Definition
Performing urinary catheterization is a fundamental nursing procedure used to drain the bladder when a patient is unable to void naturally. It requires strict aseptic technique to prevent infection and ensure patient safety.
Types
- Intermittent catheterization: Insertion and removal of a catheter in patients who require short-term based management of urinary bladder.
- Indwelling catheterization: Insertion of catheter into bladder to provide continuous urinary drainage.
Intermittent Catheterization
Purposes
- To relieve bladder distention.
- To assess for residual urine after voiding.
- To obtain a sterile specimen.
- To empty bladder prior to delivery or abdominal surgery.
Indwelling Catheterization
Purposes
- To facilitate urinary elimination in incontinent patients.
- To facilitate continuous bladder drainage after injury/surgery on urinary tract or other major surgeries.
- To splint urethra to promote healing after urological surgery.
- To relieve acute or chronic urinary retention.
- To prevent urine from contacting an incision after perineal surgery.
Articles
A clean tray containing:
- Flashlight/drop light.
- Sponge holding forceps.
- Disposable gloves.
- Kidney tray.
- Antiseptic solution.
- Sterile saline.
- Adhesive tape and scissors (in case of retention catheter).
- Specimen container.
- Water soluble lubricant.
- Mackintosh.
- Bowl with warm water.
- Bowl with soapy water (for convenience) or soap in a soap dish.
- Paper bag or appropriate disposal bag as per hospital policy to dispose soiled pads, and swabs.
- Bedpan (to be placed below the bed).
Perineal care tray:
A sterile tray containing:
- A small bowl containing cotton swabs.
- A bowl containing gauze pieces.
- Artery forceps.
- Thumb forceps.
- Kidney tray.
A sterile tray with:
- Sterile gloves.
- Sterile drape/fenestrated towel.
- Small bowl.
- Cotton swabs.
- Catheter (indwelling/straight of appropriate size)
- Kidney tray.
- Artery forceps.
- Dissecting forceps.
- Sterile syringe (20 mL) and distilled water (in case of retention catheter).
Procedure
| Nursing Actions | Rationale | |
| 1. | Before procedure Review physician’s order and nursing care plan. | Helps in identifying the reason for catheterization. |
| 2. | Identify and assess the patient for time of last voiding, level of awareness mobility, physical limitation, and pathological condition, e.g. prostate enlargement, bladder distention, etc. | Proper assessment helps in identifying patient’s ability to cooperate during procedure and any possible obstruction in passing catheter. |
| 3. | Explain the procedure to the patient by emphasizing how he/she has to cooperate. | Reduces anxiety and promotes cooperation which ensures smooth insertion of the catheter. |
| 4. | Arrange for help if needed for maintaining position of patient. | Promotes safety and proper body mechanics. |
| 5. | Provide privacy. | Reduces embarrassment to patient. |
| 6. | During procedure Wash hands and don the clean pair of gloves. | Reduces risk of transmission of microorganisms. |
| 7. | Raise bed to appropriate working level. Stand on right side of patient and shift patient closer to you. | Promotes use of correct body mechanics. |
| 8. | Position of patient: Female: Dorsal recumbent with knees flexed, and thighs externally rotated. Male: Supine position with thighs slightly abducted. | Provides good view of perineal structures. Prevents tension of abdominal and pelvic muscles. |
| 9. | Wash perineal area/genitalia with soap and water. Steps of need-based perineal care: Place mackintosh under the patient’s buttocks. Open the perineal care tray. With the help of artery and thumb forceps, pick a cotton swab and wet it by dipping in the bowl of plain water and clean the perineum followed by cleaning with soapy swab and again with wet swab. Clean the perineum from the outside to inside (labia majora-labia minora-urinary meatus and vagina towards anus) in single downward stroke each time. | Cleaning reduces the number of microorganisms around urinary meatus and possibility of introducing microorganisms with the catheter. To prevent spillage and spread of microorganism. Cleaning from most clean to least clean areas ensure prevention of cross contamination. |
| 10. | Dispose the soiled swabs. Remove the gloves and dispose. | To prevent spread of infection and contamination. |
| 11. | Adjust spotlight/flashlight to view urinary meatus clearly. | |
