CATHETERIZATIO

N
 OBJECTIVES
After completing this lesson, the students should
be able to:
 Mention words dealing with urinary
catheterization
 Mention the purposes of urinary
catheterization
 Communicate with a client while
administering urinary catheterization
 DEFINITION
 Urinary catheterization is the insertion of a
hollow tube through the urethra (urinary
opening) into the bladder for removing
urine.
 Catheterization is a way of completely draining
urine from your bladder. This keeps urine from
sitting in your bladder. If urine sits in your
bladder too long, it can cause a bladder or
kidney infection.
 Indwelling Urinary catheterization is the permanent
catheterization for a period of time
PURPOSES OF
URINARY CATHETERIZATION
 Relieve urinary retention
 Empty the bladder (before,
during, or after surgery)
 Urine retention
(Inability to Urinate)
• When you cannot empty your bladder completely, or at all, despite an urge to urinate,
you have urinary retention. To understand how urinary retention occurs, it is important
to understand the basics of how urine is stored in and released from the body.
• The bladder is a balloon-like organ in the lower part of the belly (pelvis) that stores
urine.
• Urine is composed of waste and water filtered from the blood by the kidneys.
• It travels down two thin tubes called ureters (one from each kidney) to the bladder.
• When about 1 cup (200 ml-300 ml) of urine has collected in the bladder, a signal is
produced in response to the stretch of the bladder from the nerves located in the
bladder wall. This signal is sent to the nerves in the spinal cord and the brain, and the
brain then returns a signal that starts contractions in the bladder wall. At the same
time, another signal is sent to the internal sphincter muscle to relax.
• These two reactions combined allow urine to flow out of the bladder and down a
narrow tube called the urethra.
• From there, it is released from the body by urination (or micturition).
• To a certain point, urination can be voluntarily controlled. We are all familiar with the
experience of having to urinate at an inconvenient time. When you "hold it in," you are
squeezing a muscle called the external sphincter to keep urine in the urethra.
• Urinary retention can be an acute (new, short-term) or chronic (ongoing, long-term)
condition. It routinely requires medical attention, sometimes hospitalization, for
treatment, symptom relief, and detection of the underlying cause. Failure to treat the
condition can lead to infections or damage to the urinary tract and kidneys.
• Urinary retention is not an unusual condition, and it is more common in men than in
women.
 Common Causes
of Urine Retention
• Blockage (obstruction): The most common cause of blockage of the urethra in men is
enlargement of the prostate. In males, the prostate gland partially surrounds the urethra. If
the prostate becomes enlarged, which is common in older men, it presses on the urethra and
can block it. The most common cause of prostate enlargement is benign prostatic
hypertrophy (often called BPH). Other causes of prostate enlargement include prostate
cancer and prostate infection (prostatitis). Causes of blockage of the urethra that can occur in
both sexes include scar tissue, injury (as in a car wreck or bad fall), blood clots, infection,
tumors in the pelvic region, and stones (rare).

• Nerve problems: Disruption of the nerves between the bladder and the brain can cause you
to lose control of your bladder function. The problem may lie in the nerves that send
messages back and forth or in the nerves that control the muscles used in urination, or both.
Some forms of this condition are referred to as neurogenic bladder. Occasionally, urinary
retention is the first sign of spinal cord compression, a medical emergency that must be
treated right away to prevent permanent, serious disability. The most common causes of this
disruption include spinal cord injury, spinal cord tumour, strokes, diabetes mellitus, herniated
or ruptured disk in the vertebral column of the back, or an infection or blood clot that places
pressure on your spinal cord.

• Infection: An infection in the pelvic area, such as herpes, can interfere with nerves in the
area. Inflammation and swelling caused by infections can also compress the urethra.
Infections around the spinal cord can cause retention by placing pressure on the nerves of
the spinal cord.

