Catheterizing the Male 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 chart for any limitations in physical activity. Confirm the medical order for indwelling catheter insertion.

2. Bring 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 patient’s ability to assist with the procedure. Ask the patient if he 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. Position the patient on his back with thighs slightly apart. Drape the patient so that only the area around the penis is exposed. Slide waterproof pad under patient.

9. Put on clean gloves. Clean the genital area with washcloth, skin cleanser, and warm water. Clean the tip of the penis first, moving the washcloth in a circular motion from the meatus outward. Wash the shaft of the penis using downward strokes toward the pubic area. 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. Open sterile drape and place on patient’s thighs. Place fenestrated drape with opening over penis.

13. Place catheter set on or next to patient’s legs on sterile drape.

14. 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. Remove cap from syringe prefilled with lubricant.

15. Place drainage end of 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.

16. Lift penis with nondominant hand. Retract foreskin in uncircumcised patient. Be prepared to keep this hand in this position until catheter is inserted and urine is flowing well and continuously. Using the dominant hand and the forceps, pick up a cotton ball or antiseptic swab. Using a circular motion, clean the penis, moving from the meatus down the glans of the penis. Repeat this cleansing motion two more times, using a new cotton ball/swab each time. Discard each cotton ball/swab after one use.

17. Hold penis with slight upward tension and perpendicular to patient’s body. Use the dominant hand to pick up the lubricant syringe. Gently insert tip of syringe with lubricant into urethra and instill the 10 mL of lubricant (Society of Urologic Nurses and Associates, 2005c).

18. Use the dominant hand to pick up the catheter and hold it an inch or two from the tip. Ask the patient to bear down as if voiding. Insert catheter tip into meatus. Ask the patient to take deep breaths. Advance the catheter to the bifurcation or “Y” level of the ports. Do not use force to introduce the catheter. If the catheter resists entry, ask patient to breathe deeply and rotate catheter slightly.

19. Hold the catheter securely at the meatus with your nondominant hand. Use your dominant hand to inflate the catheter balloon. Inject the entire volume of sterile water supplied in the prefilled syringe. Once the balloon is inflated, the catheter may be gently pulled back into place. Replace foreskin over catheter. Lower penis.

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

21. Attach catheter to drainage system, if necessary.

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

23. Remove gloves. Secure catheter tubing to the patient’s inner thigh or lower abdomen (with the penis directed toward the patient’s chest) with Velcro leg strap or tape. Leave some slack in catheter for leg movement.

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

25. 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.

26. 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.

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