Catheterization:

Binal Joshi, Assistant professor , MTIN

Objectives
Demonstrate correct technique for inserting indwelling and
straight catheters
Recognizes signs and symptoms of infection related to urinary
catheters
Demonstrate aseptic routine care of a patient with an
indwelling catheter
Demonstrate correct technique for removing an indwelling
catheter.
Demonstrate correct procedure for application of condom
catheter
Document and report to RN care related to urinary drainage
 Introduction
• Urinary catheterization is the introduction of a
pliable tube [ catheter] in to the bladder to
allow drainage of urine.
• Catheterization of the urinary bladder is the
insertion of a hollow tube through the urethra
into the bladder for removing urine. It is an
aseptic procedure for which sterile equipment
is required.
PRIOR to Catheterization
Know and Confirm
• Doctor’s order
• Last void
• Patient’s level of consciousness and understanding
• Mobility, physical limitations, ability to cooperate
• Sex, age, catheter size
• Kids 6-10
• Female 14-16
• Male 16-18)
• Allergies to antiseptics, tape, rubber, latex
• Adverse conditions
• Impaired passage such as enlarge prostate
Purpose:
To obtain a sterile urine specimen.
To provide fro intermittent or continuous bladder drainage & irrigation.

Empty the bladder for surgical or diagnostic purpose.

Prevent or treat bladder overdistension & urinary retention when other measure fails.

Measure the urine that remains in the bladder after the patient voids. To prevent the urine
from passing over a wound e.g., after repair of the perineum.
To manage incontinency when all other measures to prevent skin breakdown have failed.
 A condom catheter, consists of a soft plastic or rubber sheath,
tubing, and a collection bag for the urine. The sheath is placed
over the penis and the collection bag is attached to the leg.
Collects urine when there is no need for catheter insertion.

A straight catheter, is used when the catheter is

to be inserted and removed immediately.

Types of An indwelling catheter, also known as

Foley catheter, is left inside the bladder
catheter: to provide continuous urine drainage.

A suprapubic catheter is a type of indwelling catheter. The

suprapubic catheter is inserted into the bladder through a
surgical incision made in the abdominal wall, right above the
pubic bone.
A 3-way catheter for continuous bladder irrigation
(CBI) is a type of indwelling catheter. It is inserted to
irrigate the bladder to prevent obstruction (i.e
bleeding)
 Catheters

Straight

Condom

Suprapubic Indwelling
 3-way CBI

Irrigations performed on intermittent or

continuous basis to maintain catheter
patency. A closed system can provide
continuous or intermittent irrigation
without disrupting sterility
 Condom Catheter

Catheter (External, Texas, Urinary Sheath)

Types - • Incontinent men
Condom • Soft rubber, latex, silicone
• Slides over Penis
• Tubing connects to tip of condom and
flows into collection bag.
 Remove for thirty minutes each day,

clean and dry penis, re-apply new catheter.

Catheter
Types - Elastic tape may be used to secure catheter in
Condom place. This tape will expand when the penis
changes size.
Never use adhesive tape- cuts off blood flow which
causes injury.
Rules for Catheterization
1. Wash hands, use gloves
2. Tubing without kinks/obstructions
3. Drainage bag below bladder
4. Attach to non-movable bed part
5. Secure with leg strap
6. Check system for leaks
7. Perform perineal care BID, after all BMs &with cath care
8. Watch I&O closely
9. Report complaints of discomfort to nurse (pain, burning,
irritation)
10. Record amount, color, clarity, odor, particles
 Catheter are
sized by the
diameter of the
Silicone, latex lumen; the
PVC catheter is Men need
It is usually or polyvinyl larger the
good for long- larger diameter
made of rubber chloride [PVC] number, the
term use [ up to than women –
or plastic. may also be larger the
6 weeks]. 18 No.
used. number. For
e.g. 8 & 10 – for
children, 14 &
16 – for adult,
Straight catheter
Straight catheter:

It is a single lumen tube that is inserted for

immediate drainage of the bladder.

After the bladder is empty or the sample obtained,

the catheter is removed & the patient resumes
voiding immediately.
Catheter Types - Straight
Straight Catheter
• Removes urine from bladder aseptically due to
1. Incontinence
2. Post void residuals
3. Sterile specimen
• Does not attach to a collection bag
• Considered a sterile procedure
Indwelling catheter:
Also known as Foley or retention catheter.