• Surgery: Urinary retention is a relatively common problem after surgery. It can be a direct
result of the anaesthetic or the type of operation. Relative immobility after a surgery can also
contribute to urinary retention. Previous bladder or prostate surgeries can sometimes cause
urinary retention because of the formation of strictures (narrowing) due to scar tissue.
 Other causes
• Chronic urinary retention usually develops slowly
because the bladder does not empty completely. It
may take a very long time to be diagnosed because
you may not have any symptoms.

• A weak bladder muscle, chronic obstruction, and nerve

diseases or injury all can contribute to chronic urinary
retention.

• Chronic retention can lead to urinary incontinence (the

unwanted leakage of urine from the bladder), urinary
tract infection, and kidney failure.

• Prolonged immobility can increase the risk of urinary

retention.
 VOCABULARY
• Catheter (n) • Kateter
• Catheterization (n) • Kateterisasi
• Drape (n) • Kain penutup
• Tube (n) • Selang
• Forceps (n) • Forsep
• Drape (n) • Kain penutup
• Rubber mat (n) • Perlak
• Urine bag (n) • Kantong urine
• Cotton ball (n) • Bola kapas
• Alcohol (n) • Alkohol
• Sterile water (n) • Air steril
• Syringe (n) • Alat suntik
• Lubricant gel (n) • Jel pelumas
• Urinal (n) • Alat utk BAK utk pria
• Bedpan (n) • Alat utk BAK/BAB utk wanita
• Tape (n) • Plaster
•
VOCABULARY
Penis (n) • Penis
• Vagina (n) • Vagina
• Meatus (n) • Pembukaan (lubang) uretra
• Labia minora (n) • Labia minora
• Clitoris (n) • Klitoris
• Buttock (n) • Pantat
• Kidney (n) • Ginjal
• Ureter (n) • Ureter
• Bladder(n) • Kandung kemih
• Urethra (n) • Urethra
• Pubic hair (n) • Rambut kemaluan
• End / tip of penis (n) • Ujung penis
• Penis glans (n) • Kepala penis
• Urinary tract (n) • Saluran perkemihan
• Urine retention(Ischuria) • Retensi urine
 VOCABULARY
• Pass urine (v) • BAK (pipis)
• Hold (v) • Menahan
• Lie (v) • Berbaring
• Put off (v) • Melepas (pakaian)
• Open (v) • Membuka
• Spread (v) • Melebarkan
• Bend (v) • Menekuk
• Cleanse (v) • membersihkan
• Wipe (v) • Mengusap
• Breathe (v) • Bernapas
• Insert (v) • Memasukkan
• Flow out (v) • Mengalir keluar
• Reach (v) • Mencapai
• Attach (v) • Melekatkan
• Secure (v) • mengamankan
• Move (v) • bergerak
COMMODE BEDPAN

PISPOT
BIDET
TYPES OF URINARY CATHETERS

 The catheters most

commonly used are made
of plastic.
 Each type of catheter (figure
3-1) has a rounded tip to
prevent injury to the meatus
or the urethra.
 The Foley catheter is
frequently used. It is usually
inserted by the nurse.
SORRY .....
I’m not
trying to be
vulgar
URINARY CATHETERIZATION
FEMALE MALE
Inflatable balloon
for catheterization
 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.
1. Gather All Equipment.
– Disposable indwelling catheter kit (permanent). The
kit contains the required equipment needed for
catheterization and is packaged to ensure that the
equipment is sterile. The kit includes the catheter, a
drape, a receptacle/container to receive urine,
materials to clean the area of insertion, a lubricant, a
specimen container, and sterile gloves.
– Urine collection bag
– Anchoring tape / Velcro leg strap
– Disposal bag
– Waterproof pad / rubber mat
2. Explain the procedure to the patient. Advise the patient
that he may feel a burning sensation and pressure as
the catheter is inserted, and that he will feel that he
needs to void after the catheter is in place. Do not
suggest to the patient that he may feel pain; however,
introducing a catheter in swollen or injured tissue may
cause discomfort.
3. Provide for Privacy and Adequate Lighting.
– Close the door or pull the curtain surrounding the patient's bed
and position the lamp at the end of the bed.
– Position the female patient in a dorsal recumbent position with
the knees flexed and the feet about two feet apart. Place
rubber mat under the patient's buttocks. 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. Place rubber mat
under the patient's buttocks. 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.
PROCEDURE

