Republic of the Philippines

SULTAN KUDARAT STATE UNIVERSITY

ACCESS. E.J.C. Montilla, Tacurong City

College of Health Sciences

URINARY CATHETERIZATION

Catheterization is a common procedure and is the last option when a full holistic
assessment has shown no other suitable alternatives can be used. A catheter is inserted
into the bladder through the urethra for drainage of urine. Using an aseptic technique, this
can be for a short period of time or for a long period of time and requires continual
assessment. Not to be used for nursing convenience to maintain patients continence. It
should therefore be the therapy of choice only when all other interventions are deemed to
be inappropriate or have been unsuccessful.

Indications for Urethral Catheterization

Urethral catheters are often indicated in circumstances such as:
 During and post-surgery
 Monitoring renal function during critical illness
 Acute urinary retention
 Chronic urinary retention (if symptomatic and/ or renal problems)
 To irrigate the bladder if hematuria is a concern
 For investigations, such as urodynamics
 To instill medication into a bladder
 Where it is assessed as ‘in the patient’s best interest’ to use a catheter, such as
end of life care.
 Neurological bladder dysfunctions
 Damaged skin (open sacral or perianal wound in an incontinent patient)
 Incontinence alone is not an indication for catheterization.

Contra-indications for Urethral Catheterization

 Unexplained bleeding
 History of bladder tumor
 History of infection
 Risk of urethral damage
 False passages
 Risk of damage to internal and external sphincters
 Urethral surgery
 Gender reassignment surgery

Risks Associated with Urethral Catheterization

 Trauma
 Urethral erosion
 Urinary tract infection
 Bacteremia
 Encrustation
 Urethral perforation
 Bladder calculi neoplastic changes
 Sepsis
 For those with spinal injuries, there is the risk of autonomic dysreflexia.
 PROCEDURE CHECKLIST ON URINARY CATHETERIZATION (FEMALE)

