URINARY CATHETERIZATION

Garre R. Garcia, RN
 URINARY CATHETERIZATION

involves the introduction of a rubber or plastic

tube through the urethra into the bladder.
 Kinds
1. Intermittent catheters
- also known as straight catheters, are
placed into the bladder for short periods of
time (5 -10 minutes).

2. Indwelling/Retention or Foley catheter

- are those placed into the bladder for
extended periods of times.
- these catheters have a balloon at the distal
end that is inflated after insertion.
 Purposes
• To relieve acute or chronic urinary retention.
• To empty bladder before, during and after
surgery and before certain diagnostic
procedure.
• To determine amount of residual urine after
voiding
• To measure accurately the hourly urine
output of critically ill patients.
 Purposes

• To instill medications into the bladder

• To irrigate the bladder
• To obtain urine specimen for diagnostic
purposes.
CATHETERIZING THE
FEMALE URINARY
BLADDER
 Equipment

• sterile catheter kit that contains:

- sterile gloves
- sterile drapes (one of which is fenestrated)
- sterile catheter
- antiseptic solution
- lubricant
 Equipment

- cotton balls or gauze squares

- forceps
- pre-filled syringe
- basin
- specimen container
 Equipment
• flashlight or lamp
• waterproof disposable pad
• disposable urine collection bag and drainage
tubings
• disposable gloves
 Assessment
• Assess bladder fullness before performing
procedure, and question patient about any
allergies, especially to latex and iodine.

• Ask patient if she has been catheterized. If

she had an indwelling catheter previously,
ask why and for how long it was used. The
patient may have urethral strictures that may
make insertion more difficult.
Implementation with Rationale
 Nursing Action Rationale
1. Assemble all Organization facilitates
equipment. performance of the
task. Hand hygiene
Perform hand defers spread of
hygiene. Explain microorganisms.
the skill and its Explanation
purpose to patient. encourages patient
Discuss any cooperation and
reduces apprehension.
allergies with Most catheters and
patient, especially gloves in kits are made
to iodine and latex. of latex. Some
antiseptic solution
contains iodine.
 Nursing Action Rationale

2. Provide for good Good lighting is

light. Artificial light necessary to see
is recommended. meatus clearly.
 Nursing Action Rationale

3. Provide for Catheter insertion

privacy by closing may be
the curtain or door. embarrassing for
the patient.
 Nursing Action Rationale

4. Assist patient to Good visualization of

dorsal recumbent the meatus is
position with knees important.
flexed and feet about Embarrassment and
2 ft. apart. Drape tension can interfere
patient or if with catheter
preferable, place insertion; patient
patient in side-lying comfort will promote
position. Slide water relaxation. The drape
proof drape under the serve to protect bed
patient. from moisture
 Nursing Action Rationale

5. Done gloves. Spread Gloves reduce the risk

labia well with fingers, of exposure to blood
and clean area at and body fluids. Clean
vaginal orifice with technique decreases
washcloth and warm the possibility of
water, using a different introducing
corner of the washcloth microorganism.
with each stroke. Wipe
from above orifice
downward toward
sacrum (front to back).
Rinse and dry. Remove
gloves. Perform hand
hygiene again.
 Nursing Action Rationale

6. Prepare urine This facilitates

drainage set up if connection of the
indwelling catheter catheter to the
is to be inserted drainage system
and if a separate and provides for
urine collection easy access.
system is to be
used.
 Nursing Action Rationale

7. Open sterile Placement of

catheterization equipment near
tray on a clean worksite
over-bed table increases
using sterile efficiency. Sterile
technique. technique
protects patient
and prevents
spread of
microorganisms.
 Nursing Action Rationale
8. Put on sterile gloves. The drapes provides a
Grasp upper corners of sterile field close to the
drape and unfold drape meatus. Covering the
without touching gloved hands will keep
unsterile areas. Fold the gloves sterile while
back a corner on each placing the drape.
side to make a cuff
over gloved hands. Ask
patient to lift her
buttocks and slide
sterile drape under her
with gloves protected
by cuff.
 Nursing Action Rationale

9. A fenestrated sterile The drape extends the

drape maybe placed sterile field and
over the perineal area, protects against
exposing the labia. contamination. Use of a
fenestrated drape may
limit visualization and
is considered optional
by some practitioners.
 Nursing Action Rationale

10. Place sterile tray This provides easy

on drape between access to supplies.
patient's thighs.
Open all supplies:
 Nursing Action Rationale
- If catheter is to be A balloon that does
indwelling, test not inflate or that
catheter balloon. leaks needs to be
Remove protective replaced before
cap on tip of syringe insertion.
and attached syringe
pre-filled with sterile
water to injection
port. Inject
appropriate amount
of fluid. If balloon
inflates properly,
withdraw fluid.
 Nursing Action Rationale