1
 Figure 3-5. Washing the female meatus Figure 3-7. Securing (female)
indwelling catheter

On Female

Figure 3-6. Inserting the catheter in a female

 INSERTING THE FOLEY CATHETER IN A FEMALE PATIENT

1. The following procedures are used to insert the Foley

catheter in a female patient.
2. Wash the area around the meatus with warm soap and
water. Rinse and dry.
3. Wash your hands.
4. Open the sterile catheter kit by using forceps with
sterile technique.
5. Put on sterile hand gloves.
6. Place the drape on the patient with the hole over the
female genitalia.
7. Apply lubricating gel to the catheter tip. Lubricate at
least three inches of the catheter for the female. Leave
the lubricated catheter over the cotton balls.
8. Place the urine bag within reach.
1
 INSERTING THE FOLEY CATHETER IN A FEMALE PATIENT

9. 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.
10. 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.
11. Keeping the labia separated, cleanse each side of the meatus
in the same downward manner (figure 3-5). Do not go back
over any previously cleansed area.
12. Deposit each cotton ball into the disposal bag. After the last
cotton ball is used, deposit the forceps into the bag as well.
13. Continue to hold the labium apart after cleansing. Insert the
lubricated catheter into the female patient's urinary meatus.
14. 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.
2
 INSERTING THE FOLEY CATHETER IN A FEMALE PATIENT

15. 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.
16. Hold the catheter in place while the urine drains into
the collection container.
NOTE: If the catheter is unintentionally placed in the
patient's vagina, leave it in place temporarily. Insert
another catheter properly by repeating the entire
procedure using another sterile set; then remove the
catheter from the vagina.
17. Attach the syringe to the balloon port of the catheter.
Inject the water slowly to inflate the balloon. If the
water will not inject easily or the patient complains of
pain, deflate the balloon completely and advance the
catheter further, then re-inflate.
18. Remove the syringe. To position the balloon correctly,
pull on the catheter gently until you feel resistance. 3
 INSERTING THE FOLEY CATHETER IN A FEMALE PATIENT

19. Connect the drainage bag to the catheter. Secure the

catheter to the inner aspect of the female patient's thigh.
20. Attach the urinary drainage bag to the bed, below the level of
the bladder but off the floor. Coil any extra tubing on the
bed.
21. Remove any lubricant or antiseptic on the patient's skin.
Remove your gloves, the drapes and the Chux® from around
the patient.
22. Discard disposable equipment and return reusable equipment
to the appropriate area.
23. Record the time that the procedure was done and by whom,
the patient's reaction to the procedure, all patient teaching
done, and the patient's level of understanding. Report
observations to the charge nurse to include:
- The amount, color, and clarity of the urine.
- Any difficulty with the procedure.
- The presence of blood in the urine.