STEPS OF THE PROCEDURES RATIONALE

1. Review patient’s chart for Doctor’s order.  Assess symptoms, indications,
contraindications and ascertain
necessity of catheterization.
 Allows for individualized Nursing care
plan for the patient.
2. Checks completeness of supplies.  Checking for completeness and
preparation ahead of time enhances
patient comfort and safety and avoid
delays and disruption.
3. Assesses whether patient is allergic to iodine or  Prevent adverse reactions from
plaster exposure and contact with such items.
4. Washes hands. Assemble equipment.  Deter the spread of microorganisms
 Bath blanket that causes disease and
 Waterproof underpad contamination.
 Sterile fenestrated drape  Organization facilitates time
 Sterile catheter of appropriate size (Fr. 12-14 for management and performance of task
adults; Fr 8-10 for children) in a swift and efficient manner.
 Kidney basin  Equipment should be within reach to
 Sterile gloves avoid stretching and over reaching
 Forceps and disruption in the performance of
the procedure.
 OS
 Betadine solution
 Sterile dry CB
 Water soluble lubricant
 Specimen Container
Indwelling Catheter
 Foley Catheter
 10cc syringe with 10 cc sterile water
 Plaster
 Urine bag
5. Identify the client and explain the procedure.  Avoid error in patient identification and
render appropriate care/procedure to
appropriate patient.
 Obtain valid and informed consent.
 Promotes reassurance, provides
knowledge about the procedure and
facilitates understanding and
cooperation.
6. Close curtains around bed and close the door to the  Ensure the patient’s privacy. The
room, if possible. Provide client privacy patient may be embarrassed as
catheterization involves exposure of
the genital area.
 Helps protect patient dignity.
7. Replaces top sheet with a bath blanket.  Unnecessary exposure may cause
embarrassment and chilliness which
could cause the patient to be tense.
Tension could interfere with easy
introduction of the catheter.
 Helps protect patient dignity.
8. Position the patient on a dorsal recumbent with feet  Facilitates good visualization of the
apart and drape the patient meatus which is essential in the
introduction of the catheter. Gravity
will aid in the flow of urine when the
 bladder is higher than the end of the
catheter.
9. Provide good light and visibility on the perineum.  Adequate lighting helps with accuracy
and speed of catheter insertion.
10. With aseptic technique, open the catheterization pack.  Ensure items remain sterile and not
contaminated.
11. Place the fenestrated drape into the perineum  Ensures unnecessary exposure and
exposing the genital area of the patient. exposing only the perineal area of the
patient.
 The outer 2.5 cm is considered non-
sterile on a sterile drape.
12. Places waterproof under pad  Ensure urine does not leak onto
bedclothes. Prevent soiling of bed and
linens.
13. Don sterile gloves.  Deter the spread of microorganisms.
 Universal precaution in handling body
fluids and mucous membranes.
 Reduce risk of cross-infection.
14. Check the integrity of the catheter.  Pretesting indwelling catheters before
 Note: Test the catheter balloon for any defect insertion avoid infections, catheter
before inserting it by attaching the prefilled syringe malfunction or various production
to the indwelling catheter inflation hub errors.
 Inflate the balloon of the catheter by injecting 5cc
of sterile water to the indwelling catheter inflation
hub
 After checking, deflate the balloon of the catheter
by aspirating the sterile water on the indwelling
catheter inflation hub.
15. Saturate the cleansing balls with antiseptic solution  Ensures preparation and organization
and place it on the sterile field for procedure.
16. Squeeze a small amount of lubricant over the sterile  Ensures preparation and organization
OS. for procedure.
17. Clean the genital area.  Thorough cleansing of the meatus
 Use your non-dominant hand to spread the labia. and the area surrounding it reduces
Establish a firm but gentle position possible introduction of
 Pick up cleansing ball using the dominant hand, microorganism into the bladder.
and wipe one side of the labia majora. Use a new
ball in the opposite side. Repeat for the labia
minora
 Use the last ball to cleanse directly over the
meatus
18. Lubricate 1-2 inches of the catheter tip.  The lubricant reduces friction which
causes pain and discomfort.
 Lubrication minimizes urethral trauma
and discomfort during procedure.
19. Maintains hold until after catheter has been inserted.  Holding catheter closer to the tip will
help to control and manipulate
catheter during insertion.
 Withdrawing the catheter and pushing
it back into the urethra increases the
possibility of contamination to the
urethra.
20. Insert the tip of the catheter into the urethral meatus  Ensure safe insertion of catheter and
located below the clitoris about 2-3 inches or until to prevent infection.
urine flows. Asks the patient to breathe deeply as  Insert an indwelling catheter until
catheter is inserted urine flows ensures that the catheter
is correctly positioned in the bladder.
21. If a Foley catheter is used, introduce 5cc of sterile  Inadvertent inflation of the balloon
water to secure the catheter; instruct patient to take a within the urethra is painful and
slow deep breath, insert catheter as client exhales; causes urethral trauma.
gently pulls the catheter until retention balloon is  Insert an indwelling catheter up to the
snuggled against the neck of the bladder. Tape the catheter's bifurcation before you
catheter to the inner thigh. inflate the balloon ensures that the
balloon isn't inflated while in the
prostatic urethra, which would cause
pain and bleeding.
 Maintain patient comfort and to
reduce the risk of urethral
erosion/damage and bladder neck
trauma and aid drainage
22. Attach catheter to the urinary drainage bag below the  Provide drainage for urine once
level of the bladder catheter is inserted.
 Maintain a closed system to reduce
risk of cross infection
23. If straight catheter is used, hold the catheter securely  Ensure safe insertion of catheter and
with the non-dominant hand while bladder is emptied. to prevent infection.
Collect specimen if required  Insert an indwelling catheter until
urine flows ensures that the catheter
is correctly positioned in the bladder.
 Urine specimen may be required for
analysis. Collect as per agency policy.
24. Remove the catheter smoothly and slowly (if straight  Minimize discomfort and pain in the
catheter is used) removal of the catheter.
25. Remove and clean the equipment. Make the client  Prevents transmission and spread of
comfortable microorganisms and infection. Prevent
environmental contamination.
 Promotes comfort and safety of the
patient. Maintain patient’s dignity and
comfort.
26. Remove gloves and washes hands  Prevents transmission and spread of
microorganisms and infection.
27. Records the time of the catheterization; the amount of  Provides accurate documentation of
sterile water injected; the amount of the urine the procedure, condition of the
removed; description of the urine; the patient’s patient, and response to intervention
reaction to the procedure. provided.
 A careful documentation is important
for planning and individualizing the
patient’s care.
 Provide point of reference or
comparison in the event of later
queries.
 Republic of the Philippines
SULTAN KUDARAT STATE UNIVERSITY
ACCESS. E.J.C. Montilla, Tacurong City

