust spot light/ flash light to view
urinary meatus clearly
11. Open the sterile tray, pour the antiseptic Keeping all articles ready for use helps in
solution into the bowl, open the outer saving time and prevents chance of
cover of catheter and place in the tray if contamination.
prepackaged.
12. Open lubricant, squeeze and discard the First drop of the lubricant may be
first drop and after that, drop some on contaminated.
sterile gauze in the tray.
13. Don sterile gloves
14. Drape perineal area
15. Place sterile tray on drape between Provides easy access to supplies.
patient’s thighs
16. If doing retention catheterization, fill the Provides easy access to supplies,
syringe with sterile water, if not already checking balloon helps in identifying
prefilled and test balloon of catheter by leaks in the balloon.
inflating it.
Deflate it and keep catheter aside with
syringe attached to it.
17. Open sterile specimen bottle and sterile
urine receiver ready for use In the sterile
tray.
18. Lubricate tip of catheter liberally and Lubrication aids in easy insertion of
place it in the sterile tray ready for use. catheter by reducing friction.
19. Clean meatus with antiseptic solution if
recommended by agency.
20. Female:
a. With nondominant hand,
carefully retract labia fully and
expose urethral meatus. Maintain
position of hand throughout the
procedure.
b. Using dominant hand, take
sterile cotton swabs dipped in
antiseptic solution and clean
perineal area from clitoris
towards anus in the following
sequence- meatus, labia minora
and then labia majora. Use one
swab for each wipe. Removes disinfectant which can be
c. Repeat cleaning with cotton irritating to the skin and mucus
swabs dipped in sterile normal membrane.
saline in same sequence.
Male: Foreskin coming back into position before
a. Grasp firmly below glans with catheter is in situ will cause
nondominant hand. Retract the contamination.
 foreskin and hold it retracted till
end of procedure.
b. With dominant hand, use sterile
swabs dipped in antiseptic
solution to clean meatus and
moving out in circular motion.
c. Use one swab for each wipe.
d. Repeat the cleaning using sterile
saline in same sequence.
21. Insert the catheter for 15-25 cm in male Male urethra is very narrow and flexing
and 2.5 cm in female, until the urine catheter can be traumatizing sphincter and
begins to flow, do not force the catheter. urethra. Deep breathing can aid muscle
If met with resistance, twist catheter and relaxation.
wait for some time to allow sphincter to
relax. Encourage patients to take deep
breaths while inserting.
22. Collect the urine and remove the
catheter if intermittent catheterization is
done.
23. If retention catheterization is performed, Inflating the balloon helps in retaining
introduce the distal water to inflate the catheter into the balloon.
balloon.
24. Connect catheter to urosac tied to bed Urosac sac above or at the level of
below the level of bladder. bladder may cause backflow of urine and
can cause the infection.
25. Fix catheter to the thigh using adhesive Traction on catheter can lead to injury to
tapes. Ensure adequate length to avoid urinary meatus.
traction.
26. Clean and replace equipment
27. Wash hands and document the
procedure.