| 12. | Open the sterile tray (without touching inside of the sterile tray using sponge holding forceps), pour antiseptic solution into bowl, open outer cover of catheter and place in tray if prepackaged. | Keeping all articles ready for use helps in saving time and prevents chance of contamination. |
| 13. | Open lubricant, squeeze and discard first drop and after that, drop some on a sterile gauze in the tray. | First drop of lubricant may be contaminated. |
| 14. | Don sterile gloves. | Helps in preventing spread of microorganisms. |
| 15. | Drape perineal area, using fenestrated towel. | |
| 16. | Place sterile tray on drape between patient’s thighs. | Provides easy access to supplies. |
| 17. | If doing retention catheterization, fill the syringe with sterile water, if not already prefilled and test balloon of catheter by inflating it. Deflate it and keep catheter aside with syringe attached to it. | Provides easy access to supplies, checking balloon helps in identifying leaks in the balloon. |
| 18. | Open sterile specimen bottle and sterile urine receiver ready for use in the sterile tray. | |
| 19. | Lubricate tip of catheter liberally and place it in the sterile tray ready for use. | Lubrication aids in easy insertion of catheter by reducing friction. |
| 20. | Clean meatus with antiseptic solution if recommended by agency. Female: With nondominant hand, carefully retract labia fully and expose urethral meatus. Maintain the position of hand throughout the procedure. Using dominant hand, take sterile cotton swabs dipped in antiseptic solution and clean perineal area from clitoris towards anus in the following sequence–meatus, labia minora and then labia majora. Use one swab for each wipe. Repeat cleaning with cotton swabs dipped in sterile normal saline in same sequence. Male: Grasp penis firmly below the glans with nondominant hand. Retract the foreskin and hold it retracted till the end of procedure. With dominant hand, use sterile swabs dipped in antiseptic solution to clean meatus and moving out in circular motion. Use one swab for each wipe. Repeat the cleaning using sterile saline in same sequence. | Labia coming over meatus before catheter is in situ will cause contamination. Removes disinfectant which can be irritating to the skin and mucous membrane. Foreskin coming back into position before catheter is in situ will cause contamination. Disinfectant can be irritating to skin and mucous membrane. |
| 21. | Insert catheter for 15-25 cm in male patients and 2.5-5 cm in female, until urine begins to flow, do not force catheter. If met with resistance, twist catheter and wait for some time to allow sphincter to relax. Encourage patients to take deep breaths while inserting. | Male urethra is very narrow and flexing catheter can traumatize the sphincter and urethra. Deep breathing can aid in muscle relaxation. |
| 22. | Collect all urine in the sterile kidney tray. If needed, collect urine specimen in the specimen container. | Collecting urine helps in assessing the volume of urine drained. |
| 23. | Remove catheter if intermittent catheterization is done. | |
| 24. | If retention, catheterization is performed, introduce sterile distilled water to inflate balloon. | Inflated balloon helps in retaining catheter inside the bladder. |
| 25. | Pull catheter outward lightly to ascertain stability. | |
| 26. | Connect catheter to urosac tied to bed below level of bladder. | Urosac above level of bladder will lead to back flow of urine causes risk of infection. |
| 27. | Fix catheter to thigh using adhesive tapes. Ensure adequate length to avoid traction. | Traction on catheter can lead to injury to urinary meatus. |
| 28. | Clean and replace equipment and remove gloves. | Keeps equipment ready for next use. |
| 29. | Wash hands. | Reduces risk of transmission of microorganisms. |
| 30. | Record procedure and observation in patient’s chart. | Promotes communication between staff members. |
Special Considerations
- Avoid over inflation of balloon which can lead to leak or rupture of balloon membrane.
- Catheter should not be forced, to avoid trauma.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
Stories are the threads that bind us; through them, we understand each other, grow, and heal.
JOHN NOORD
Connect with “Nurses Lab Editorial Team”
I hope you found this information helpful. Do you have any questions or comments? Kindly write in comments section. Subscribe the Blog with your email so you can stay updated on upcoming events and the latest articles.