College of Health Sciences

PROCEDURE CHECKLIST ON URINARY CATHETERIZATION (MALE)

STEPS OF THE PROCEDURES RATIONALE

1. Review patient’s chart for Doctor’s order.  Assess symptoms, indications,
contraindications and ascertain
necessity of catheterization.
 Allows for individualized Nursing care
plan for the patient.
2. Checks completeness of supply  Checking for completeness and
preparation ahead of time enhances
patient comfort and safety and avoid
delays and disruption.
3. Assesses whether patient is allergic to iodine or plaster  Prevent adverse reactions from
exposure and contact with such items.
4. Washes hands. Assemble equipment.  Deter the spread of microorganisms
 Bath blanket that causes disease and
 Waterproof underpad contamination.
 Sterile fenestrated drape  Organization facilitates time
 Sterile catheter of appropriate size (Fr. 12-14 for management and performance of task
adults; Fr 8-10 for children) in a swift and efficient manner.
 Kidney basin  Equipment should be within reach to
 Sterile gloves avoid stretching and over reaching
 Forceps and disruption in the performance of
the procedure.
 OS
 Betadine solution
 Sterile dry CB
 Water soluble lubricant
 Specimen Container
Indwelling Catheter
 Foley Catheter
 10cc syringe with 10 cc sterile water
 Plaster
 Urine bag
5. Identify the client and explain the procedure.  Avoid error in patient identification and
render appropriate care/procedure to
appropriate patient.
 Obtain valid and informed consent.
 Promotes reassurance, provides
knowledge about the procedure and
facilitates understanding and
cooperation.
6. Close curtains around bed and close the door to the  Ensure the patient’s privacy. The
room, if possible. Provide client privacy. patient may be embarrassed as
catheterization involves exposure of
the genital area.
 Helps protect patient dignity.
7. Replaces top sheet with a bath blanket.  Unnecessary exposure may cause
embarrassment and chilliness which
could cause the patient to be tense.
 Tension could interfere with easy
introduction of the catheter.
 Helps protect patient dignity.
8. Position the patient on a supine and knees slightly  Facilitates good visualization of the
apart and drape the patient. male genitalia and meatus which is
essential in the introduction of the
catheter. Gravity will aid in the flow of
urine when the bladder is higher than
the end of the catheter.
9. Provide good light and visibility on the perineal area  Adequate lighting helps with accuracy
and speed of catheter insertion.
10. With aseptic technique, open the catheterization pack.  Ensure items remain sterile and not
contaminated.
11. Place the fenestrated drape into the perineum  Ensures unnecessary exposure and
exposing the genital area of the patient. exposing only the male perineal area
of the patient.
 The outer 2.5 cm is considered non-
sterile on a sterile drape.
12. Places waterproof under pad  Ensure urine does not leak onto
bedclothes. Prevent soiling of bed and
linens.
13. Don sterile gloves.  Deter the spread of microorganisms.
 Universal precaution in handling body
fluids and mucous membranes.
 Reduce risk of cross-infection.
14. Check the integrity of the catheter.  Pretesting indwelling catheters before
 Note: Test the catheter balloon for any defect insertion avoid infections, catheter
before inserting it by attaching the prefilled syringe malfunction or various production
to the indwelling catheter inflation hub errors.
 Inflate the balloon of the catheter by injecting 5cc of
sterile water to the indwelling catheter inflation hub
 After checking, deflate the balloon of the catheter
by aspirating the sterile water on the indwelling
catheter inflation hub.
15. Saturate the cleansing balls with antiseptic solution  Ensures preparation and organization
and place it on the sterile field for procedure.
16. Clean the genital area.  Thorough cleansing of the meatus
 Use your non dominant hand and lift the penis. and the area surrounding it reduces
 Pick up cleansing ball with a disposable forceps possible introduction of
using the dominant hand and cleanses the glans in microorganism into the bladder.
a circular motion moving outward from the meatus
