Far Eastern University

Institute of Health Sciences and Nursing

Department of Nursing
AY 2023-2024

Performance Evaluation Tool

URINARY CATHETERIZATION

Name:_________________________ Concept:________________ Score:_________

Section/Group No.:______________ Faculty:_________________ Date:__________

RATING QUANTITATIVE
SCALE DESCRIPTION
2 ACCEPTABLE Demonstrates expected procedures / behaviors correctly
1 MODERATELY Demonstrates expected procedure/behavior with minimal error
ACCEPTABLE
0 UNACCEPTABLE Missed procedure or procedure done but entirely incorrect

A. PREPARATION RATING REMARKS

1. Assess the clients over all condition. Aware or asleep 0 1 2
2. Assemble equipment and supplies. 0 1 2
3. Aspirate 10 cc sterile water. 0 1 2
4. Check with the doctor’s order. 0 1 2
5. Introduce yourself. 0 1 2
6. Verify the client’s identity. 0 1 2
7. Explain to the client the procedure. 0 1 2
8. Provide for client’s privacy. 0 1 2
9. Perform hand hygiene. 0 1 2
10. Don clean gloves. 0 1 2
11. Establish adequate lighting. 0 1 2
12. Stand on the clients right if you are right-handed; on the client’s
0 1 2
left if you are left-handed.
B. PROCEDURE

underpad
put
FEMALE (PERINEAL CARE)
13. Drape all areas except the perineum. 0 1 2
14. Place the client in the appropriate position. Supine, with knees
0 1 2
flexed, feet about 2 feet apart and hips slightly externally rotated.
15. Use your non dominant hand to spread the labia. 0 1 2
16. Pick up a cotton ball with the forceps in your dominant hand. 0 1 2
17. Wipe one side of the labia majora in an anterior posterior
0 1 2
direction.
18. Use a new cotton ball for opposite side. 0 1 2
19. Repeat for the labia minora. 0 1 2
20. Use the last ball to cleanse directly over the meatus. 0 1 2
21. Pour tap water to the perineum to rinse. 0 1 2
22. Pat dry the perineum with cotton balls. 0 1 2
23. Remove all used materials from the work area. 0 1 2
24. Perform handwashing. 0 1 2
B. PROCEDURE

MALE (GLANS PENIS CARE)

13. Place the client in the appropriate position. Supine, legs slightly 0 1 2
abducted.
14. Drape all areas except the penis. 0 1 2
15. Perform routine meatus care. 0 1 2
16. Use your non-dominant hand to grasp the penis just below the 0 1 2
glans. If necessary, retract the foreskin.
17. Hold the penis firmly upright, with slight tension. 0 1 2
18. Pick up a cotton ball with forceps in your hand. 0 1 2
19. Wipe from the center of the meatus in a circular motion around 0 1 2
the glans.
20. Use a new cotton ball each time; repeat three times. 0 1 2
21. Rinse with tap water using the same stroke. 0 1 2
22. Pat dry. 0 1 2
23. Remove all used materials from the work area. 0 1 2
24. Perform handwashing. 0 1 2
INSERTION (FEMALE & MALE)

25. If using a collecting bag not contained within the catheterization 0 1 2

kit, open the drainage package.
26. Place end of the tubing within reach. 0 1 2
27. Open the catheterization kit. 0 1 2
28. Place on waterproof drape under the buttocks without 0 1 2
contaminating the center of the drape with your hands.
29. Don sterile gloves. 0 1 2
30. Attach the prefilled syringe to the indwelling catheter inflation 0 1 2
hub.
31. Test the balloon. 0 1 2
32. Aspirate 10 cc of sterile water. 0 1 2
33. Attach the drainage end of the catheter in the collection bag. 0 1 2
34. Lubricate the tip of the catheter about 7-12 inches. 0 1 2
35. Gently introduces well lubricated catheter 5–7 cm (2–3 in) into 0 1 2
urethral meatus using strict aseptic technique until urine flows.
36. Advance the catheter another 1 to 2 inches farther. 0 1 2
CONTINUATION FOR BOTH

37. Collect a urine specimen, if needed allow 20 – 30 ml to flow into 0 1 2

the specimen bottle without touching the catheter to the bottle.
38. Inflate the balloon with 10 ml sterile water. 0 1 2
 39. Attach the drainage end of the indwelling catheter to the 0 1 2
collecting tubing and bag.
40. Examine and measure the urine. 0 1 2
41. Secure the catheter tubing to the inner right for the client on the 0 1 2
upper thigh, using a micropore, with enough slack to allow usual
movement.
42. Secure the collecting tubing to the bed linens. 0 1 2
43. Hang the bag below the level of the bladder. No tubing should 0 1 2
fall below the top of the bag. And getotine sample
C. REMOVAL OF CATHETER (BOTH)

44. Perform handwashing. 0 1 2

45. Prepare syringe and tissue paper in a tray and bring to bedside. 0 1 2
46. Inform patient of the procedure. 0 1 2
47. Don clean gloves. 0 1 2
48. Position patient accordingly. 0 1 2
49. Aspirate 10 cc water from the balloon of the catheter. 0 1 2
50. Kinks the catheter. 0 1 2
51. Gently pulls out the catheter while the patient breathes through 0 1 2
the mouth.
D. AFTER CARE

52. Wipe the perineal area or meatus of any remaining antiseptic or 0 1 2

lubricant.
53. Position client comfortably. 0 1 2
54. Discard all used supplies in appropriate receptacles. 0 1 2
55. Perform hand hygiene. 0 1 2
E. DOCUMENTATION

56. Document: 0 1 2
a. Time and date of catheterization
b. Reason for catheterization
c. Type and size of the catheter
d. Amount of water used to inflate the balloon
e. Amount, color, and clarity of urine obtained
f. Whether specimen was taken and sent to the laboratory
g. Assessment before and after the procedure

Female Catheterization: Total Score ________ ÷ 112 X 100 = ________________

Male Catheterization: Total Score _________÷ 112 X 100 = ________________

__________________________ _________________________
Name and Signature of Student Name and Signature of Faculty

///revised as of Oct.. 2023