CATHETERIZATION

DEFINITION:
The introduction of a catheter into the bladder through the urinary meatus and urethral canal.

PURPOSES:
1. To relieve bladder distention.
2. To obtain sterile urine specimen.
3. To empty the bladder before the surgery where general and spinal anesthesia are used.
4. To check and or remove residual urine.
5. To prevent voiding when there are wounds in the genito-urinary tract or other condition which make it
important that the area be kept clean and dry.

STEPS RATIONALE
1. Check physician’s order. - Catheterization is dependent nursing
action.
- Never catheterized without a written
order by the physician.
Check for allergies to the lubricating or anaesthetic
gel, latex allergy ang cleansing solution to prevent
allergic reactions.
2. Inform the client. - (Self introduction and knowing client
Dialogue)
- “The procedure we will be carry out is
Urinary catheterization, it involves the
insertion of a tube into your bladder. It
helps to remove wastes and fluid from
your body. Since you’re having trouble
peeing on your own, that’s why you need
a catheter. It may feel uncomfortable
during insertion but it won’t be that that
long. “
- Discussing the procedure with the patient,
and explaining any associated risks or
benefits will make patient to cooperate.
3. Wash hands and observe other - Handwashing deters the spread of
appropriate infection control procedures. microorganisms.
- Obtain the equipment needed to perform
the female catheterisation procedure,
following aseptic non-touch technique
(ANTT) guidance. This equipment should
include:
- Sterile catheterization tray
- Lubricant (KY jelly/water soluble)
- Syringe
- Sterile water
- Collection bag
- Sterile pair of gloves
- 2 rubber catheters Fr. 14 and Fr. 16 for
women( or fine the smallest
- Pitcher with sterile solution
- Perineal tray
- Bedpan with cover
- Flashlight/penlight
Exhaust all nursing measures to induce voiding
before resorting to catheterization.
-
4. Provide for client privacy. - To lessen embarrassment, and to provide
privacy and dignity of the patient.
5. Place the client in the appropriate position - In order for the patient to be relaxed and
 and drape all areas except the perineum. is convenient for us to see the meatus
And Establish adequate lighting. while doing the procedure and avoid
“Are you now comfortable with your interruption because of uncomfortable
position? “ position.
6. Stand on the client’s right if you are right- For me to comfortably manipulate
handed, on the client’s left if you are left- insertion of the catheter.
handed.
7. Arrange equipments to provide - Placing equipment in order of use increase
convenience and to avoid having to reach speed of performance. Reaching over
over sterile field. sterile items increase risk of
contamination.
8. Done sterile gloves. - Sterile equipment can be handled without
contamination when sterile gloves are
worn.
9. Lubricate catheter for about ½ inch, being - Lubricant reduces friction and facilitates
careful not to plug eye of catheter. easy insertion of catheter.
- Never use glycerine, it is irritant.
10. Female - Stretching tissue straighten labia fold
Place thumb and index finger between makes meatus visible for any insertion of
labia minora, spread and then pull catheter. Touching labia contaminates
upward, gloved hand separating labia is gloves hands.
now considered contaminated.
11. Cleanse exposed area of meatus - Moving from area where there is likely to
thoroughly. Move cotton ball from above be less contamination to an area where
meatus down toward rectum. there is more contamination prevent
spread of organism. Thoroughly cleansing
helps reduce possibility of introducing
organism into the bladder.
12. Insert the catheter.
Grasp the catheter firmly 2-3 inches from - Slight resistance is expected as the
the tip. Ask the client to take a slow deep catheter passes through the sphincter.
breath, and insert the catheter as the - The female catheter 1.5” to 2.5” inches
client exhales. long. Applying force on the catheter is
likely to injure mucous membranes.
-
13. Advance the catheter 2 inches further - To be sure that the catheter is fully in the
after the urine begins to flow through it. bladder.
14. For an indwelling catheter, inflate the - Once the balloon is inflated, withdraw the
retention balloon with the designated catheter slightly to ensure the catheter is
volume. in the bladder and is secure.
The most common balloon size used is 5 -
mL, and it is typically inflated with 10 mL
of sterile water.
15. Hold catheter securely while bladder - Withdrawal and reinsertion of catheter
empties. Avoid pushing the catheter in and creates friction thus it provide discomfort
out. If necessary, attached the drainage to the patient.
end of an indwelling catheter to the - Then make the patient comfortable. Help
collecting tubing and bag. her get dressed if required and ensure the
bed is clean and dry.
-
- Dispose off equipment in a clinical waste
bag according to local policy. Wash your
hands to prevent cross contamination.
16. Care of equipment and urine specimen as Fully document the procedure including:
required and record results.
Reason for insertion;
Date and time of catheterisation;
Catheter type;
Length;
Balloon size and volume of water inserted;
Batch/lot number;
Manufacturer;
Expiry date;
 Meatal cleansing solution;
Lubricant;
Name and signature of health professional in
charge of the insertion
and any problems encountered on insertion; we
should also indicate
Date of removal/change.

