DE LA SALLE LIPA

COLLEGE OF NURSING
Nursing Care Management 109

Procedural Checklist in
Urinary Catheterization

Name: Year/Sec: Rating:

General Objective:
Given simulated situations/conditions, the students will be able to assess, observe and perform
appropriate technique on how to Insert an Indwelling Urinary Catheter for Male and Female Adult patients.

Specific Objectives:
1. Identify indications for urinary catheter insertion.
2. Explain special nursing considerations before, during and after urinary catheterization.
3. Demonstrate appropriate technique on how to insert an Indwelling urinary catheter.

CRITERIA:
Item Weight Descriptors Verbal Interpretation
1 Excellent Performed the procedure with great ease and confidence, observing work
ethics (prudent, accepts criticisms and suggestions), able to rationalize
scientifically and shows diligence in documenting observations at all times.
0.5 Satisfactory Performed the procedure with less confidence and requires close supervision
observing work ethics (prudent, accepts criticisms and suggestions), able to
rationalize scientifically and shows minimal diligence in documenting
observations.
0 Needs Failed to perform the procedure, unable to function well and needs repeated
Improvement specific/ detailed guidance or direction.
I. Values Based 1.0 0.5 0 Remarks
1. Verify the doctor’s order. Ensures that patient receives correct size and type of
catheter.
2. Perform hand hygiene. To prevent spread of microorganism.
3. Assemble equipment and supplies.
• 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
• forceps
4. Identify the patient’s identity. Ensures correct patient.
5. Explain the procedure to the patient and provide privacy. Promotes
comfort and protects patient confidentiality
6. Raise side rail on opposite side of the bed. Promotes safety
2.1 Place water proof pad under the patient. Prevents soling of bed linen
2.2 Position lamp to illuminate perineal area. Good lighting is necessary to
see the meatus clearly.

II. Knowledge Based

7. Position and drape the patient.

7.1 Female patient:
a. Help to dorsal recumbent position (on back with knees
flexed). Ask patient to relax thighs so you can rotate
hips. Exposes perineum and allows hip joints to be externally rotated.
b. 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.
Alternate position is more comfortable if patient cannot abduct leg at hip
joint (e.g., patient has arthritic joints or contractures).
 c. Place blanket in a diamond fashion over patient, one corner at
patient’ neck side corners over each arm and side, last corner over
perineum. This avoids unnecessary exposure of body parts and maintain
client’s comfort.

7.2 Male patient:

a. Position supine with legs extended and thighs slightly abducted.
Comfortable position for patient aids in visualization of penis.
b. Drape upper trunk with bath blanket and cover lower extremities with
bed sheets exposing only genitalia. This avoids unnecessary exposure
of body parts and maintain client’s comfort.

8. Open the catheterization kit according to directions, using aseptic

technique. Aseptic technique prevents spread of microorganisms.
8.1 Don sterile gloves. This allows nurse to handle sterile supplies without
contamination.
8.2 Attach the prefilled syringe to the indwelling catheter inflation hub and
test the balloon. Checks the integrity of the balloon.
8.3 Lubricate the catheter and place it with the drainage end inside the
collection container. This eases insertion of catheter through urethral canal.

9. Applying fenestrated sterile drapes

9.1 For Male. 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. The drape expands sterile field and protects
against contamination.
9.2 For Female. 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. The
drape expands sterile field and protects against contamination.
9.3 Place sterile tray and contents on sterile drape between thighs. This
provides easy access to supplies during catheter insertion.

10. Perform Perineal Care

10.1 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. Cleansing the area around the meatus and under the
foreskin in the uncircumcised patient helps prevent infection.

10.1.1 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.

10.2 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. Allowing labia to drop back into
position may contaminate the area around the meatus. Clean from less contaminates area to
more contaminated area.

11. 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.
Holding catheter near tip allows for its easier manipulation during insertion. Coiling catheter in
palm prevents distal end from striking nonsterile surface.
11.1 Insert the catheter. For Male patients.
11.1.1 Lift penis to a position perpendicular (90 degrees) to patient’s
body and apply gentle upward traction. Straightens urethra to ease catheter insertion.
11.1.2 Ask patient to bear down as if to void and slowly insert catheter
through urethral meatus. Relaxation of external sphincter aids in insertion of catheter.
11.1.3 Advance catheter 17 to 22.5cm (7 to 9 inches) or until urine flows
out end of catheter. Do not force against resistance. There are variations in length of
male urethra. Flow of urine indicates that tip of catheter is in bladder or urethra but not necessarily
that the balloon portion of an indwelling catheter is in bladder.
11.1.4 When urine appears in an indwelling catheter, advance it to
bifurcation (inflation and deflation ports exposed) Further advancement of catheter to
bifurcation of drainage and balloon inflation port ensures that balloon portion of catheter is not still
in prostatic urethra

11.2 Insert the catheter. For Female patients.

11.2.1 Ask patient to bear down gently and slowly insert catheter
through urethral meatus. Bearing down may help visualize urinary meatus and promotes
relaxation of external urinary sphincter, aiding in catheter insertion.
 11.2.2 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. Urine flow
indicates that catheter tip is in bladder or lower urethra.
11.2.3 Release labia and hold catheter securely with nondominant
hand.
* If no urine appears, catheter may be in vagina. If misplaced, leave catheter in vagina as
landmark indicating where not to insert and insert another sterile catheter.

12. Collect urine specimen as needed. Sterile specimen for culture analysis can be
obtained.
12.1 Inflate catheter balloon with amount of fluid designated by manufacturer.
With free dominant hand, connect prefilled syringe to injection port at end of
catheter. Slowly inject total amount of solution. Holding on to catheter before inflating
balloon prevents expulsion of catheter from urethra.
12.2 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. By moving
catheter slightly back into bladder, pressure on bladder neck is avoided.
13. 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.
Anchoring reduces the possibility of tissue injury in the area.

13.1 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.
This facilitates drainage of urine and prevents the backflow of urine.

III. Outcome Oriented

14. Help patient to comfortable position. Dispose supplies in appropriate
receptacles. Measure urine and record. Document the catheterization
procedure, including catheter size and results, in the client record.

IV. Leadership and Governance

15.Reports with proper grooming and displayed correct
decorum. Observed work ethics and showed resourcefulness.
Manifested great confidence in his/her work, showed diligence in documenting
observations.

Comments / Strengths & Weaknesses:

Conforme: Evaluated by:

Student’s Signature Clinical Instructor’s Signature

Date: Date: