Catheterization

CATHETERIZATIO
N
NCM 109- Skills Lab
Straight Catheter- (drain and secure
specimen)
Foleycatheter – indwelling, I&O

monitoring
Three way catheter – Cystoclysis/Bladder irrigation

Catheter Size
◦ Urinary catheters exist in varying forms and sizes.
◦ The unit of measurement is the French.
◦ One French equals 1/3 of 1 mm.
◦ The sizes can vary from 6 Fr (very small, pediatrics) to 48 (extremely
large) Fr in size.
◦ The most common sizes are 14-18 Fr and 20-24 Fr for hematuric
catheters.
◦ The higher the number the larger the diameter of the

catheter.
Inserting an Indwelling Catheter
◦
◦ Purposes:
• To drain urine from the bladder
• To obtain urine specimen
• To relieve bladder distention
Equipments:
• Sterile drainage tubing and

bag
• Device to secure catheter
• extra sterile gloves and
catheter (optional)
• Bath blanket
• Waterproof absorbent pad
Equipments:
• Clean gloves, basin with warm
water, soap or perineal
cleanser, washcloth and towel
for perineal care
• Additional lighting as needed
• Measuring container for urine
• Bladder scanner (if available
◦ Catheter kit containing the following:
• Straight/ intermittent catheterization kit

