Urinary

Catheterization
NCM 109
Urinary Catheterization
•the placement of a tube through the urethra into the bladder to drain urine.
•Urinary catheters are made with one to three lumens
•Single-lumen catheters are used for intermittent catheterization 
•Double lumen catheters, designed for indwelling catheters
•Triple-lumen catheters are used for continuous bladder irrigation or when it becomes necessary to instill medications into the bladder
 • To relieve acute or chronic retention
• To provide for continuous bladder drainage
and irrigation
• To prevent urine from contacting an incision
Purpose after perineal surgery.
• To facilitate accurate measurement of
urinary output for critically ill patients
whose outputs need to be monitored
hourly.
• To instill medications into the bladder.
Equipment

• Sterile gloves
• Sterile drapes
• Lubricant
• Antiseptic cleansing solution
• Cotton balls
• Forceps
• Prefilled syringe with normal saline to inflate balloon
• Flashlight or gooseneck lamp
• Bath blanket
• Waterproof absorbent pad
• Thrash receptacle
• Specimen container
• Sterile drainage tubing and collection bag, tape, 
• Catheter of correct size
Preparation of Equipment

• Verify the order on the patient’s

medical record to determine if a
catheter size or type has been
specified. 
• Perform hand hygiene, select the
appropriate equipment, and
assemble it at the patient’s bedside.
Implementation
• Identify the patient’s identity.
• Explain the procedure to the patient and
provide privacy.
• Face the patient, stand on left side of the bed
if right-handed. Raise side rail on opposite
side of the bed
•  Place waterproof pad under the patient
Position Lamp to Illuminate Perineal Area
Position the patient (FEMALE):

1. Help to dorsal recumbent position (on back with

knees flexed). Ask patient to relax thighs so you
can rotate hips supine, with knees flexed, feet
about 2 feet apart, and hips slightly externally
rotated.
2. Alternate female position: Position side-lying
(Sims’) position with upper leg flexed at knee and
hip. Support patient with pillows if necessary, to
maintain position.
MALE patient:
Position supine with
legs extended and
thighs slightly
abducted.
DRAPE THE PATIENT (MALE)

Drape upper trunk with bath

blanket and cover lower
extremities with bed sheets
exposing only genitalia
DRAPE THE PATIENT
(FEMALE)

Drape with blanket.

Place blanket in a diamond
fashion over patient, one
corner at patient’ neck side
corners over each arm and
side, last corner over
perineum 
• Open the catheterization kit.
• Apply sterile gloves.
• Attach the prefilled syringe to the
indwelling catheter inflation hub and test
the balloon.
• Lubricate the catheter and place it with the
drainage end inside the collection
container.
• If desired, place the fenestrated drape over
the perineum, exposing the urinary
meatus.
APPLYING FENESTRATED STERILE DRAPES

Apply drape over thighs just below

the penis.
Pick up fenestrated sterile drape,
allow it to unfold, and drape it over
penis with fenestrated slit resting
over penis.
APPLYING FENESTRATED STERILE DRAPES

• Pick up fenestrated sterile drape and allow it

to unfold without touching any unsterile
object.

• Apply drape over the perineum, exposing

labia and make sure not to touch
contaminated surface.
Place sterile tray
and contents on
sterile drape
between thighs
Male Patient:

• With nondominant hand (now contaminated) retract

foreskin (if uncircumcised) and gently grasp penis at
shaft just below glans. Hold shaft of penis at right angle
to body. This hand remains in this position for
remainder of procedure.

• Using uncontaminated dominant hand, clean the

meatus with cotton balls/swab sticks, using circular
strokes, beginning at the meatus and working outward
in a spiral motion.