- Fluff cotton balls in It is necessary to

tray before pouring open all supplies
antiseptic solution and prepare for the
over them. Open procedure while
specimen both hands are
container if sterile.
specimen is to be
obtained.
 Nursing Action Rationale

- Lubricate 1” to 2” Lubrication
of catheter tip. facilitates catheter
insertion and
reduces tissue
trauma.
 Nursing Action Rationale
11. With thumb and one Smoothing the area
finger of non- immediately
dominant hand, surrounding the
spread labia and meatus helps to make
identify meatus. Be it visible. Allowing the
prepared to maintain labia to drop back
separation of labia into position may
with one hand until contaminate the area
catheter is inserted around the meatus as
and urine is flowing well as the catheter.
well and Your non-dominant
continuously. hand is now
contaminated.
 Nursing Action Rationale
12. Using cotton balls Moving from one area
held with forceps, move where there is likely to
cotton ball from above be less contamination
meatus down toward helps prevent the
rectum discarding each spread of
cotton ball after one microorganisms.
downward stroke. Cleaning the meatus
Clean both labial folds last helps reduce the
and then directly over possibility of
the meatus, discarding introducing
each cotton ball after microorganisms into
one downward stroke. the bladder.
 Nursing Action Rationale
13.With uncontaminated This facilitates drainage
gloved hand, place of urine and minimizes
drainage end of risk of contaminating
catheter in receptacle. sterile equipment.
For insertion of an
indwelling catheter
that is pre-attached to
sterile tubing and
drainage container,
position catheter and
setup within easy reach
on sterile field. Ensure
that clamp on drainage
bag is closed.
 Nursing Action Rationale
14. Insert catheter tip into The female catheter is
meatus 5 to 7.5cm (2” about 3.7 to 6.2 cm
to 3”) or until urine (1.5” to 2.5”) long.
flows. Do not force Applying force on the
catheter through catheter is likely to
urethra into bladder. injure mucous
membranes.
Ask patient breathe The sphincter release
deeply, and rotate and the catheter can
catheter gently if slight enter the bladder easily
resistance is met as when the patient
catheter reaches relaxes. Advancing an
external sphincter. For indwelling catheter an
an indwelling catheter , additional 1.3 to 2.5
once urine drains, (1/2” to 1”) ensures
advance catheter placement in the
another 2.5 to 5.0 cm bladder and facilitates
(1” to 2”). inflation of the balloon
without damaging the
urethra.
 Nursing Action Rationale
15. Hold catheter securely Withdrawing and
with non-dominant reinserting the catheter
hand while bladder increases the chances
empties. Collect a of contaminating it. In
specimen if required; general, no more than
specimen should be 750 ml of urine should
caught in middle of be removed at one
flow. After 50 to 100 ml time.
of urine has drained,
place specimen
collection device under
opening of catheter and
allow urine to drain into
container.
When enough urine has Pelvic floor blood
been caught, remove vessels may become
specimen container. engorged from the
Continue drainage sudden release of
according to agency pressure, leading to
policy. possible hypotensive
episode. This may also
cause painful bladder
spasms.
 Nursing Action Rationale
16. Remove catheter This causes less
smoothly and slowly
discomfort to
if a straight
catheterization was patient.
ordered.
If catheter is to be indwelling:
 Nursing Action Rationale
- Inflate balloon The balloon
according to anchors the
manufacturer's catheter in place in
recommendations. the bladder. Sterile
water is used to
inflate the balloon
as a precaution in
case the balloon
ruptures.
 Nursing Action Rationale

- Tug gently on Improper inflation can

catheter after balloon cause patient
is inflated to feel discomfort and
resistance. malpositioning of
catheter
 Nursing Action Rationale

- Attach catheter to Closed drainage

drainage system if system minimizes the
necessary. risk for
microorganisms
being introduced into
the bladder.
 Nursing Action Rationale

- secure to upper Proper attachment

prevents trauma to the
thigh with tape. urethra and meatus from
Leave some slack in tension on the tubing.
catheter for leg Whether to take the
movement. drainage tubing over or
under the leg depends
on gravity flow, patient's
mobility and comfort of
the patient.
.
 Nursing Action Rationale

Check the
drainage tubing is This facilitates
not kinked and that drainage of urine
movement of side and prevents the
rail does not backflow of urine.
interfere with
catheter or drainage
bag.
 Nursing Action Rationale

- Remove catheter This causes less

smoothly and slowly discomfort to patient.
if a straight
catheterization was
ordered.
If catheter is to be indwelling:
 Nursing Action Rationale

- Inflate balloon The balloon anchors

according to the catheter in place
manufacturer's in the bladder. Sterile
water is used to
recommendations. inflate the balloon as
a precaution in case
the balloon ruptures.
 Nursing Action Rationale

