CATHETERIZING THE FEMALE & MALE URINARY BLADDER (Straight & Indwelling)

  1. Assemble equipment. Perform hand hygiene. Explain procedure and purpose to patient. Discuss any allergies with patient, especially iodine or latex.
  2. Provide good light. Artificial light is recommended (use of flashlight requires an assistant to hold and position it).
  3. Provide privacy by closing curtains or door.
  4. Assist patient to the dorsal recumbent position with knees flexed and feet about 2 feet apart. Drape patient. Or, if preferable, place patient in the side-lying position. Slide waterproof drape under patient.
  5. Clean genital and perineal areas with warm soap and water. Rinse and dry. Perform hand hygiene again.
  6. Prepare urine drainage setup if indwelling catheter is to be inserted and separate urine collection system is used. Secure to bed frame according to manufacturer’s directions.
  7. Open sterile catheterization tray on overbed table using sterile technique.
  8. Put on sterile gloves. Grasp upper corners of drape and unfold without touching unsterile areas. Fold back cuff over gloved hands. Ask patient to lift her buttocks. Slide sterile drape under her with gloves protected by cuff.
  9. Place a fenestrated sterile drape over perineal area, exposing the labia.
  10. Place sterile tray on drape between patient’s thighs.
  11. Open all supplies.
    1. If catheter is to be indwelling, test catheter balloon. Remove protective cap on tip of syringe and attach syringe prefilled with sterile water to injection port. Inject appropriate amount of fluid. If balloon inflates properly, withdraw fluid and leave syringe attached to port.
    2. Pour antiseptic solution over cotton balls or gauze. Open specimen container if specimen is to be obtained.
    3. Lubricate 1 to 2 inches of catheter tip.
  12. With thumb and one finger of your nondominant hand, spread labia and identify meatus. Be prepared to maintain separation of labia with one hand until urine is flowing well and continuously.
  13. Using cotton balls held with forceps, clean both labial folds and then directly over meatus. Move cotton ball from above the meatus down toward the rectum. Discard each cotton ball after one downward stroke.
  14. With uncontaminated gloved hand, place drainage end of the catheter in receptacle. For insertion of an indwelling catheter that is preattached to sterile tubing and drainage container (closed drainage system), position catheter and setup within easy reach on the sterile field.
  15. Insert catheter tip into the meatus 5 to 7.5 cm (2-3 inches) or until urine flows. Do not use force to push catheter through the urethra into the bladder. Ask patient to breathe deeply. Rotate catheter gently if slight resistance is met as catheter reaches the external sphincter. For an indwelling catheter, once urine drains advance catheter another 2.5 to 5.0 cm (1-2 inches).
  16. Hold catheter securely with the nondominant hand while bladder empties. Collect specimen if required. Continue drainage according to agency policy.
  17. Remove catheter smoothly and slowly if a straight catheterization was ordered.
  18. If the catheter is to be indwelling:
    1. Inflate balloon according to manufacturer’s recommendations.
    2. Tug gently on catheter after balloon is inflated to feel resistance.
    3. Attach catheter to drainage system if necessary.
    4. Secure to upper thigh with a Velcro leg strap or tape. Leave some slack in catheter to allow for leg movement.
    5. Check that drainage tubing is not kinked and that movement of side rails does not interfere with catheter or drainage bag.
  19. Remove equipment and make patient comfortable in bed. Clean and dry perineal area, if necessary. Care for equipment according to agency policy. Send urine specimen to laboratory promptly or refrigerate it.
  20. Perform hand hygiene.
  21. Record time of catheterization, amount of urine removed, description of urine, patient’s reaction to procedure, and your name.
 
 
Skills Lab 43-3
Catheterizing the Male Urinary Bladder
(Straight and Indwelling)
 
  1. Assemble equipment and follows Actions 1 to 3 for female catheterization in Skill 43-2.
  2. Position patient on his back with thighs slightly apart, Drape patient so that only area around penis is exposed.
  3. Follow Actions 5 through 7 for female catheterization in skill 43-2.
  4. Put on sterile gloves. Open sterile drape and place on patient’s thighs. Place the fenestrated drape with the opening over penis.
  5. Place catheter set on or next to patient’s legs on the sterile drape.
  6. Open all supplies.
    1. If catheter is to be indwelling, test catheter balloon. Remove protective cap on tip of syringe and attach syringe prefilled with sterile water to the injection port. Inject appropriate amount of fluid. If balloon inflates properly, withdraw fluid and leave syringe attached to port.
    2. Pour antiseptic solution over cotton balls or gauze. Open specimen container if specimen is to be obtained.
    3. Remove cap from syringe prefilled with lubricant.
  7. Lift penis with your nondominant hand, which is then considered contaminated. Retract foreskin in the uncircumcised male patient. Clean area at meatus with cotton ball held with forceps. Use circular motion, moving from the meatus toward base of the penis for three cleansings.
  8. Hold the penis with slight upward tension and perpendicular to patient’s body. Gently insert tip of syringe with lubricant into urethra and instill 10 ml. of lubricant.
  9. Ask patient to bear down as if voiding. With your dominant hand, place drainage end of catheter in the receptacle. For insertion of indwelling catheter that is preattached to sterile tubing and drainage container (closed drainage system), position the catheter and setup within easy reach on the sterile field.
  10. Insert the tip into the meatus. Advance intermittent catheter 15 to 20 cm (6-8 inches) or until urine flows. Do not use force to introduce the catheter. Once balloon is inflated, catheter may be gently pulled back into place. Replace the foreskin in uncircumcised patient. Lower the penis.
  11. Follow Actions 16 through 21 for female catheterization in Skill 43-2 except that the catheter may be secured to the upper thigh or lower abdomen with the penis directed toward the patient’s chest. Slack should be left in the catheter to prevent tension.

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