4
Figure 3-2. Cleansing the male meatus Figure 3-4. Anchoring (male) indwelling
catheter

ON MALE

Figure 3-3. Positioning the penis at

a 90-degree angle
 Procedure of Male Catheterization
1. Greet and inform the patient about what you’re going
to do to him.
2. Advise the patient that he may feel a burning sensation
and pressure when the catheter is inserted, and that
he will feel that he needs to void after the catheter is in
place.
3. Close curtain.
4. Wear gloves.
5. Position a male patient in a supine position.
6. Shave the perineum (for female patients), if necessary.
7. Cover the genital area with sterile drape (cloth cover)
with a hole for the penis.
8. Disinfect the tip of the penis (meatus) with sterile
cotton balls.
9. Disinfect the penis gland with antiseptic solution (e.g.
Betadine) and rinse it with sterile water (e.g. Aquades).
1
 Procedure of Male Catheterization
10. Lubricate the catheter with jelly (avoid the hole).
11. Hold the penis upward at 90o angle.
12. Gently insert the catheter through the urethra 15-20 cm
when the patient is taking a deep breath.
13. Inject the water 10-15 ml slowly (by using a syringe) to
inflate the balloon.
14. Let all urine flow out from the bladder through the tube
into the urinary bag.
15. After emptying the bladder, deflate the balloon by
withdrawing the water (for temporary catheterization).
16. Remove the tube from the urethra slowly (for
temporary catheterization)..
17. Remove the drape.
18. Attach the catheter tube to the thigh (femur) with tape.
19. Connect the catheter to the urinary bag.
20. Tidy all instruments.
2
21. Confirm the patient’s comfort.
 TRANSLATE INTO ENGLISH
 Saya tidak bisa BAK. Kandung kemih saya penuh.
 Saya tdk dpt mengosongkan kandung kemih saya
secara total setelah BAK.
 Anda mengalami retensi urine
 Saya perlu melakukan pemasangan kateter pada
anda utk mengosongkan kandung kemih anda.
 Saya akan memasang katerter permanen pada
anda,
 Apakah itu menyakitkan?
 Jangan kuatir, hanya sakit sedikit kok.
 Anda akan merasakan rasa panas dan
tekananketika saya masukkan kateter ke dalam
penis (vagina) anda.
 Useful Expressions
 I can’t pass urine. My bladder is full.
 I can’t empty my bladder after passing urine.
 You have a urine retention.
 I need to administer catheterization in you
now to empty your bladder.
 I will put a permanent catheter in you.
 Does it hurt?
 Don’t worry it hurts a little.
 You will feel a burning sensation and
pressure when I insert a catheter in your
penis (vagina).
 TRANSLATE INTO ENGLISH
 Lepas celana panjang / celana pendek / rok anda.
 Berbaringlah terlentang.
 Buka (renggangkan) dan tekuk kaki anda.
 Nggak usah malu. Ini yang memang harus kita lakukan untuk mengosongkan
kandung kemih anda.
 Ambil napas dalam.
 Saya akan memasukkan kateter ini dgn lembut dan pelan.
 Saya akan memasukkan kateter ini ke dalam meatus anda dgn lembut dan
pelan.
 Saya akan lakukan ini selembut mungkin. Tenang saja.
 Kateternya sudah di dalam kandung kemih anda . Apakah anda merasakan
nyeri?
 Urine anda mulai mengalir keluar dari kandung kemih - melewati kateter -
menuju kantong urine.
 OK. Sudah selesai.
 Kamu akan merasa tidak nyaman. Tapi, ini akan segera hilang segera
setelah anda terbiasa dgn itu.
 Jika anda harus berjalan, berjalanlah dgn hati-hati.utk memastikan
kateternya masih melekat pada anda.
 Bila kateter anda lepas, panggil saya, dan saya akan membetulkannya
segera.
 Useful Expressions
 Put off your trousers/shorts/skirt.
 Lie on your back in supine position.
 Open (spread) and bend your legs.
 Don’t be ashamed. It’s something that we must do now to empty your
bladder.
 Take a deep breath.
 I will insert the catheter nicely and slowly.
 I will insert the catheter into the meatus nicely and slowly.
 I’ll do it as nice as possible. Just take it easy.
 The catheter is now in your bladder. Do you feel pain?
 Your urine starts flowing out from the bladder-passing the catheter-into
the urine bag.
 OK. It’s done.
 You will feel uncomfortable. But it will go away soon as you get
accustomed with it.
 If you have to walk, do it carefully to make sure that the catheter is fully
attached in you.
 If your catheter is loosen. Call me and I’ll fix it up immediately.
THANKS for your attention
• Fatimah fathur fadila
• Ima lailatul
• Diana fitri Andriyani
• Putri Apsari
• Ifantri Hakiki
• Siti Fatimah
• Juniar Nur R.
• Marissa Sylvia
• Anna Qurrota A’yun
• Dwi Sari
• Ika Anita Sari