Catheterization

Definition:
- Introduction of a catheter to the urethra into the urinary bladder to remove urine.

Purposes:
- To relieve discomfort due to bladder distention or to provide gradual decompression
of a distended bladder.
- To assess the amount of residual urine if the bladder empties incompletely.
- To obtain a sterile urine specimen.
- To empty the bladder completely prior to surgery.
- To facilitate accurate measurement of urinary output for critically ill clients whose
output needs to be monitored hourly.
- To provide for intermittent or continuous bladder drainage and or irrigation.
- To prevent urine from contracting an incision after perineal surgery.
- To manage incontinence when other measures have failed.

Equipment:
- Sterile catheter of appropriate size (extra catheter)
- Catheterization Kit or individual sterile items:
• 1-2 pair sterile gloves
Waterproof drapes
Antiseptic Solution
Cleansing balls
Forceps
Urine receptacle
Specimen container
Water-soluble lubricant
• For an indwelling catheter
Syringe prefilled with sterile water in amount specified by catheter manufacturer
Collection bag and tubing
• 2% Xylocaine gel
• Disposable clean gloves
• Supplies for performing perineal cleansing
• Bath blanket or sheet for drapping the client
• Adequate lighting (flashlight or lamp)

Procedure:
1. Introduce self.
2. Perform hand hygiene
3. Provide privacy
4. Place the client in appropriate position and drape
a. Female: Supine with knees flexed, feet about 2 feet apart and hips slightly
externally rotated.
b. Male: Supine, thighs slightly abducted or apart
5. Establish adequate lighting. Stand on clients right if right-handed, left if left-handed.

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6. If using a collecting bag and it is not contained within the catheterization kit open the
drainage package and place the end of the tubing within reach. – Since one hand is
needed to hold the catheter once it is in place, open the package while two hands
are still available.
7. If agency policy permits, apply clean gloves and inject 10-15ml Xylocaine gel into the
urethra of the male client. Wipe the underside of the shaft to distribute the gel up the
urethra. Wait at least 5 minutes for the gel to take effect before inserting the
catheter. Remove gloves.
8. Open the catheterization kit. Place a waterproof drape under the buttocks (f) or penis
(m) without contaminating the center of the drape with your hands.
9. Put on sterile gloves.
10. Organize the remaining supplies
- Saturate the cleansing balls with the antiseptic solution
- Open the lubricant package
- Remove the specimen container and place it nearby with the lid loosely on top.
11. Attach the prefilled syringe to the indwelling catheter inflation hub and test the
balloon. - If the balloon malfunctions, it is important to replace it prior to use.
12. Lubricate the catheter (1 to 2 inches Female) or (6 to 7 inches Male) and place it
with the drainage end inside the collection container.
13. If desired place the fenestrated drape over the perineum exposing the urinary
meatus.
14. Clean the meatus:
a. Women – Use nondominant hand to spread the labia. Establish a firm but gentle
position. The antiseptic may make the tissues slippery but the labia must not be
allowed to return over the cleaned meatus. Pick up a cleansing ball with the
forceps in your dominant hand and wipe one side of the labia majora in an
anteroposterior direction. Use great care that wiping the client does not
contaminate this sterile hand. Use a new ball for the opposite side. Repeat for
the labia minora. Use the last ball to cleanse directly over the meatus.
b. Men – Use your nondominant hand to grasp the penis just below the glans. If
necessary retract the foreskin. Hold the penis firmly upright, with slight tension. –
Lifting the penis in this manner helps straighten the urethra. Pick up a cleansing
ball with the forceps in your dominant hand and wipe from the center of the
meatus in a circular motion around the glans. Use a new ball and repeat three
more times. The antiseptic may make the tissues slippery but the foreskin must
not be allowed to return over the cleaned meatus nor the penis be dropped.
15. Insert the catheter.
- Grasp the catheter firmly 2 to 3 inches from the tip. Ask the client to take a slow
breath and insert the catheter as the client exhales. Slight resistance is expected
as the catheter passes through the sphincters. If necessary, twist the catheter or
hold pressure on the catheter until the sphincter relaxes.
- Advance the catheter 2 inches further after the urine begins to flow through it, to
be sure it is fully in the bladder. For male client’s some agency’s policy and
procedures indicate to advance the catheter to the “y” bifurcation of the catheter.
- If the catheter accidentally contracts the labia or slips into the vagina, it is
considered contaminated and a new sterile catheter must be used. The

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 contaminated catheter maybe left in the vagina until the new catheter is inserted
to help avoid mistaking the vaginal opening for the urethral meatus.
16. Hold the catheter with the nondominant hand. In males lay the penis down onto the
drape, being careful that the catheter does not pull out.
17. For an indwelling catheter, inflate the retention balloon with the designated volume.
- Without releasing the catheter, hold the inflation valve between two fingers of
your nondominant hand while you attach the syringe and inflate with your
dominant hand. If the client complains of discomfort, immediately withdraw the
instilled fluid, advance the catheter further and attempt to inflate the balloon
again.
- Pull gently on the catheter until resistance is felt to insure that the balloon has
inflated and to place it in the trigone of the bladder.
18. Collect a urine specimen if needed. Allow 20 to 30ml to flow into the bottle without
touching the catheter to the bottle.
19. Allow the straight catheter to continue draining. If necessary attach the drainage end
of an indwelling catheter to the collecting tubing and bag.
20. Examine and measure the urine. In some cases only 750 to 1000ml of urine are to
be drained from the bladder at one time. Check agency policy for further instructions
if this should occur.
21. Remove the straight catheter when urine flow stops. For an indwelling catheter,
secure the catheter tubing to the inner thigh for female clients or the upper
thigh/abdomen for male with enough slack to allow usual movement. Tape or a
manufactured catheter securing device should be use to secure the catheter tubing
to the client. This prevents unnecessary trauma to the urethra. Also secure the
collecting tubing to the bed linens and hang the bag below the level of the bladder.
No tubing should fall below the top of the bag.
22. Wipe the perineal area of any remaining antiseptic or lubricant. Replace the foreskin
if retracted earlier. Return the client to a comfortable position and thank for the
cooperation.
23.Discard all used supplies in appropriate receptacles and wash hands.
24.Document the catheterization procedure including catheter size and results in the
client record using forms or check list supplemented by narrative noted when
appropriate.

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