Procedure:
1. Confirm the physicians order to remove. Assume handwashing & prepare the equipment needed such as receptacle for the catheter, clean disposable towel, clean gloves & sterile syringe to deflate the balloon, a large one.
2. Prepare the client. Explain the procedure & assist to a supine position. Optimal: Obtain a sterile specimen before removing the catheter. Check agency protocol.
3. Remove the tape or catheter securing device attaching the catheter to the client, put on gloves & then place the towel between the legs of the female client or over the thighs of the male.
4. Insert the syringe into the injection port of the catheter & withdraw the fluid from the balloon. If not all of the fluid can be removed report this fact to the nurse incharge before proceeding.
5. Do not pull the catheter while the balloon is inflated; doing so may injure the urethra.
6. After all of the fluid is withdrawn from the balloon, gently withdraw the catheter & place it in the waster receptacle.
7. Dry the perineal area w/ a towel.
8. Remove gloves.
9. Measure the urine in the drainage bag & record the removal of the catheter
- Time the catheter was removed
- Amount, color & clarity of the urine
- Intactness of the catheter
- Instructions given to the client
10. Provide the client w/ either a urinal (M) bedpan, commode or toilet collection device to be used w/ each subsequent unassisted void.
11. Following removal of the catheter, determine the time of the first voiding & the amount voided during the first 8 hours. Compare this output to the client intake.
12. Observe for dysfunctional voiding behaviors which might indicate urinary retention. If this occurs, perform an assessment of post void residuals using a bladder scanner if available. Generally postvoid residuals greater than 200 cc will require straight catheterization as needed.
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