If it is the patient’s first catheterisation, the urine

output should be measured and recorded on
insertion to help monitor renal function and fluid
balance. The volume also provides important
information about bladder capacity in patients
who have urinary retention.

To end up with the procedure, Check the patient

she is comfortable
“Ok ma’am, how are you feeling with the
catheter? “
“…To remind you, we’ve used an indwelling
catheter to you as ordered by the doctor, and it is
scheduled to be changed for every 2 weeks, to
prevent any complications of having blockage or
urinary infections.”

Removal of catheterization
Definition
Catheters are routinely removed early in the morning. This means that any
problems, such as urinary retention, will normally present during the day and can
be dealt with by appropriate health professionals.

The purpose of removing catheter is to help prevent infection and other

complications such as blockage or having urinary infections.

To begin with the assessment…

1. ●Check physicians order.
It is important to understand the reason for removal and whether the
catheter is being removed permanently or in a planned or unplanned change
due to problems encountered by the patient, such as a blocked catheter.
--Check the patient’s records to see how much water was used to inflate the
catheter balloon. The same volume should be removed to completely deflate
the balloon, before attempting to remove the catheter.

2. ●Inform the client

Ensure the patient understands the procedure and gain consent to remove
the catheter. Explain any symptoms that may occur after removal, such as
urgency, frequency and discomfort, and what action to take if these occur.

(Dialogue)
 “Good morning, we will now remove the Foley catheter since you no longer
needed it. You may experience milds burning, discomfort or small volume
voiding which will subside…

You may have certain urinary symptoms for up to 48 hours after your Foley
catheter is removed. These include urinary urgency and frequency. Urinary
urgency means you feel such a strong need to urinate that you have trouble
waiting. You may also feel discomfort in your bladder.”

Rationale: By informing, patient will have prior knowledge about the removal
of catheter.
Because patient may be anxious about pain and discomfort during the
procedure, and about passing urine afterwards.

3. Provide for client privacy by drawing the curtains -

To lessen embarrassment, and to provide privacy and dignity of the patient.

4. Assemble the relevant equipment. Screen the patient to maintain privacy

and protect bed linen using protective covering.
5. Ask the patient to lie in a supine position so the catheter is easily accessible
and the patient can relax.
6. Release any catheter fixation devices to allow easy removal.

7. Empty the patient’s catheter bag or drain the bladder via a catheter valve to
prevent any spillage of urine during removal.
8. Wash your hands and put on non-sterile gloves to reduce the risk of cross
infection.
9. Place the paper towel under the patient and a kidney dish between the
patient’s legs to receive the used catheter and to catch any urine spillage.
10. If necessary, clean around the meatus and catheter using an
appropriate solution. Always swab away from the urethral opening to reduce
the risk of introducing infection into the urethra. In women, never clean from
the perineum or vagina towards the urethra as this can transfer bacteria and
potentially cause urinary tract infection.
11. Following the manufacturer’s instructions, attach the syringe to the
inflation/deflation valve to deflate balloon. Do not pull on the syringe but
allow the solution to flow back naturally as the balloon deflates.
12. Check that the volume of fluid in the syringe is equal to the volume
inserted; this indicates that the balloon is completely deflated (although
silicon catheters may not give back the same volume as fluid can be lost from
the balloon by osmosis).
13. Ask the patient to relax, and to breathe in and out as this relaxes the
pelvic floor muscles.
 14. Ask the patient to exhale and gently remove the catheter using
continuous traction. Women can experience a stinging sensation and
discomfort.
15. Clean and dry the meatus if necessary and make the patient
comfortable.
16. Inspect the removed catheter for any signs of encrustation, especially if
a new catheter is to be inserted. This can affect how often the catheter is
replaced.
17. Dispose of equipment according to local policy.
18. Remove gloves, and wash and dry hands. Ensure the patient is able to
walk to the toilet or has a call bell to ask for help.
19. Patients often experience symptoms of urgency and frequency so calls
for assistance should be responded to promptly.
20. Document the date and time of the catheter removal.
21. Record urine output until the frequency and voided volumes are
satisfactory.
22. (Encourage the patient to)
Ok ma’am, it is recommended for you to drink 2-3L of fluid a day. This helps
to flush out any bacteria that may be present in the urinary tract and prevent
infections, which in turn will prevent burning/pain on passing urine.
Concentrated urine can also irritate the bladder and cause unwanted
contractions and spasms. And we don’t want that to happen.”

I want you to also observe for any signs of voiding difficulties and report these
immediately by using the call bell beside you. “
23. Fully Document the procedure done, including
-date of the removal /change
Cleansing solutions
Name and signature of health professional in charge of the removal
and any problems encountered on removal.