Document Code NSG-F0-00

Revision 00
Effectivity Date 2022/07/01
SCHOOL OF HEALTH AND NATURAL SCIENCES Page/s 1 of 3

Name of student: Year/Clinical Group:

PERFORMANCE EVALUATION TOOL FOR URINARY CATHETERIZATION

DIRECTIONS: Below is a list of criteria to evaluate the student’s skill in Urinary Catheterization. Indicate your
evaluation by placing the number of scores on the appropriate column using the following descriptive scale.

0- Not Done 1- Done Correctly

PREPARATIONS RATING REMARK

S
1. Assess:
 The client’s overall condition.
 If the client is able to cooperate and hold still during the procedure.
 If the client can be positioned supine, with head relatively flat.
 When the client last voided or was last catheterized.
 Percuss the bladder to check for fullness or distension.
2. Determine: The most appropriate method of catheterization.
3. Assemble equipment and supplies:
-Sterile catheter of appropriate size. An extra catheter should also be at hand.

For Catheterization kit or individual sterile items:

1-2 pairs of sterile gloves, Waterproof drape(s), Antiseptic solution, Cleansing
balls, Water-soluble lubricant, Urine receptacle, Specimen container
For an indwelling catheter:
Syringe prefilled wit sterile water in amount specified by the catheter’s
manufacturer. Collection bag and tubing, 2% Xylocaine gel (if agency permits)
Disposable clean gloves, supplies for performing perineal cleansing. Bath
blanket or sheet for draping the client. Adequate lighting – obtain a flashlight or
lamp, if
necessary.
IMPLEMENTATION
1. Introduce yourself and verify client’s identity. Explain to the client what you are
going to do, why it is necessary, and how the client can cooperate.
2. Perform hand hygiene, and observe other appropriate infection control
procedures.
3. Provide client privacy.
4. Perform routine perineal care to cleanse the meatus from gross contamination.
Female: supine, with knees flexed, feet about 2 feet apart, and hips slightly
externally rotated
Male: supine, legs slightly abducted.
4. Establish adequate lighting. Stand on the client’s right if you are right-handed, on
the client’s left if you are left-handed.
5. If using a collecting bag not contained within the catheterization kit, open the
drainage package, and place the end of the tubing within reach.
6. If agency policy permits, apply clean gloves and inject 10-15 mL Xylocaine gel
into the urethra of the male client. Wipe the underside of the shaft to distribute
the gel up the urethra. Wait at least 5 minutes for the gel to take effect before
inserting the
catheter. Remove gloves.
7. Open the catheterization kit. Place a waterproof drape under the buttocks
(female) or penis (male) without contaminating the center of the drape with your
hands.
8. Saturate the cleansing balls with the antiseptic solution.
9. Open the lubricant package. Squeeze enough amount of lubricant and place in the
sterile area.
Fill the syringe with sterile water according to manufacturer’s recommendation.
Remove the specimen container, and place it nearby, with the lid loosely on top.
 10.
11. Wear sterile gloves.

12. Lubricate the catheter, and place it with the drainage end inside the collection
container.
13. If desired, place the fenestrated drape over the perineum, exposing the urinary
meatus.
For Female
14. Use your nondominant hand to spread the labia. Establish a firm but gentle
position.
15. Pick up a cleansing ball in your dominant and, and wipe one side
of the labia majora in an anteroposterior direction
16. Use a new ball for the opposite side
17. Repeat for the labia minora.
18 Use the last ball to cleanse directly over the meatus.
For Male
19. Use your nondominant hand to grasp the penis just below the glans. If necessary,
retract the foreskin. Hold the penis firmly upright, with slight tension.
20. Pick up cleansing ball in your dominant hand, and wipe from the
center of the meatus in a circular motion around the glans.
21. Use a new ball, and repeat tree more times.
22. Grasp the catheter firmly 2-3 inches from the tip. Ask the client to take a slow deep
breath, and insert the catheter as the client exhales.
23. Advance the catheter 2 inches further after the urine begins to flow through it or
per agency policy.
24. If the catheter accidentally contacts the labia or slips into the vagina, it is
considered contaminated, and a new, sterile catheter must be used. The
contaminated catheter may be left in the vagina until the new catheter is inserted
to help avoid mistaking the vaginal opening for the urethral meatus.
25. Hold the catheter with the nondominant hand. In males, lay the penis down onto
the drape, being careful that the catheter does not pull out.
26. Without releasing the catheter, hold the inflation valve between two fingers of
your nondominant and while you attach the syringe, and inflate with your
dominant hand.
27. If the client complains of discomfort, immediately withdraw the instilled fluid,
advance the catheter further, and attempt to inflate the balloon again.
28. Pull gently on the catheter until resistance is felt to ensure that the balloon has
inflated and to place it in the trigone of the bladder.
29. Collect the urine specimen, if needed. Allow 20-30 mL to flow into the bottle
without touching the catheter to the bottle.
30. Allow the catheter to continue draining. Attach the drainage end of an indwelling
catheter to the collecting tubing and bag.
31. Examine and measure the urine. In some cases, only 750-1,000mL of urine are to
be drained from the bladder at one time. Check agency policy.
32. For an indwelling catheter, secure the catheter tubing to the inner thigh for female
clients, or the upper thigh/abdomen for male clients, with enough slack to allow
usual movement.
33. Also secure the collecting tubing to the bed linens, and hang the bag below the
level of the bladder. No tubing should fall below the top of the bag.
34. Wipe the perineal area of any remaining antiseptic or lubricant. Replace foreskin, if
retracted earlier. Return the client to a comfortable position.
35. Discard all used supplies in appropriate receptacles, and perform hand hygiene.
36. Document the catheterization procedure including catheter size and results in the
client record.
AVERAGE /36

Comments:

Student’s signature over printed name/Date/Time:

Clinical Instructor’s signature over printed name/ Date/Time: