CENTRO ESCOLAR UNIVERSITY

Manila * Makati * Malolos

SCHOOL OF NURSING
PROCEDURE CHECKLIST
Inserting A Straight or Indwelling Catheter

NAME OF STUDENT: SCORE:

YEAR/SECTION/GROUP/NUMBER:

Rate the student's performance by checking the appropriate box using the following
criteria:
5 - Excellent (Carries out procedures efficiently, systematically and
independently/Personality trait is observed at all times)
4 - Very Satisfactory (Carries out procedures efficiently and systematically but
requires minimal guidance and supervision/Personality trait is observed at all times)
3 - Satisfactory (Carries out the procedures efficiently and systematically but requires
moderate guidance and supervision/Personality trait is observed at all times)
2 - Fair (Carries out the procedures efficiently and systematically but requires close
guidance and supervision/Personality trait is observed at all times)
1 - Poor (Carries out the procedures inefficiently, unsystematically even under close
guidance and supervision/Personality trait is observed at all times)
0 - Not done
CRITERIA 5 4 3 2 1 0
ASSESSMENT:
1.Assess the status of the Patient
1.1 When patient last voided
1.2 Level of awareness or developmental
stage
1.3 Mobility and physical limitations of
patient
1.4 Patient’s sex and age
1.5 Distended bladder
1.6 Any pathological conditions and
allergies

PLANNING:
1. Prepare the materials needed.

1.1 Sterile gloves

1.2 Sterile drapes
1.3 Lubricant KY jelly
1.4 Antiseptic cleansing solution
1.5 Cotton balls
1.6 Forceps
1.7 Prefilled 10 cc syringe with normal
saline to inflate balloon of indwelling catheter
1.8 Catheter of correct size and type of
procedure (i.e., intermittent or indwelling)
1.9 Flashlight or gooseneck lamp
IMPLEMENTATION:

1. Wash your hands. Wear gloves and

follow standard precautions if contact
with blood or body fluids cannot be
avoided
2. Identify the person, and greet him or her
by name.
3. Explain the procedure and encourage the
person to participate as appropriate.
4. Provide privacy. Close the door and the
curtain.
5. Facing patient, stand on left side of bed if
right handed. Clear bedside table and
arrange equipment.
6. Place side rail on opposite side of the bed.
7. Place waterproof pad under patient.
8. Position client. Assist to supine position
with thighs slightly abducted.
9. Drape patient. Drape upper trunk with
bath blanket and cover lower extremities
with bed sheets exposing only genitalia.
10. When inserting indwelling catheter, open
package containing drainage system. Place
drainage bag over edge of bottom bed
frame. Bring drainage tube up between side
rail and mattress.
11. Open catheterization kit according to
directions, using aseptic technique. Place
waste receptacle in accessible place.
12. Don sterile gloves.
13. Organize supplies on sterile field:

13.1 Open sterile package containing

catheter; pour sterile package of antisepti
solution in correct compartment containing
sterile cotton balls.
13.2 Lubricate tip of catheter, remove
specimen container and pre-filled syringe
from collection compartment of tray and set
them aside of sterile field.
14. Nurses may want to ensure that
inflatable balloon of indwelling catheter is
intact by inserting syringe tip through valve
of intake lumen and injecting sterile fluid until
balloon inflates. Then aspirate all fluid out of
inflated lumen.
15. Apply sterile drape. Apply drape over
thighs just below penis. Pick up fenestrated
sterile drape, allow it to unfold, and drape it
over penis with fenestrated slit resting over
penis.
16. Place sterile tray and contents on sterile
drape between thighs.
17. Determine that catheter tip is properly
lubricated. Male 12.5-17.5 cm (5-7 inches).
18. Cleanse urethral meatus.

18.1 If patient is not circumcised, retract

foreskin with non-dominant hand. Grasp
penis at shaft just below glans. Retract
urethral meatus between thumb and
forefinger. Maintain non-dominant hand in
this position throughout procedure.
18.2 With dominant hand, pick up cotton ball
with forceps and clean penis. Move it in
circular motion from meatus down to base of
glans. Repeat cleansing two more time
using clean cotton balls each time.
Pickup catheter with gloved dominant hand
7.5-10 cm (3-4 inches) from catheter tip.
Hold end of catheter loosely coiled in palm
of dominant hand. Place distal end of
catheter in urine tray specimen.
20. Insert catheter

20.1 Lift penis to position perpendicular

traction.
20.2 Ask patient to bear down as if to void
and slowly insert catheter through meatus.
20.3 Advance catheter 17.5-22.5 cm (7-9
inches) in adult and 5-7.5 cm (2-3 inches) in
young child, or until urine flows out
catheter’s end. If resistance is felt, withdraw
catheter and do not force it through urethra.
When urine appears, advance catheter
another 5 cm (2 inches).