It is used for continuous bladder drainage.

It is usually double lumen tube; one lumen used for urine drainage & second
lumen used to inflate a balloon near the tip of the catheter.

The inflated balloon holds the catheter in place.

Catheter Types - Indwelling
Indwelling Catheter (Foley)
To remove urine aseptically
Sterile procedure
Has urinary collection bag
May be used for extended periods of time
Catheter Types - Suprapubic
Suprapubic

Catheter inserted into the bladder through an opening in the

lower abdomen (about 1 inch above the symphysis pubis)
Placed under anesthesia

May be left in place for long periods of time

Sutured into place.

A triple – lumen catheter:

It is used when the patient requires intermittent or continuous bladder irrigation.

First – urine drainage.

Second – irrigation.

Third – balloon inflation.

Condom Catheter
Condom drainage:
In condom drainage, a condom is attached to a piece of plastic drainage tube, & is inserted over the penis. The tube is connected to a
drainage bag.
Advantages:

Urine is collected in the drainage bag as & the bladder empties.

Since the urine is not falling on the bed, it prevents bed sore & keeps the patient dry.

It prevents the urinary tract infection, that results from an indwelling catheter.

For bed ridden patient, it helps the patient to empty the bladder without getting out of bed.

It is a pain less procedure & prevents the trauma to the urinary tract.

It is economical.

It does not interfere with bladder functioning.

 PREPARING FOR
CATHETERIZATION
• A catheter should be used only when absolutely
necessary and the catheterization procedure itself should
be done only by trained personnel under sterile
conditions. Infection is a major risk of urinary
catheterization.
a.Preparation for Articles
Gather All Equipment.
• Catheter
• 10cc syringe
• Sterile water
• Cotton balls with betadine
• Lubricant
• Sterile gloves.
• Flashlight or lamp.
• Urine collection bag.
• Velcro leg strap or anchoring tape.
• Disposal bag.
b. Explain the Procedure to the Patient.
c. Provide for Privacy and Adequate Lighting.
d. Positioning
• Position the female patient in a dorsal recumbent position with the knees
flexed and the feet about two feet apart. Cover the upper body and each
leg. Place the catheter set between the female patient's legs.
• Position a male patient in a supine position. Drape the patient so that only
the area around the penis is exposed. Place the catheter set next to the
legs of the male patient.
INSERTING THE FOLEY CATHETER
IN A MALE PATIENT
. Cleanse the genital and perineal areas with warm soap and water. Rinse and dry.
b. Wash your hands carefully.
c. Open the sterile catheterization kit, using sterile technique.
d. Put on the sterile gloves.
e. Open the sterile drape and place on the patient's thighs. Place fenestrated drape with opening on
the penis.
Apply sterile lubricant liberally to the catheter tip. Lubricate at least six inches of the catheter. Leave
the lubricated catheter on the sterile field.
g. Pour the antiseptic solution over the cotton balls.
h. Place the urine specimen collection container within easy reach.
Position
i. Grasp the patient's penis between your thumb and
forefinger of your nondominant hand. Retract the
foreskin of an uncircumcised male. The gloved hand
that has touched the patient is now contaminated.

j. Use the forceps to hold the cotton balls.This will

maintain the sterility of one hand. Using the forceps,
pick up one cotton ball and swab the center of the
meatus outward in a circular manner.

k. Continue outward, using a new cotton ball for each

progressively larger circle. Clean the entire glands.
Deposit each cotton ball in the disposal bag. After the
last cotton ball is used, drop the forceps into the
disposal bag as well.
l. Holdthe penis at a 90-degree angle. Advance
the catheter into the patient's urinary meatus.
You may encounter resistance at the prostatic
sphincter.
(1) Pause and allow the sphincter to relax.
(2) Lower the penis and continue to advance
the catheter.
NOTE: Never force the catheter to advance.
Discontinue the procedure if the catheter will
not advance or the patient has unusual
discomfort. Get assistance from the charge
nurse or physician.
m. When the catheter has passed
through the prostatic sphincter into the
bladder, urine will start to flow. Gently
insert until 1 to 2 inches beyond where
urine is noted

n. Inflate balloon, using correct amount

of sterile liquid (usually 10 cc but check
actual balloon size)

o. Gently pull catheter until inflation

balloon is snug against bladder neck

p. Connect catheter to drainage system

q. Anchor the catheter tubing to the lateral abdomen with tape, without tension
on tubing

r. Place drainage bag below level of bladder

s. Evaluate catheter function and amount, color, odor, and quality of urine

t. Remove gloves, dispose of equipment appropriately, wash hands

u. Document size of catheter inserted, amount of water in balloon, patient's

response to procedure, and assessment of urine
INSERTING THE
FOLEY CATHETER
IN A FEMALE
PATIENT

