Name:________________________________Date:_____________Section/Group: _______

Performing Urinary Catheterization

CHECKLIST
Legend:
3-Very Satisfactory 0- Did not perform the procedure
2- Satisfactory 1- Needs Improvement

Goal: To introduce solution into the large intestine to promote expulsion of feces.
PROCEDURES 3 2 1 0

Explain the need to insert urinary catheter.

Identify the patient and explain the procedure.

Gather materials needed.

Provide the client privacy.

Assist the client to a comfortable and appropriate position.

Establish adequate lighting. Stand on the client’s right if you are

righthanded.

Wash hands and prepare the catheterization kit.

Place waterproof drape under the buttocks or penis.

Apply sterile gloves.

Saturate the cleansing balls with the antiseptic solution and cleanse the
meatus.

Lubricate the catheter (1to 2 inches for females and 6to7 inches for
males).

Ask the client to take slow deep breath and insert he catheter as the
client exhales. Advance the catheter 2 inches further after the urine
begins to flow through it.

Inflate the retention balloon with the designated volume. (10-15ml)

Secure it with plaster.

Do the after care.

Wash hands.

Document the procedure and assessment of the urine.

For the next items, evaluate the students in general according to the criteria. (5 as the
highest score)
5 4 3 2 1

Mastery

Orderliness

Proper attitude in assessing the client followed.

Ability to answer questions

Proper reporting observed.

Student’s Name and Signature:

_____________________________________________ Evaluator’s Name and
Signature: ___________________________________________ Comments:
____________________________________________________________________________
____________________________________________________________________________
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