20.4 Lower penis and hold catheter securely

in non-dominant hand.

Place end of catheter in urine tray receptacle.

For Female Patient

21. Cleanse urethral meatus
21.1 With non-dominant hand, carefully
retract the labia to fully exposed retract the
labia to fully exposed urethra
meatus. Maintain position of non-dominant
hand throughout the procedure.
21.2 With dominant hand, pick up cotton ball
with forceps and clean perineal by wiping
from front to back or from clitoris towards
anus. Use new cotton ball for each wipe
along near labial fold, directly over meatus
and along labial fold.
22. Pick up catheter with gloved dominant
hand 7.5-10 cm (3-4 inches) from catheter
tip. Hold the end of catheter loosely coiled in
the palm of the dominant hand. Place distal
end of catheter in urine tray specimen.
23. Insert catheter

23.1 Ask patient to bear down as if to void

and slowly insert catheter through meatus.

23.2 Advance catheter 5-7.5 cm (2-

3inches) in adult and 2.5 cm (1 inch) in
young child or until urine flows in young
child or until urine flows out catheter’s end.
When urine appears, advance catheter up
to another 5 cm (2 inches). Do not force
against resistance.
23.3 Release labia and hold catheter
securely with non-dominant hand.
24. Collect urine specimen as needed: fill
specimen cup to desired level (20-30 mL) by
holding the end of catheter with the
dominant hand over the cup. With dominant
hand, pinch catheter to stop urine flow
temporarily. Release catheter to allow
remaining urine in bladder to drain in the
collection tray. Cover the specimen cup and
set aside for labelling.
25. Allow bladder to empty full (750-1000
mL) unless institution policy restricts
maximal volume of urine to drain with each
catheterization.
25.1 For straight, single use catheter, pinch
catheter and remove slowly but smoothly
when urine ceases to flow.
25.2 For indwelling catheter, inflate balloon
of the indwelling catheter.
25.3 While holding catheter with your thumb
and little finger of the non-dominant hand at
meatus, take end of catheter and place it
between first two fingers of non-dominant
hand.
25.4 With free dominant hand, attach
syringe to injection port at the end of
catheter.
25.5 Slowly inject total amount of solution. If
client complains of sudden pain, aspirate
back solution and advance catheter further.
25.6 After inflating the balloon fully, release
catheter with the non-dominant hand and
pull it gently if there is resistance.
26. Attach end of catheter to the collecting
tube of drainage system. Drainage bag
must be below level of bladder.

27. Tape catheter tubing on top of thigh or

lower abdomen. Allow slack in catheter so
movement does not create tension on
catheter.
28. Be sure that there are no obstructions or
kinks in tubing. Inspect all that may lead to
obstruction in the flow of the urine from the
catheter to the drainage bag.
29. Remove gloves and dispose of
equipment, drapes and urine in proper
receptacle.
30. Assist client to comfortable position.
Wash dry perineal area as needed.
31. Instruct patient on ways to lie in bed with
catheter. Side lying facing drainage system
with catheter and tubing draped over thigh
and side lying facing away from the system,
catheter and tubing extended between legs.
32. Caution patient against pulling the
catheter.
33. Wash hands thoroughly.
EVALUATION
1. Palpate bladder and ask if patient remains
uncomfortable.
2. Determine if there is no urine leaking from
catheter or tubing connections.
3. Record time of procedure, characteristics
and amount of urine in drainage system.
4. Observe for signs of obstruction (e.g.,
decreased urine in collection bag, voiding
around the catheter, abdominal discomfort
and bladder distention).
Total Score:
Comments/Suggestions:
Computation: Total Score divided by (number of items) x 20 (factor) = _________________
*Total points shall be transmuted using the table for 100 pts. Passing cut-off point is 65.
Equivalent Numeric Grade: _______________
Interpretation: __________________________
EVALUATOR: CONFORME: DATE:

___________________________ _____________________
CLINICAL INSTRUCTOR'S NAME & SIGNATURE STUDENT'S SIGNATURE