Catheterizing the Female Urinary Bladder

Goal: The patient’s urinary elimination is maintained, with a urine output of at least 30 mL/hour, and the patient’s bladder is not distended.

1. Review the patient’s chart for any limitations in physical activity. Confirm the medical order for indwelling catheter insertion.

2. Bring the catheter kit and other necessary equipment to the bedside. Obtain assistance from another staff member, if necessary.

3. Perform hand hygiene and put on PPE, if indicated.

4. Identify the patient.

5. Close curtains around bed and close the door to the room, if possible. Discuss the procedure with the patient and assess the patient’s ability to assist with the procedure. Ask the patient if she has any allergies, especially to latex or iodine.

6. Provide good lighting. Artificial light is recommended (use of a flashlight requires an assistant to hold and position it). Place a trash receptacle within easy reach.

7. Adjust the bed to a comfortable working height, usually elbow height of the caregiver (VISN 8 Patient Safety Center, 2009). Stand on the patient’s right side if you are righthanded, patient’s left side if you are left-handed.

8. Assist the patient to a dorsal recumbent position with knees flexed, feet about 2 feet apart, with her legs abducted. Drape patient. Alternately, the Sims’, or lateral, position can be used. Place the patient’s buttocks near the edge of the bed with her shoulders at the opposite edge and her knees drawn toward her chest. Allow the patient to lie on either side, depending on which position is easiest for the nurse and best for the patient’s comfort. Slide waterproof pad under patient.

9. Put on clean gloves. Clean the perineal area with washcloth, skin cleanser, and warm water, using a different corner of the washcloth with each stroke. Wipe from above orifice downward toward sacrum (front to back). Rinse and dry. Remove gloves. Perform hand hygiene again.

10. Prepare urine drainage setup if a separate urine collection system is to be used. Secure to bed frame according to manufacturer’s directions.

11. Open sterile catheterization tray on a clean overbed table using sterile technique.

12. Put on sterile gloves. Grasp upper corners of drape and unfold drape without touching unsterile areas. Fold back a corner on each 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.

13. Based on facility policy, position the fenestrated sterile drape. Place a fenestrated sterile drape over the perineal area, exposing the labia.

14. Place sterile tray on drape between patient’s thighs.

15. Open all the supplies. Fluff cotton balls in tray before pouring antiseptic solution over them. Alternately, open package of antiseptic swabs. Open specimen container if specimen is to be obtained.

16. Lubricate 1 to 2 inches of catheter tip.

17. With thumb and one finger of nondominant hand, spread labia and identify meatus. Be prepared to maintain separation of labia with one hand until catheter is inserted and urine is flowing well and continuously. If the patient is in the side-lying position, lift the upper buttock and labia to expose the urinary meatus.

18. Use the dominant hand to pick up a cotton ball or antiseptic swab. Clean one labial fold, top to bottom (from above the meatus down toward the rectum), then discard the cotton ball. Using a new cotton ball/swab for each stroke, continue to clean the other labial fold, then directly over the meatus.

19. With your uncontaminated, dominant hand, place the drainage end of the catheter in receptacle. If the catheter is preattached to sterile tubing and drainage container (closed drainage system), position catheter and setup within easy reach on sterile field. Ensure that clamp on drainage bag is closed.

20. Using your dominant hand, hold the catheter 2 to 3 inches from the tip and insert slowly into the urethra. Advance the catheter until there is a return of urine (approximately 2 to 3 inches [4.8 to 7.2 cm]). Once urine drains, advance catheter another 2 to 3 inches (4.8 to 7.2 cm). Do not force catheter through urethra into bladder. Ask patient to breathe deeply, and rotate catheter gently if slight resistance is met as catheter reaches external sphincter.

21. Hold the catheter securely at the meatus with your nondominant hand. Use your dominant hand to inflate the catheter balloon. Inject entire volume of sterile water supplied in prefilled syringe.

22. Pull gently on catheter after balloon is inflated to feel resistance.

23. Attach catheter to drainage system if not already preattached.

24. Remove equipment and dispose of it according to facility policy. Discard syringe in sharps container. Wash and dry the perineal area, as needed.

25. Remove gloves. Secure catheter tubing to the patient’s inner thigh with Velcro leg strap or tape. Leave some slack in catheter for leg movement.

26. Assist the patient to a comfortable position. Cover the patient with bed linens. Place the bed in the lowest position.

27. Secure drainage bag below the level of the bladder. Check that drainage tubing is not kinked and that movement of side rails does not interfere with catheter or drainage bag.

28. Put on clean gloves. Obtain urine specimen immediately, if needed, from drainage bag. Label specimen. Send urine specimen to the laboratory promptly or refrigerate it.

29. Remove gloves and additional PPE, if used. Perform hand hygiene.