Urinary Catheterization

Urinary Catheterization

  1. Check order
  2. Consider why patient is being catheterized
  3. Provide perineal care (especially for female patients); note if additional lighting and/or help will be needed for catheter insertion
  4. Gather needed equipment (and help if required); if you need something other than medium sterile gloves, get the correct size of gloves (most catheterization kits come with size 7 - 7 1/2 gloves) 
    Catheterization kit

    Contents: 
    -Waterproof Absorbent Underpad
    -Pair Latex-Free gloves
    -Fenestrated Drape
    -1 Package Povidone-Iodine Solution
    -5 Cotton Balls
    -1 Package Water-Soluble Lubricant
    -1 Prefilled 10 ml Syringe of Sterile Water 

    Minicath 

    Minicath for collection of sterile urine specimen from female patients

    Coude catheter 

    14 G Coude tipped catheter

    Malecot tip 14 G Malecot tipped catheter

    Mushroom tip 14 G Mushroom tipped catheter

    Catheter for continuous bladder irrigation 

    3-way catheter for irrigation

     

  5. Set up equipment
    Sterile drape is on top in kit
    Contents of catheterization kit

    Position patient:
    -female patient: lithotomy position (can also use sidelying position)
    - male patient: supine with thighs together.

    Remove sterile drape from catheterization kit.

    Lift the drape away from the kit to prevent contamination.

    Maintaining sterility of drape
    Placing sterile drape on a female patient 

    For the female patient:

    Placing sterile drape on a male patient 

    For the male patient

    Positioning glove package for donning gloves
    Placing the fenestrated drape on a male patient 

    The fenestrated drape is frequently not used for female patients since it may obscure your view.

    Contents of top tray in catheterization kit

    Now finish preparing the equipment. You may want to do this before placing drape if patient cannot hold still for long.

    Pour povidone-iodine over cotton balls 

    You may want to save one cotton ball to remove excess povidone-iodine from urinary meatus to improve visualization. Move one of the cotton balls to elsewhere on the tray before pouring the solution.

    Squeeze lubricant onto tray

    For the female patient, you will lubricate the end of the catheter.

    For a male patient, you can insert the lubricant directly into the end of the penis. Check facility policy to see if lidocaine jelly can be used for a lubricant with male patients.

    Moving the top tray
    How not to move the tray
    Remove cover from catheter
    Check balloon patency
    Grasp tray from top 

    Place top tray back onto box.

    Move entire box to patient.

    Female patient: place box next to sterile field between patient's legs.

    Male patient: place box on overbed table over patient's thighs.

     

  6. Insert catheter

    Locating the urinary meatus

    Once you have separated the labia with your nondominant hand, you must keep correct hand placement until after the catheter is inserted.

    Critical point: correct visualization of the urethral orifice

    Variations that make identifying the urinary meatus difficult

    Cleansing with providone-iodine 

    Cleanse each side and down the middle, going from top to bottom (clean to dirty).
    If you saved one cotton ball without povidone-iodine, you can wipe down the middle to improve visualization.

    Catheter insertion
    Urinary meatus
    Stabilize catheter after urine return
    Catheter placement  in the bladder

    Once the balloon is inflated, 

    • you can let go of the catheter
    • remove the syringe (while maintaining pressure)
    • put drainage bag on the side of the bed,
    • drape catheter tubing on the bed (no dependent loops)
    • Attach catheter to patient's thigh according to agency policy, leaving enough slack to prevent pulling on catheter with patient movement
    • Document procedure, including appearance and volume of urine and patient tolerance of procedure

    For the male patient

    Cleanse the meatus using a circular motion cleansing around the meatus, then around the tip of the penis (use a new cotton ball for each circle)
    When inserting a catheter in the male patient, hold the penis upright to straighten the urethra.
    Catheter insertion in a male patient

    Insert catheter approximately 8 inches until urine is obtained. Advance catheter another 1-2 inches before inflating balloon (to be sure that balloon is in bladder before inflation)

    Coude catheters

    A catheter specifically for male catheterization may need to be used.

    Prostatic hypertrophy is a common cause of difficulty in passing a catheter in a male patient. If resistance is felt, lower the penis to a 450 angle.

    If a catheter is taped into position, the recommendation is to tape it to the patient's abdomen to prevent pressure being placed on the urethra
    Preventing urethral irritation
    Catheter drainage