- Tug gently on Improper inflation can

catheter after balloon cause patient
is inflated to feel discomfort and
resistance. malpositioning of
catheter.
 Nursing Action Rationale

- Attach catheter to Closed drainage

drainage system if system minimizes the
necessary. risk for
microorganisms
being introduced into
the bladder.
 Nursing Action Rationale

- Secure to upper thigh Proper attachment

with tape. Leave prevents trauma to
some slack in the urethra and
catheter for leg meatus from tension
movement. on the tubing.
Whether to take the
drainage tubing over
or under the leg
depends on gravity
flow, patient's
mobility, and comfort
of the patient.
 Nursing Action Rationale

- Check that drainage This facilitates

tubing is not kinked drainage of urine and
and that movement of prevents the backflow
side rails does not of urine.
interfere with catheter
or drainage bag.
 Nursing Action Rationale

17.Remove equipment
and make patient
comfortable in bed.
Send urine
specimen to
laboratory promptly.
 Nursing Action Rationale

18. Perform perineal Perineal care is

care. done to remove
antiseptic solution,
which may cause
skin irritation.
 Nursing Action Rationale

19.Remove gloves from Contaminated area

inside out. Perform does not come in
hand hygiene. contact with hands or
wrist. Hand hygiene
defers spread of
microorganisms.
 Nursing Action Rationale
20.Record time of A careful record is
catheterization, size of important for planning
catheter and balloon, the patient's care.
amount of urine
removed urine
appearance, whether a
specimen was sent, and
the patient's reaction in
the medical record; also
document urine amount
on intake/output flow
sheet.
 Unexpected Situations and Associated
Interventions

> Urine flow initially contains a large

amount of sediment, and then suddenly
stops; bladder remains palpable: Urinary
catheter may be plugged with sediment.
After obtaining a physician's order, gently
irrigate the catheter.
 Unexpected Situations and Associated
Interventions

> After balloon is inflated, patient voids

large amount. Check to make sure that
required amount of solution has been
injected into the balloon. Do not over inflate
balloon. Leaking around a catheter is a
common occurrence when initially inserting
catheter owing to a large amount of urine
pressure. If this continues to happen, a
larger catheter may need to be inserted.
 Unexpected Situations and Associated
Interventions

> Patient complains of extreme pain when

nurse is inflating balloon: Stop inflation of
balloon. Balloon is most likely still in urethra.
Allow solution in a balloon to withdraw.
Insert catheter an additional 1.3 to 2.5 cm
and slowly attempt to inflate balloon again.
 Special Considerations
> If there is no immediate flow of urine
after the catheter has been inserted,
several measures may prove helpful:

- Have the patient take a deep breath, which

helps to relax the perineal and abdominal
muscles.
- Rotate the catheter slightly, because a
drainage hole may be resting against the
bladder wall.

- Raise the head of the patients bed to

increase pressure in the bladder area.

- Some catheter kits do not contain the

catheter. This allows you to select a catheter
and balloon size separately.
CATHETERIZING THE MALE
URINARY BLADDER
Catheter insertion for a male patient is
performed for the same reason as for a
female. Although the skill is similar, it is
important to keep in mind the anatomic
difference in the male and female
urethra.
 Equipment
> sterile catheter kit that contains:
- sterile gloves
- sterile drapes (one of which is fenestrated)
- sterile catheter
- antiseptic solution
- lubricant
 Equipment
- cotton balls or gauze squares
- forceps
- pre-filled syringe
- basin
- specimen container
 Equipment

> flash light or lamp

> waterproof disposable pad
> disposable urine collection bag and
drainage tubings
> disposable gloves
 Assessment

> Assess bladder fullness before procedure

> Ask patient about allergies, especially to

latex and iodine.
 Assessment
> Ask patient if he has ever been catheterized.
If he had indwelling catheter previously, ask
why and how long it was used. The patient
may have urethral strictures, which may
take catheter insertion more difficult. If the
patient is 50 or older, ask if he has had any
prostate problems. Prostate enlargement
typically is noted around the age of 50
years.
Implementation with Rationale
 Nursing Action Rationale

Follow actions 1
through 3 for female
catheterization.
 Nursing Action Rationale

4. Position patient on This prevents

his back with his unnecessary
thighs slightly apart. exposure.
Drape patient so that
only the area around
the penis is exposed.
 Nursing Action Rationale

Clean the penile area.

