Equipment
■ Washcloth and towel; soap and water.
■ At least 2 pairs of procedure gloves.
■ Bath blanket.
■ Procedure lamp or flashlight.
■ 2% lidocaine gel (according to agency policy and patient need).
■ Catheter insertion kit containing sterile gloves, antiseptic cleansing agent, forceps, cotton balls, sterile waterproof drapes, sterile lubricant, double-lumen or triple-lumen catheter with a balloon tip for inflation instead of a single-lumen rubber catheter.
■ Syringe prefilled with sterile water.
■ Tube holder, tape, or leg strap.
■ Urine collection bag with drainage tubing attached (the tubing may also be attached to the catheter).
Assessment
■ Assess the cognitive level to determine whether the patient will be able to follow instructions.
■ Assess:
■ Conditions that may impair the patient’s ability to assume the necessary position.
■ For signs and symptoms of bladder infection (e.g., elevated temperature, urinary frequency, dysuria).
■ Degree of bladder distention (to establish a baseline).
■ General size of the urinary meatus.
■ Determine time of last voiding or last catheterization; allergy to iodine (if that is the antiseptic solution in the kit); and allergy to latex.
■ Be Safe! Note conditions (e.g., enlarged prostate in men) that may make it difficult to pass the catheter.
■ Be Smart! Assess the need for extra lighting.
Post-Procedure Reassessment
■ Note:
■ Any difficulty with catheter insertion.
■ Characteristics of the urine obtained (e.g., amount, color, odor, presence of sediment or mucus).
■ Any bladder distention.
■ Be Smart! Some facilities have a bladder-scanning device that will allow you to determine whether residual urine remains.
■ Monitor to see that drainage is not obstructed and that the drainage bag is below the level of the bladder.
Key Points
■ Be Smart! Allow adequate time for this procedure: Experienced nurses need at least 15 minutes. You will need more time if problems arise—and even more time if you are a novice.
■ Be Smart! Take an extra pair of sterile gloves and an extra sterile catheter.
■ Be sure to have good lighting.
■ Work on the right side of the bed if you are right-handed; and on the left side if you are left-handed.
■ Drape the patient for privacy.
■ Perform perineal care before the procedure.
■ Don sterile gloves and maintain sterile technique while manipulating the supplies in the kit and performing the procedure.
■ Be Safe! Use a different solution for cleansing the perineum if the patient is allergic to iodine.
■ Be Safe! For indwelling catheterization, pretesting the balloon by inflating it before insertion is not necessary, especially with silicone catheters, because the practice can cause the balloon to form cuffs. Cuffing can cause harm to the patient’s urethra.
■ Lubricate the catheter tip before insertion.
■ Insert the catheter 5 to 7.5 cm (2 to 3 in.) for women, 17 to 22.5 cm (7 to 9 in.) for men, until urine flows use the smallest size catheter possible.
■ Be Smart! Once you have touched the patient’s perineum with your nondominant hand, do not remove that hand from the patient.
■ Drain the bladder; collect needed samples; measure urine; and connect the drainage bag.
Documentation
■ Record:
■ Time and date of the procedure.
■ Size of catheter used.
■ Amount of urine obtained (on the I&O portion of the graphics sheet).
■ Color of urine.
■ Odor, presence of mucus and blood (in the nursing notes).
■ Patient’s subjective statements.
■ Time a specimen was collected and sent to the lab.
■ Some facilities require that you record the amount of saline used to inflate the balloon.
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| Draping a patient for privacy |
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| Cleansing the urinary meatus, through a fenestrated drape |
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| Inserting the urinary catheter |
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