with the use of CB with betadine. Discard and
clean again with cotton ball with betadine.
17. Squeeze a small amount of lubricant over the sterile  Ensures preparation and organization
OS. for procedure.
18. Lubricate 3-4 inches of the catheter tip  The lubricant reduces friction which
causes pain and discomfort.
 Lubrication minimizes urethral trauma
and discomfort during procedure.
19. With the hand still holding the shaft of the penis, pick  The maneuver straightens the penile
up the catheter with the dominant hand 3-4 inches urethra and facilitates easier insertion
below the tip. Pull the penis slightly upward and asks of catheter.
the patient to bear down as if to void  Maintaining the grasp of the penis
prevents contamination and retraction
of penis.
 Helps visualize urethral meatus and
relax external urinary sphincter.
20. Slowly insert the catheter in the meatus about 7-9  Facilitates easier insertion of catheter
 inches using a rotating motion until urine flows and lesser discomfort on the part of
the patient.
 Ensure safe insertion of catheter and
to prevent infection
 The male urethra is a canal extending
from the bladder to the end of the
glans penis. The length varies within
wide limits; the average length is
about 21 cm.
21. If resistance is felt withdraws a little the catheter and  Aid ease and comfort on catheter
asks the patient to take a deep breath again if insertion.
resistance persists, removes it and notifies the  Some resistance may be due to
physician spasm of external sphincter. Inability
to pass the catheter may mean that a
urethral stricture or other form of
urethral pathology exists. The urethra
may have to be dilated with a sound
by a urologist.
22. Gently pushes the catheter in 1-2 inches more after  Advancing the catheter ensures its
urine starts to flow. position in the bladder.
23. If a Foley catheter is used, introduce 5cc of sterile  Inadvertent inflation of the balloon
water to secure the catheter; instruct patient to take a within the urethra is painful and
slow deep breath, insert catheter as client exhales; causes urethral trauma.
gently pulls the catheter until retention balloon is  Insert an indwelling catheter up to the
snuggled against the neck of the bladder. Tape the catheter's bifurcation before you
catheter to the inner thigh. inflate the balloon ensures that the
balloon isn't inflated while in the
prostatic urethra, which would cause
pain and bleeding.
 Maintain patient comfort and to
reduce the risk of urethral
erosion/damage and bladder neck
trauma and aid drainage
24. Attach catheter to the urinary drainage bag below the  Provide drainage for urine once
level of the bladder catheter is inserted.
 Maintain a closed system to reduce
risk of cross infection
25. If straight catheter is used, hold the catheter securely  Ensure safe insertion of catheter and
with the non-dominant hand while bladder is emptied. to prevent infection.
Collect specimen if required  Insert an indwelling catheter until
urine flows ensures that the catheter
is correctly positioned in the bladder.
 Urine specimen may be required for
analysis. Collect as per agency policy.
26. Remove the catheter smoothly and slowly (if straight  Minimize discomfort and pain in the
catheter is used) removal of the catheter.
27. Remove and clean the equipment. Make the client  Prevents transmission and spread of
comfortable microorganisms and infection. Prevent
environmental contamination.
 Promotes comfort and safety of the
patient. Maintain patient’s dignity and
comfort.
28. Remove gloves and washes hands  Prevents transmission and spread of
microorganisms and infection.
29. Records the time of the catheterization; the amount of  Provides accurate documentation of
sterile water injected; the amount of the urine removed; the procedure, condition of the
description of the urine; the patient’s reaction to the patient, and response to intervention
procedure. provided.
 A careful documentation is important
for planning and individualizing the
patient’s care.
 Provide point of reference or
comparison in the event of later
queries.
 Republic of the Philippines
SULTAN KUDARAT STATE UNIVERSITY
ACCESS. E.J.C. Montilla, Tacurong City