• Single lumen catheter (Commonly 12-14fr)
• Drapes ( one fenestrated-has an opening in the center)
• Sterile gloves
• Lubricant
• Cleansing solution incorporated in an applicator
or to be added to cotton balls( forceps to pick up
cotton balls)
• Specimen container
Implementation: Inserting a straight (intermittent) or indwelling catheter
1.Checked patients plan of care for size and type of catheter, use
smallest size if possible
2.Assemble equipment and supplies
B. Performance
1. Introduce self and verify clients’ identity. Explain procedure
◦ To ensure correctness of procedure to the right client and to gain
his cooperation.
2. perform hand hygiene
◦ Reduces transmission of microorganism
3. provide privacy by closing room door and bedside curtain
◦ Protects patient confidentiality
4. Raise bed to appropriate working height. If side rails in use, raise side
rails on opposite side of bed and lower side rails on working side
• Promotes good body mechanics. Use of side rails in this manner
promotes patient’s safety
5. Place waterproof pads under patient
 Prevents soiling of bed linen
6. Provide perineal hygiene if needed(apply clean gloves, complete
cleansing, discard gloves and perform hand hygiene)
 Hygiene before catheter insertion removes secretions, urine and
feces that could contaminate the sterile field and increase risk for
catheter associated UTI
7. Position and drape patient
◦ FEMALE PATIENT
• Help to dorsal recumbent position (supine with knees flexed) ask patient to relax thighs to
externally rotate hip joints
◦ Provides good visualization of structures of perineum and decreases risk for fecal
contamination
• Alternate female position: side lying (sims) position with upper leg flexed at knee and hip.
Ensure that the rectal area is covered with pillows if necessary, to maintain position
◦ Alternate position is more comfortable if patient cannot abduct leg at hip joint
◦ Male patient
• Position supine with legs extended and thighs slightly abducted
8. Position light to illuminate genitals or have assistant available to hold light source to visualize
urinary meatus
• Adequate visualization of urinary meatus helps with speed and accuracy of catheter
insertion
9. Perform hand hygiene
10. Open catherization kit. Placed opened kit on clean bedside table or if possible between
patients open legs. patient size and positioning will dictate exact placement.
• Provides easy access to supplies during catheter insertion
11. If present open inner sterile wrap covering box using sterile technique
◦ straight/ intermittent catheterization- all needed supplies are in sterile tray. Tray that can be used
for urine collection
• Inner sterile wrap serves as sterile field. Straight catherization trays do not routinely
come with double wrapping
B. Indwelling Catheterization open system: open separate package containing drainage bag,
check to make sure that clamp on drainage port is closed, and placed drainage bag and tubing
easily accessible. Open outer package of sterile catheter, maintaining sterility of inner wrapper.
• An open drainage bag system requires separate sterile packaging for sterile catheter,
drainage bag, and tubing and insertion kit.
◦ Indwelling catheterization closed system: all supplies are in sterile tray. Once sterile gloves
are put on, check to make sure clamp on drainage bag is closed.
• Closed drainage bag system have catheter preattached to drainage tubing and bag.
12. Apply sterile gloves. Drape perineum, keeping gloves and working surface of drape sterile.
 Sterile drapes provide sterile field over which nurse work during catheterization.
13. Arrange supplies on sterile field, maintaining sterility of gloves. Place sterile tray with cleaning
medium (pre moistened swab sticks or cotton balls, forceps, and solution) lubricant, catheter and
prefilled balloon inflation syringe on sterile drapes.
• Provide easy access to supplies during catheter insertion and helps to maintain aseptic
technique. Appropriate placement is determined by size of patient and position during
catheterization.
14. Cleanse urethral meatus.
◦ Female patient
 Gently separate labia with fingers of non-dominant hand (now contaminated) to fully expose urinary
meatus.
◦
◦ Optimal visualization of urethral meatus is possible. Closure of labia during cleansing means that
area is now contaminated and requires cleaning procedure to be repeated
◦
 Maintain position of nondominant hand throughout remainder of procedure.
 Use forceps to hold one cotton ball or hold one swab stick at a time. Clean labia and urinary meatus from
clitoris toward anus. Use new cotton ball or swab for each area you cleanse. Cleanse by wiping far labial
fold, near labial foal, and directly over center of urethral meatus
 Front-to-back cleansing is cleaning from area of contamination toward highly contaminated area.
15. Inserted catheter, explained to patient that feeling for burning or pressure is normal and will go
away:
• Asked patient to bear down, inserted catheter slowly through urethral meatus
◦ Bearing down may help visualize urinary meatus and promotes relaxation of external
urinary sphincter, aiding in catheter insertion
• Advanced catheter appropriately or until urine flows out end
◦ Urine flow indicates that catheter tip is in bladder
• Released labia, held catheter securely with nondominant hand.
◦ prevents accidental dislodgement of catheter
16. Allowed bladder to empty fully unless volume was restricted.
◦ There is no definitive evidence regarding whether there is benefit in limiting maximal
volume drained.
17. Collect urine as needed.
◦ Sterile specimen can be obtained.
18. If straight catheter, withdraw slowly until removed.
19. Inflate catheter balloon with designated amount of fluid.
 Continued to hold catheter with non-dominant hand
Prevents accidental removal
 Connected prefilled syringe to injection port with free dominant hand.
◦ Balloon should not be overinflated
 Inject total amount of solution.
 Release catheter after inflating balloon pulled catheter until resistance felt
◦ Ensure proper drainage by gravity
 Connect drainage tubing to catheter if not preconnected.
20. Secure indwelling catheter with securement device.
◦ Securing reduces risk of trauma, urethral erosion, CAUTI and accidental removal
21. Ensured there was no obstruction to urine flow, coiled excess tubing on bed, fastened to
bottom sheet with securement device.
◦ Obstruction prevents free flow of urine and increase risk for CAUTI.
22. Provided hygiene as needed, assisted patient to comfortable position.
23. Disposed of supplies in appropriate receptacles.
◦ Reduces transmission of microorganisms.
24. Measured urine and recorded the amount.
25. Removed gloves, performed hand hygiene
◦ EVALUATION
1. Palpated bladder for distension or used bladder scan.
◦ Determines if distension is relieved
2. Asked patient to describe level of discomfort.
◦ Determines if patient’s sensation of discomfort or bladder fullness has been relieved.
3. Observe character and amount of urine in age system for indwelling catheter.
◦ Determines if urine is flowing adequately.
4. Ensured there was no urine leaking from catheter or tubing connections for indwelling catheter.
◦ Prevents injury to patient’s skin and ensures closed sterile system.
◦ EVALUATION
5. Asked patient to describe how to keep urine flowing out of catheter.
6. Identified unexpected outcomes.
Title Lorem Ipsum
LOREM IPSUM DOLOR SIT AMET, NUNC VIVERRA IMPERDIET PELLENTESQUE HABITANT
CONSECTETUER ADIPISCING ENIM. FUSCE EST. VIVAMUS A MORBI TRISTIQUE SENECTUS ET
ELIT. TELLUS. NETUS.

Catheterization

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CATHETERIZATIO

Foleycatheter – indwelling, I&O

Three way catheter – Cystoclysis/Bladder irrigation

◦ The higher the number the larger the diameter of the

• Sterile drainage tubing and

• Straight/ intermittent catheterization kit

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