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 & 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 w/ sterile water in amount specified by catheter manufacturer
Collection bag & 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 & drape
a. Female: Supine w/ knees flexed, feet about 2 feet apart & 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.

6. If using a collecting bag & it is not contained within the catheterization kit open the drainage package & 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 is still available.

7. If agency policy permits, apply clean gloves & 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 w/ your hands.

9. Put on sterile gloves.

10. Organize the remaining supplies
- Saturate the cleansing balls w/ the antiseptic solution
- Open the lubricant package
- Remove the specimen container & place it nearby w/ the lid loosely on top.

11. Attach the prefilled syringe to the indwelling catheter inflation hub & 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) & place it w/ 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 w/ 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, w/ slight tension. – Lifting the penis in this manner helps straighten the urethra. Pick up a cleansing ball w/ the forceps in your dominant hand & wipe from the center of the meatus in a circular motion around the glans. Use a new ball & 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 & 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 & 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 & a new sterile catheter must be used. The 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 w/ 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 w/ the designated volume.
- Without releasing the catheter, hold the inflation valve between two fingers of your nondominant hand while you attach the syringe & inflate w/ your dominant hand. If the client complains of discomfort, immediately withdraw the instilled fluid, advance the catheter further & attempt to inflate the balloon again.

- Pull gently on the catheter until resistance is felt to insure that the balloon has inflated & 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 & bag.

20. Examine & 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 & 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 & thank for the cooperation.

23. Discard all used supplies in appropriate receptacles & wash hands.

24. Document the catheterization procedure including catheter size & results in the client record using forms or check list supplemented by narrative noted when appropriate.