College of Health Sciences

PROCEDURE CHECKLIST ON REMOVING AN INDWELLING CATHETER

STEPS OF THE PROCEDURES RATIONALE

1. Checks the order on the patient’s chart  Assess symptoms, indications,
contraindications and ascertain
necessity of removal of catheter.
 Allows for individualized Nursing care
plan for the patient.
2. Check completeness of supplies.  Checking for completeness and
preparation ahead of time enhances
patient comfort and safety and avoid
delays and disruption.
3. Washes hands. Assemble equipment.  To deter the spread of
 Ticket for the procedure microorganisms that causes disease
 5-10ml syringe and contamination.
 Absorbent towel  Organization facilitates time
 Bath blanket management and performance of task
 Gloves in a swift and efficient manner.
 Equipment should be within reach to
avoid stretching and over reaching
and disruption in the performance of
the procedure.
4. Identify the client and explain the procedure.  Avoid error in patient identification and
render appropriate care/procedure to
appropriate patient.
 Obtain valid and informed consent.
 Promotes reassurance, provides
knowledge about the procedure and
facilitates understanding and
cooperation.
 Patient must be informed of what to
expect after catheter is removed and
how to measure urine output, etc.
5. Close curtains around bed and close the door to the  Ensure the patient’s privacy. The
room, if possible. Provide client privacy patient may be embarrassed as
catheterization involves exposure of
the genital area.
 Helps protect patient dignity.
6. Replaces top sheet with a bath blanket.  Unnecessary exposure may cause
embarrassment and chilliness which
could cause the patient to be tense.
Tension could interfere with easy
removal of the catheter.
 Helps protect patient dignity.
7. Position the patient and drape the patient.  Facilitates easier access and good
 Dorsal recumbent with feet apart for female. visualization of the genitalia and
 Supine and knees slightly apart for male patient meatus which is essential in the
removal of the catheter.
8. Wear gloves  Deter the spread of microorganisms.
  Universal precaution in handling body
fluids and mucous membranes.
 Reduce risk of cross-infection.
9. Place an absorbent towel on the mattress under the  Ensure urine does not leak onto
catheter bedclothes. Prevent soiling of bed and
linens.
10. Attach the syringe to the balloon port, withdraw the  A partially deflated balloon will cause
water from the balloon until resistance is met urethral wall trauma and pain.
11. With the non-dominant hand, hold the absorbent towel  Prevents accidental spilling of urine
in front of the perineum and pull catheter out smoothly from the catheter.
and slowly.  Minimizes urethral trauma and
discomfort during procedure.
12. Hold the catheter at an upward angle to the drainage  Prevents accidental spilling of urine
tubing so that the urine drains to the drainage from the catheter.
13. Inspect the catheter to make certain it is intact. If it is  Confirm and ensure that no fragment
not, then notify the physician immediately or portion of the catheter is left inside
the bladder and urinary tract of the
patient.
14. Measures the output in the drainage bag  Provide point of reference or
comparison in the event of later
queries.
15. Empties the urine in the into the toilet and cleans the  Prevents transmission and spread of
measuring equipment microorganisms and infection. Prevent
environmental contamination.
 Clean environment promotes comfort.
16. Removes gloves, washes hands and makes patient  Prevents transmission and spread of
comfortable. Instruct the patient to drink extra fluid and microorganisms and infection.
inform that there may be mild burning sensation with  Hand hygiene prevents the
the first few voiding. transmission of microorganisms from
patient to health care provider.
 Prevent urinary tract infections and
maintain fluid balance.
17. Document the time of removal, amount of urine  Provides accurate documentation of
collected into the I and O flow sheet and the time by the procedure, condition of the
which the patient should have next voided patient, and response to intervention
provided.
 A careful documentation is important
for planning and individualizing the
patient’s care.
 Provide point of reference or
comparison in the event of later
queries.