Follow action 5 to 7
for female
catheterization.
 Nursing Action Rationale

8. Put on sterile This maintains a

gloves. Open sterile sterile working area.
drape and place on
patient's thighs.
Place fenestrated
drape with opening
over penis.
 Nursing Action Rationale

Sterile set up be
9. Place catheter set arranged so that
on or next to nurse's back is not
patient's leg on turned to it, nor
sterile drape. should it be out of
nurse's range of
vision.
Open all supplies.
 Nursing Action Rationale
- If catheter is to be A balloon that does not
indwelling, test catheter inflate or that leaks
balloon. Remove must be replaced
protective cap on tip of before insertion.
syringe and attach
syringe, pre-filled with
sterile water to injection
port. Inject appropriate
amount of fluid. If
balloon inflates
properly, withdraw fluid
and leave syringe
attached to port.
 Nursing Action Rationale

- Fluff cotton balls It is necessary to

before pouring open all supplies
antiseptic solution and prepares for the
over the cotton balls procedure while
or gauze. Open both hands are
specimen container sterile.
if specimen is to be
obtained.
 Nursing Action

- Remove cap from

syringe pre-filled
with lubricant
 Nursing Action Rationale

10. Lift penis with non- The hand touching the

dominant hand, which penis becomes
is considered contaminated. Cleaning
contaminated. Retract the area around the
foreskin in meatus and under the
uncircumcised patient. foreskin in the
cleansings. uncircumcised patient
helps prevent infection.
 Nursing Action Rationale
11. Hold penis with slight The lubricant causes
upward tension and the urethra to distend
perpendicular to the slightly and facilitates
patient's body. Gently passages of the
insert tip of syringe with catheter without
lubricant into the traumatizing the lining
urethra and instill 10 ml of the urethra.
of lubricant. If kit does
not have pre-filled
syringe, lubricate
catheter tip.
 Nursing Action Rationale
12. With dominant hand, This facilitates drainage
place drainage end of of urine and minimizes
catheter in receptacle. risk of contamination of
For insertion of an sterile equipment.
indwelling catheter that
is pre-attached to
sterile tubing and a
drainage container,
position catheter and
set up with easy reach
on sterile field. Ensure
that clamp on drainage
bag is closed.
 Nursing Action Rationale

13. Ask patient to bear Bearing down eases

down as if voiding. the passage of the
Insert tip into meatus. catheter through the
Advance catheter 5 to urethra. The male
20 cm ( 6” to 8”) or until urethra is about 20 cm.
urine flows. Do not use Long. Having the
force to introduce patient take deep
catheter. If catheter breaths or twisting the
resists entry, ask catheter slightly may
patient to breathe ease the catheter past
deeply and rotate resistance at the
catheter slightly. sphincters.
 Nursing Action Rationale

15. For an indwelling Advancing an

catheter , once urine indwelling catheter to
drains, advance the bifurcation ensures
catheter to bifurcation its placement in the
of catheter. Once bladder and facilitates
balloon is inflated, inflation of the balloon
catheter may be gently without damaging the
pulled back into place. urethra.
Replace foreskin over
catheter. Lower penis.
 Nursing Action Rationale
Follow actions 16 to 20 This done to prevent
for female irritation at the angle of
catheterization, except the penis and scrotum.
that the catheter may Slack left in the
be secured to the catheter allows for
upper thigh or lower penile erection, which
abdomen with the can occur naturally
penis directed toward during sleep.
patient's chest. Leave
enough slack in the
catheter to prevent
tension.
 Nursing Action Rationale
21. Remove gloves from Contaminated area
inside out. Perform does not come in
hand hygiene. contact with hands or
wrists. Hand hygiene
deters the spread of
microorganisms.
 Nursing Action Rationale

22. Record time of A careful record is

catheterization, catheter important for planning
and balloon size, the patient's care.
amount of urine
removed, urine
appearance, whether a
specimen was sent, and
patient's reaction to the
procedure in the medical
record. Also document
urine amount on the
intake/output flow sheet.
 Unexpected Situations and Associated
Interventions

> Patient complaints of intense pain when nurse

begins to inflate balloon. Stop inflation. Be sure
to insert catheter all the way into the bifurcation.
The balloon is probably still in the urethra.
Damage to the urethra can result if balloon is
inflated in the urethra.
Unexpected Situations and Associated
Interventions
> Nurse cannot insert catheter past 3” to 4”;
rotating the catheter and having patient breath
deeply are of no help. If still unable to place
catheter, notify physician. Repeated catheter
placement attempts can traumatize the urethra.
 Special Considerations

> If resistance is met while inserting catheter and

rotating does not help, do not use force.
Enlargement of the prostate gland is commonly
seen in men over age 50. A special crooked
tipped catheter called a COUDE catheter may be
required to maneuver past the prostate.
 Unexpected Situations and Associated
Interventions
> Patient is obese and had retracted penis. Have
assistant available to hold patient's penis up
and back. The catheter still needs to be inserted
to the bifurcation; the length of the urethra has not
changed.
Thank you and study well!!!