• Repeat cleansing three times using clean cotton ball/

swab stick each time
PERINEAL CARE FOR FEMALE

Cleanse the meatus. Separate the labia majora and labia

minora as widely as possible with the thumb, middle, and
index fingers of your nondominant hand so you have a full
view of the urinary meatus. Keep the labia well separated
throughout the procedure.
With your dominant hand, use a sterile,
antiseptic-soaked, cotton-tipped applicator (or
pick up a sterile cotton ball with the plastic
forceps) and wipe one side of the urinary meatus
with a downward motion
• Pick up the catheter with your dominant hand, holding it 2 to 3 (5.1 to
7.6 cm) from the tip, and prepare to insert the lubricated tip into the
urinary meatus.
• Ask the patient to cough as you insert the catheter. To facilitate
insertion by relaxing the sphincter
• Tell her to breathe deeply and slowly to further relax the sphincter and
reduce spasms.
• Never force a catheter during insertion. Maneuver it gently as the
patient bears down or coughs. If you still meet resistance, stop and
notify the doctor. Sphincter spasms, strictures, or misplacement in the
vagina may cause resistance
INSERT CATHETER: Male Patient

• Lift penis to a position perpendicular (90 degrees) to patient’s body and

apply gentle upward traction.
• Ask patient to bear down as if to void and slowly insert catheter through
urethral meatus.
• Advance catheter 17 to 22.5 cm (7 to 9 inches) or until urine flows out
end of catheter.
• Stop advancing with a straight catheter. When urine appears in an
indwelling catheter, advance it to bifurcation (inflation and deflation ports
exposed)
INSERT CATHETER: FEMALE PATIENT:
1. Ask patient to bear down gently and slowly insert catheter
through urethral meatus.
2. Advance catheter total of 5 to 7.5╯cm (2 to 3 inches) or until
urine flows out of catheter. When urine appears, advance
catheter another 2.5 to 5cm (1 to 2 inches). Do not use force to
insert catheter.
3. Release labia and hold catheter securely with nondominant hand.
COLLECT URINE SPECIMEN AS NEEDED

• When urine stops flowing, attach the water-

filled syringe to the luer lock.

• Push the plunger and inflate the balloon to

keep the catheter in place in the bladder.
Inflate catheter balloon with amount of fluid
designated by manufacturer
• Never inflate a balloon without first
establishing urine flow, which assures
you that the catheter is in the
bladder.

• After inflating catheter balloon,

release catheter from nondominant
hand. Gently pull catheter until
resistance is felt. Then advance
catheter slightly.

• Connect drainage tubing to catheter

if it is not already preconnected.
A. Female Patient:
Secure catheter tubing to inner thigh, allowing enough slack to prevent tension
B. MALE PATIENT:

1. Secure catheter tubing to upper thigh or

lower abdomen (with penis directed toward
chest). Allow slack in catheter so movement
does not create tension on catheter.
2. If retracted, replace foreskin over glans penis.
• Connect drainage tubing to catheter if it
is not already preconnected.

• Hang the collection bag below bladder

level to prevent urine reflux into the
bladder, which can cause infection, and
to facilitate gravity drainage of the
bladder. Make sure the tubing doesn’t
get tangled in the bed’s side rails
• Dispose of all used supplies in the
appropriate receptacles. Remove
your gloves and discard.
• Perform hand hygiene.
• Document the procedure
RECORDING AND REPORTING
• Record and report the reason for catheterization, type and size of
catheter inserted, amount of fluid used to inflate balloon, specimen
collection (if applicable), characteristics and amount of urine,
patient’s response to procedure, and any education in nurses’ notes
and electronic health record (EHR).
• Record amount of urine on intake and output (I&O) flow sheet record.
• Report persistent catheter-related pain, inadequate urine output, and
discomfort to health care provider.
 • Teaching
• Explain that a feeling of burning, pinching,
and/or pressure may be experienced when the
catheter is inserted into the urethra. This
SPECIAL sensation is normal and will go away.
CONSIDERATI • Discuss with the patient routine care of the
ON catheter and drainage system that includes
avoiding any kinking in the drainage tubing,
keeping the drainage bag dependent, avoiding
pulling on the catheter, and daily hygiene.
• Explain that adequate fluid intake helps
prevent catheter blockage.
END