NURSING SERVICE OFFICE

Nursing Skills Update

 CATHETERIZATION

 is done to relieve acute or chronic urinary retention

 to drain urine preoperatively and post-operatively
 to determine the amount of residual urine after
voiding
 or to determine accurate measurement of urinary
drainage in critically ill patients

Reference: Lippincott Manual of Nursing Procedures

Fundamentals of Nursing by Kozier
ASSESSMENT:

a. Assess the patient and check the order to be

sure that catheterization has been ordered
for the patient.
b. Determine whether the procedure is to be a
straight or indwelling catheterization.
c. Find out whether a urine specimen is needed.
When in doubt, always obtain a specimen. It
can be discarded later if not needed.
PLANNING:

a. Wash hands.
b. Select the specific type and size of catheter
to be used.
c. Collect the appropriate equipment, including
correct catheterization set, additional
lighting if needed, and a blanket or sheet.
Wash hands.
IMPLEMENTATION:

1. Identify the patient

2. Explain the procedure to the patient and

answer any questions.

3. Close the door of the room or draw the bed

curtain for privacy. Raise the bed for appropriate
working height and drape the patient.
4. Place the diaper underneath the patient’s buttocks.
5. Position the patient.
POSITIONING PATIENT:
Female: Place in a dorsal recumbent
position, with knees flexed and legs spread.

Male: Place in supine or dorsal recumbent

position. Expose only the penis and a small
surrounding area.
6. Set-up the equipments/ materials:

1. Sterile catheter.
2. Catheterization Tray: Sterile Eye Sheet, Sterile Kidney
Basin, Cotton with NSS, Cotton with Betadine, Pick-up
Forceps, OS 4X4
3. Urine drainage/collection bag (Urobag)
4. Sterile gloves
5. Ordinary gloves
6. 10cc Syringe prefilled with STERILE WATER
7. Water-soluble lubricant
8. Specimen container
9. Diaper
10. Droplight
11. Plaster
6. Set-up the equipment

a. Arrange the lighting. If the perineal area is

soiled, provide perineal care wearing clean
gloves, with soap and water or cotton with NSS
before you begin catheterization.
b. Establish the sterile field by placing the fenestrated
sheet over the genitalia extending between the
patient’s legs
c. Open the syringe and drop it to the sterile field.
d. Drop the sterile kidney basin into the sterile area.
e. Drop at least 5 cottons with betadine to the kidney basin.
f. Drop sterile forceps into the sterile area.
g. Drop sterile urine specimen in to the sterile area.
h. Open the outer catheter pack and drop the catheter into to
the sterile field.
i. Open the urobag and drop it to the sterile field.
j. Squeeze liberal amount of lubricating gel into the kidney
basin.
k. Don sterile gloves.
 k. If an indwelling catheter is to be inserted, remove
the supplementary pack, and attach the pre-filled
syringe to the balloon port. Test the balloon by
instilling all of the sterile water and then deflating it by
withdrawing the water. Leave the syringe attached.

If the catheter is defective, ask someone to get another

catheter or remove your gloves and get both another
catheter and another pair of gloves to proceed.
 l. Connect the distal end of the catheter to the
drainage tube. If specimen is needed, you can
either not connect the catheter to the drainage
tube at this time and use the specimen cup as
collection device or obtain a specimen from the
drainage bag after you have finished.
Connect the urobag to the catheter
Lubricate approximately 3” of the distal end of the catheter. Leave in place and
proceed to disinfect the genitalia.
 7. CATHETERIZE THE PATIENT

a. Use your non dominant hand to expose the

meatus. Remember that hand is now contaminated
and cannot be used to handle equipment again.
For a man or boy, raise the penis at 45⁰ angle from the scrotum
and retract the foreskin if uncircumcised. Use gauze to gain
traction if needed.
 For a woman or a girl, separate both the labia majora and
the labia minora. Retract the labia in an outward direction.

b. After the meatus is exposed and identified, begin cleaning.

Use forceps to handle the cleansing swabs. Use each swab only
once, and then discard in the prepared receptacle. For a man or
boy, clean in a circular motion, starting at the meatus.
For female, use each swab from front to back, starting with the outside labia and
moving toward the center. Clean one side first then the other. The final stroke
should be vertical to clean the meatus itself.
c. Insert the lubricated catheter smoothly until urine flows and
advance almost to the bifurcation.
 Do not use force. If you encounter resistance,
ask the patient to breathe deeply and gently
rotate the catheter to see if it will penetrate. If it
will not enter, consult a physician before trying
again.
Hold the catheter in place while you fill the balloon
according to the manufacturer’s suggested volume.
Ensure placement by gently pulling it until you feel
resistance.
Wipe off excess lubricant from the catheter and genitalia.
8. If you are using a straight catheter, hold the catheter
in place while you fill the specimen cup. Drain the
bladder. Pinch the catheter closed to prevent further
draining and remove the catheter.

9. Tape the catheter to the patient. For a man or a boy,

tape the catheter without tension to the side of the
lower abdomen. For a woman or a girl, tape the
catheter to the inner thigh.

.
PROPER ANCHORING OF FOLEY
CATHETER FOR MALE:
 PROPER ANCHORING OF FOLEY
CATHETER FOR MALE:

The inflated balloon holds the catheter in the bladder.

(A.) Note the sharp angle formed at the penile-scrotal junction when the penis is
directed towards the thigh.
(B.) Note how correct taping of the catheter in the male patient eliminates the
potential of abrasion and erosion of the penile scrotal angle.
PROPER ANCHORING OF FOLEY
CATHETER FOR FEMALE:
FIRST LAYER

FIRST LAYER

SECOND LAYER
FIRST LAYER

SECOND LAYER

FIRST LAYER
ASPIRATION SITE FOR URINE
SPECIMEN
Secure the diaper in place.
Secure the urinary collection bag below the level of the bladder and
off the floor.  Coil any extra tubing on the bed.
10. Assist the patient to a comfortable position
and straighten and lower the bed and open
the curtains.
11. Gather and discard disposable equipment
properly.
12. Wash your hands.
EVALUATION:

Evaluate using the following criteria:

a. Indwelling catheter draining properly or

straight catheter inserted and removed
without discomfort or other difficulty.
b. Patient comfortable.
DOCUMENTATION:

a. Date and time of catheterization.

b. Type and size of catheter used.
c. Whether a specimen was obtained and sent
to the laboratory.
d. Amount of urine drained.
e. Description of the urine.
f. Patient’s response to the procedure.