Siena College of Taytay, Inc.

COLLEGE OF
NURSING
PERFORMANCE EVALUATION TOOL
NCM 107
RLE
Insertion and Removal of Indwelling Catheter
Checkmark if considered as:
 “3” (Excellent) column denotes mastering the skill.
 “2” (Satisfactory) column indicates use of recommended technique.
 “1” (Needs Practice) column indicates use of some but not all of each recommended technique.
 “0” (Not Done) column indicates failure to perform the recommended technique.
SCORE
PERFORMANCE EVALUATION TOOL (PET)
3 2 1 0
LEARNING OBJECTIVES:
 Perform a focused urinary system assessment of the patient.
 Recognize the need for urinary catheterization.
 Explain procedures to the patient using an appropriate communication framework.
 Perform the correct steps for urinary catheterization using sterile technique.
 Perform appropriate documentation.
PURPOSE OF THE PROCEDURE 4
 Relieve Urinary Retention
 Obtain a Sterile Urine Specimen from Female Patient.
 Empty the Bladder Before, During, After Surgery
 Allows accurate measurement of urine output.
PREPARATION
1. Check patient’s Chart for doctor’s order.
2. Assemble equipment and supplies
Rationale:. Organization provides accurate skill
 Cotton with betadine
 Catheter (Check size)  Lubricant
 10 cc syringe with 10 cc sterile water  anchoring tape
 1 clean gloves  Disposable container
 1 sterile gloves
 Flashlight or lamp
 Urine collection bag

performance.

PROCEDURE
3. Wash your hands and don gloves, if necessary.
Rationale: to avoid contact with bodily secretions and to reduce transmission of
microorganisms.
4.Explain the procedure to the client.
Rationale Explanation facilitates client cooperation .
5.Provide for Privacy and Adequate lighting.
6. Positioning
FEMALE patient in a dorsal recumbent position with the knees flexed and the feet about
two feet apart. Place the catheter set between the female patient’s legs
MALE patient in a supine position.

BSN LEVEL III: Date Reviewed 1st Semester; September 2, 2022

BSN 3 2022-006
Prepared by JESMAR S. ESPIRITU
Page 1
 Siena College of Taytay, Inc.

COLLEGE OF
 DRAPE the patient so that only the area around the perineum /penis is exposed.
NURSING
 Place the catheter set next to the legs of the male patient.

DISINFECT THE URINARY MEATUS

7. 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.
 Using the forceps, pick up a cotton ball saturated with antiseptic solution.
 Use one cotton ball for each stroke.
 Swab the above the meatus downward toward the rectum.
 Do not go back over any previously cleansed area.
 Discard each cotton ball into the disposal cup
9. Lubricate the catheter and insert into the urinary meatus while keeping the labia separated
with the non- dominant hand
10. 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.
11. 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)
12. Inflate balloon, using correct amount of sterile liquid I usually 10 cc (check balloon size)
13. Gently pull catheter until inflation balloon is snug against bladder neck
14. Connect catheter to drainage system
15.Secure the catheter to the inner aspect of female patient’s thigh.
16.Place drainage bag below level of bladder
17.Evaluate catheter function and amount, color, odor, and quality of urine
18.Remove gloves, dispose of equipment appropriately, wash hands
19.Document size of catheter inserted, amount of water in balloon, patient’s response to
procedure, and assessment of urine.
TOTAL SCORE: 60 points
Grade Computation: Your score / 60 x 50 +50 = Performance Rating

Final Score: _____%

Remarks:

JESMAR S. ESPIRITU PhD

Signature over Printed Name of Student Signature over Printed Name of Clinical Instructor

BSN LEVEL III: Date Reviewed 1st Semester; September 2, 2022

BSN 3 2022-006
Prepared by JESMAR S. ESPIRITU
Page 2
 Siena College of Taytay, Inc.

COLLEGE OF
NURSING

Removing an Indwelling Catheter

SCORE
PERFORMANCE EVALUATION TOOL (PET)
3 2 1 0
Procedure:
1. Check patient’s Chart
2. Assemble equipment and supplies
 10 cc syringe
 Cotton balls in soap suds
 Exam gloves
3. Identify the patient and explain the procedure to him. Advise him that there will be a slight burning
during removal of the catheter.
4. Provide for Privacy and assist the female patient into a dorsal recumbent position.
 The male should be in a supine position.
5. Wash your hands and put on exam gloves.
6. Empty the balloon by inserting the barrel of the syringe and withdrawing the amount of fluid used
during inflation.
7. Pinch off and gently pull on the catheter near the point where it exits from the meatus.
8. Clean the perineum or penis with cotton ball in soap suds solution , Rinse with water soap and
water. Dry the area well.
9. Inspect the catheter to be sure no remnants remained in the bladder. If the catheter is not totally
intact, report this promptly and save the catheter for further inspection
10. Empty the drainage bag. Measure the amount of urine and record on the intake and output (I & O)
sheet.
11. Remove the gloves and wash your hands.
12. Discard disposable supplies and return reusable supplies and equipment to the appropriate area.

13. Record that the catheter was removed, the time and date and by whom. Note the amount, color
and clarity of the urine in the drainage bag. Also document all patient teaching done and the
patient’s level of understanding.
14. After removal of the catheter, assess the patient for 24 hours for patterns of urinary elimination.
Note the time and amount of the voided urine.
15. After removal of the catheter, assess the patient for 24 hours for patterns of urinary elimination.
Note the time and amount of the first voided urine.
16. Report any of the following:
17. Inability to void within 8 to 10 hours.
18. Frequency, burning dribbling, or hesitation in starting the stream of urine.
19. Cloudiness or any other unsual color or characteristic of the urine.
20. Provide a level of fluids similar to the intake when the catheter was in place.
TOTAL SCORE: 42points
Grade Computation: Your score / 42x 50 +50 = Performance Rating 37
Final Score: %Remarks:

JESMAR S. ESPIRITU PhD

Signature over Printed Name of Student Signature over Printed Name of Clinical Instructor

BSN LEVEL III: Date Reviewed 1st Semester; September 2, 2022

BSN 3 2022-006
Prepared by JESMAR S. ESPIRITU
Page 3
 Siena College of Taytay, Inc.

COLLEGE OF
NURSING

JESMAR S. ESPIRITU PhD MAN RN RM

Signature over Printed Name of Student Signature over Printed Name of Clinical Instructor

BSN LEVEL III: Date Reviewed 1st Semester; September 2, 2022

BSN 3 2022-006
Prepared by JESMAR S. ESPIRITU
Page 4