Urinary Catheterization Nursing Procedure & Management

▪ Urinary Catheterization is the introduction of a catheter through the urethra into the bladder for the
purpose of withdrawing urine.
▪ Catheters are graded on the French scale according to the size of the lumen.
▪ Catheters vary from 12 (small) FR or 48 (Large) FR.

Purposes

● To relieve urinary retention
● To obtain a sterile urine specimen from a woman
● To measure the amount of residual urine in the bladder
● To obtain a urine specimen when a specimen cannot secure satisfactory by other means
● To empty bladder before and during surgery and before certain diagnostic examinations

Necessary Equipment for Catheterization

● For the female adult, No. 14 and No. 16 French catheters are usually used. Small catheters are generally
not necessary and the size of the lumen is also so small that it increases the length of time necessary for
emptying the bladder.
● Larger catheter distends the urethra and tends to increase the discomfort of the procedure.
● For male adult, No.18 and No. 20 French catheters usually used, but if this appears to be too large, smaller
catheter should be used.
● No. 8 and No. 10 French catheters are commonly used for children.

Types of Catheter

1. Indwelling catheters (urethral or suprapubic catheters)

▪ An indwelling catheter is a catheter that resides in the bladder. It may also be known as a Foley catheter. This
type can be useful for short and long periods of time.
 ▪ A nurse usually inserts an indwelling catheter into the bladder through the urethra. Sometimes, a healthcare
provider will insert the catheter into the bladder through a tiny hole in the abdomen. This type of indwelling
catheter is known as a suprapubic catheter.
▪ A tiny balloon at the end of the catheter is inflated with water to prevent the tube from sliding out of the
body. The balloon can then deflate when the catheter needs to be removed.

External catheters (condom catheters)

▪ A condom catheter is a catheter placed outside the body. It’s typically necessary for men who don’t have
urinary retention problems but have serious functional or mental disabilities, such as dementia. A device that
looks like a condom covers the penis head. A tube leads from the condom device to a drainage bag.
▪ These catheters are generally more comfortable and carry a lower risk of infection than indwelling catheters.

Condom catheters usually need to be changed daily, but some brands are designed for longer use. These can
cause less skin irritation than condom catheters that require daily removal and reapplication

2. Short-term catheters (intermittent catheters)

▪ A person may only need a catheter for a short period of time after surgery until the bladder empties. After
the bladder empties, it’s necessary to remove the short-term catheter. Healthcare providers refer to this as
an in-and-out catheter.
 ▪ In a home setting, people are trained to apply the catheter themselves or with the help of a caregiver. It can
be done through the urethra or through a hole created in the lower abdomen for catheterization.

Universal Precaution

▪ The potential for contact with the patient’s blood/body fluids while starting a catheter is present and
increases with the inexperience of the operator. Gloves must be worn while starting the Foley, not only to
protect the user, but also to prevent infection in the patient. Trauma protocols calls for all team members to
wear gloves, face and eye protection and gowns.

Preparation of the Patient

1. Adequate exploration.  On some instances, catheterization is the last resort, use other techniques first
for drawing out the urine before proceeding to catheterization.
2. Position. Dorsal recumbent for the female and supine for the male using a firm mattress or treatment
table, Sim’s or lateral position can be an alternate for the female patient
3. Provision for privacy

Equipment’s:

▪ Sterile gloves
▪ Sterile drapes
▪ Cleansing solution
▪ Cotton swabs
▪ Forceps
▪ Sterile water (10 cc)
▪ Foley catheter (FR 16-18)
▪ Syringe (10 cc)
▪ Lubricant (water base)
▪ Collection bag and tubing

Retention or Indwelling Catheter (Foley) 

 ● A catheter to remain in place for the following purposes:

1.
1. The gradual decompression of an over distended bladder
2. For intermittent bladder drainage
3. For continuous bladder drainage

● An indwelling catheter has a balloon which is inflated after the catheter is inserted into the bladder.
Because the inflated balloon is larger than the opening to the urethra, the catheter is retained in the
bladder.

Procedure for Insertion

1. Gather all the equipment’s.

2. Explain the procedure to the client.
3. Assist the patient in Dorsal recumbent for female and supine for male.
4. Wear clean gloves, place absorbent cloth underneath the buttocks and clean the perineal area.
5. After cleaning the perineum remove gloves and discard properly
6. Open catheterization kit and catheter.
7. Prepare sterile field, wear gloves.
8. Inflate the balloon with the prefilled syringe before inserting the catheter to check for balloon patency.
Aspirate the fluid back into the syringe when it is determined that the balloon is patent.
9. Generously coat the distal portion of the catheter with lubricant.
10. Apply sterile drape.
11. If female, separate the labia using the non-dominant hand. If male, hold the penis with non-dominant
hand.
 12. Hold the catheter with one hand and inflate the balloon according to the manufacturer’s instructions, as
soon as the catheter is in the bladder and urine has begun to drain from the bladder. Usually 5 ml to 10
ml of sterile water is used
13. If the patient complains of pain after the balloon is inflated, allow it to empty and replace the catheter
with another one. The balloon is probably located in the urethra and is causing discomfort owing to
distention of the urethra
14. Exert slight tension on the catheter after the balloon is inflated to assure its proper placement in the
bladder
15. Connect the catheter to the drainage tubing and drainage bag if not already connected
16. Tape the catheter along the anterior aspect of the thigh for a female patient. Be sure there is no tension
on the catheter when it is taped to the patient
17. Hang the drainage bag on the frame of the bed below the level of the bladder

Caring for the Patient with an Indwelling Catheter 

1. Be sure to wash hands before and after caring for a patient with an indwelling catheter
2. Clean the perineal area thoroughly, especially around the meatus, twice a day and after each bowel
movement. This helps prevent organisms for entering the bladder
3. Use soap or detergent and water to clean the perineal area and rinse the area well
4. Make sure that the patient maintains a generous fluid intake. This helps prevent infection and irrigates
the catheter naturally by increasing urinary output
5. Encourage the patient to be up and about as ordered
6. Record the patient’s intake and output
7. Note the volume and character of urine and record observations carefully
8. Teach the patient the importance of personal hygiene, especially the importance of careful cleaning after
having bowel movement and thorough washing of hands frequently
9. Report any signs of infection promptly. These include a burning sensation and irritation at the meatus,
cloudy urine, a strong odor to the urine, an elevated temperature and chills
10. Plan to change indwelling catheters only as necessary. The usual length of time between catheter
changes varies and can be anywhere from 5 days to 2 weeks. The less often a catheter is changed, the
less the likelihood than an infection will develop

Removing the Indwelling Catheter and Aftercare of the Patient

1. Be sure the balloon is deflated before attempting to remove the catheter. This may be done by inserting
a syringe into the balloon valve or by cutting the balloon valve
2. Have the patient take several deep breaths to help him relax while gently removing the catheter. Wrap
the catheter in a towel or disposable, waterproof drape
3. Clean the area at the meatus thoroughly with antiseptic swabs after the catheter is removed
4. See to it that the patient’s fluid intake is generous and record the patient’s intake and output. Instruct
the patient to void into the bedpan or urinal
5. Observe the urine carefully for any signs of abnormality
6. Record and report any usual signs such as discomfort, a burning sensation when voiding, bleeding and
changes in vital signs, especially the patient’s temperature. Be alert to any signs of infection and report
them promptly