Follow procedure same with male from step a-

h.
Procedure
I. Place the thumb and forefinger of your nondominant hand between the labia minora, spread and
separate upward. The gloved hand that has touched the patient is now contaminated.
J. Using the forceps, pick up a cotton ball saturated with antiseptic solution. Use one cotton ball for
each stroke. Swab from above the meatus downward toward the rectum.
K. Keeping the labia separated, cleanse each side of the meatus in the same downward manner Do
not go back over any previously cleansed area.
L. Deposit each cotton ball into the disposal bag. After the last cotton ball is used, deposit the forceps
into the bag as well.
i
Procedure
m. Continue to hold the labium apart after cleansing. Insert the lubricated catheter into the female
patient's urinary meatus.
n. Angle the catheter upward as it is advanced. If the catheter will not advance, instruct the patient
to inhale and exhale slowly. This may relax the sphincter muscle. Do not force the catheter.  
o. When urine starts to flow, insert the catheter approximately one inch further. Place the cup under
the stream of flowing urine to obtain a sterile specimen if required.
. Inflate balloon, using correct amount of sterile liquid (usually 10 cc but check actual balloon size)

q. Gently pull catheter until inflation balloon is snug against bladder neck

r. Connect catheter to drainage system

s. Connect the drainage bag to the catheter. Secure the catheter to the inner
aspect of the female patient's thigh

t. Place drainage bag below level of bladder

u. Evaluate catheter function and amount, color, odor, and quality of urine

v. Remove gloves, dispose of equipment appropriately, wash hands

w. Document size of catheter inserted, amount of water in balloon, patient's

response to procedure, and assessment of urine
MAINTAINING AN INDWELLING
CATHETER
a. Wash your hands before and after caring for the patient and wear
gloves when handling an indwelling catheter.
b. Clean the perineal area with soap and water twice daily and after
each bowel movement, especially around the meatus. Use a
separate area of the cloth for each stroke.
c. Avoid use of lotions or powder in the perineal area.
d. Arrange for the patient to take a shower or tub bath when
permitted. The collecting container may be hung over the side of
the tub. The catheter should be clamped temporarily if the
collecting container is higher than the bladder.
e. Teach the patient to maintain the catheter. Self-care helps the
patient develop a feeling of independence and promotes
cleanliness. If the patient is ambulatory, instruct him in use of the
leg bag. Encourage the patient to intake 2500 cc to 3000 cc of fluid
daily.
f. Change the indwelling catheter as necessary or in accordance with
local policy.
 Assemble Identify Provide
• Assemble all • Identify the • Provide
REMOVING supplies and patient and privacy and
equipment. explain the assist the
AN • (1) 10 cc procedure to female
INDWELLIN syringe. him. Advise patient into
G CATHETER • Washcloth him that
there will be
a dorsal
recumbent
and towel.
• Exam a slight position. The
gloves. burning male should
• Soap and during be in a
removal of supine
water. the catheter. position.
d. Wash your hands and put on exam gloves.
e. Empty the balloon by inserting the barrel of the syringe and withdrawing
the amount of fluid used during inflation.
f. Pinch off and gently pull on the catheter near the point where it exits from
the meatus.
g. Clean the perineum or penis with soap and water. Dry the area well.
h. Inspect the catheter to be sure no remnants remained in the bladder. If the
catheter is not totally intact, report this promptly and save the catheter for
further inspection.
i. Empty the drainage bag. Measure the amount of urine and record on the
intake and output (I&O) sheet.
j. Remove the gloves and wash your hands.
k. Discard disposable supplies and return reusable supplies and equipment to
the appropriate area.
l. Record that the catheter was removed, the time and date
and by whom. Note the amount, color, and clarity of the urine
in the drainage bag. Also document all patient teaching done
and the patient's level of understanding.

m. After removal of the catheter, assess the patient for 24

hours for patterns of urinary elimination. Note the time and
amount of the first voided urine. Report any of the following:

• (1) Inability to void within 8 to 10 hours.

• (2) Frequency, burning, dribbling, or hesitation in starting the stream of urine.
• (3) Cloudiness or any other unusual color or characteristic of the urine.
• n. Provide a level of fluids similar to the intake when the catheter was in place.
• o. Record that the catheter was removed, the date and time, and by whom.
 It involves cleaning the external
genitalia & surrounding area.
To prevent
bad odour.
Perineum To promote
comfort.
care
Clean the perineum from the
cleanest to the less clean area.
The urethral orifice is considered as the cleanest area
& the anal orifice is considered as the dirtiest area.
 Indication:
Who are unable to do self care.
Genito urinary tract infection.

Incontinence of urine & stool.

Excessive vaginal discharge.
Indwelling catheter.
Post partum patient.
After surgery on genito-urinary system.
Injury, ulcer or surgery on the perineum area or
rectum.
 Preliminary assessment:

Assess Assess the condition of the perineal skin.

Assess Assess the need & frequency of perineal care.

Check Check the physician orders for any specific instruction.

Assess Assess the patient’s ability for self care.

Assess Assess the patient’s mental state to follow instruction.

Check Check the articles available in the patient's unit.

 Mackintosh
A jug with warm water or antiseptic solution.
Wet cotton balls or rag pieces in a bowl.
Gauze or rag pieces in a container.
Articles: Long artery forceps in the kidney tray.
Paper bag.
Clean linen [ personal & bed linen].
Pads, dressing.
Bed pan.
Preparation of the patient & unit:

Explain Provide Remove Give Place Offer

Explain Provide Remove all Give extra Place the Offer the bed
procedure to privacy by articles – pillow for to mackintosh pan.
the patient. screen & knee pillow, raise the under the
drapes. air cushion. head. buttocks
over the
draw sheets.
After care of the patient & articles:

Take the bedpan

to the sanitary
annex. Remove
Apply the Make the Immerse it in
Remove Change the linen the cotton swabs
medicine & pad patient lotion to
mackintosh. if necessary. & rinse the
if necessary. comfortable. disinfect.
bedpan with
cold water using
a brush.
 Record the
procedure with
Wash hand date, time & the
observations
Remove the made.
screen & tidy up
Clean all the the unit.
articles. Boil the
Wash & dry well forceps. Replace
& keep it on the the articles.
bedpan rack.
Documentation
Document
• Type of procedure
• Size of catheter and balloon
• Amount of fluid actually instilled into balloon
• Amount of urine returned
• Characteristics of urine (color, odor, sediment)
• Specimen sent if applicable
• How patient tolerated procedure
Problems During Insertion

Catheter inserted into Vagina

1. Leave in place

2. Reposition fingers to re-visualize meatus

3. Use new catheter

4. Repeat procedure
 Unable to insert into female

1. Ask patient or other team member to hold legs apart

Problems 2. Observe urethral opening (before cleansing) for

During movement when pressure is applied

Insertion
3. Improve lighting

4. Repeat insertion procedure

Problems During
Insertion
Unable to insert catheter into male
1. Notify nurse
2. Repeat procedure but change the angle
of the penis
3. Try an a coude catheter
Problems During Insertion
Catheter comes out with balloon inflated

1. Check with nurse

2. Check for urethral trauma (pain, bleeding)

3. Monitor urine output for bleeding

4. Obtain new catheter kit & reinsert with

10 ml balloon per nurse’s instruction

Care of Patient with a Catheter

Secure tubing onto bed

Attach drainage bag to
Keep catheter bag below – urine should flow Empty catheter bag
bed frame (not side
level of bladder freely from catheter to every 8 hours or prn
rails)
bag (coil tubing on bed)

Do not allow the drain

Provide catheter care & Keep drainage bag off
on the bag to touch any
pericare as needed the floor
surface
Catheter Removal
Documentation

Document :
• Size of catheter removed
• Size and amount of fluid in balloon
• Patient tolerance
• Output in catheter bag
• Description of urine
• Peri care
• Time of removal
Voiding Following Catheter Removal
Hints to assist patient to void after catheter removal
• Encourage oral fluids
• Proper position to urinate
• Sound of running water
• Sitz bath
Thank you