Saint Mary’s University

SCHOOL OF HEALTH and NATURALSCIENCES

Nursing Department
Bayombong, Nueva Vizcaya

Name of student: __________________________________ Year/Clinical Group: ______________________

PERFORMANCE EVALUATION TOOL FOR URINARY CATHETERIZATION

DIRECTIONS: Below is a list of criteria to evaluate the student’s skill in Urinary Catheterization.
Indicate your evaluation by placing the number of score on the appropriate column using the following
descriptive scale.

0- Not Done 1- Done Incorrectly 2- Done Correctly

Preparation Remarks
0 1 2
1. Assess:
 The client’s overall condition.
 If the client is able to cooperate and old still
during the procedure.
 If the client can be positioned supine, with head
relatively flat.
 When the client last voided o was last
catheterized.
 Percuss the bladder to check for fullness or
distension.
2. Determine:
 The most appropriate method of catheterization.
3. Assemble equipment and supplies:
 Sterile catheter of appropriate size. An extra
catheter should also be at and.
 Catheterization kit or individual sterile items:
 1-2 pairs of sterile gloves
 Waterproof drape(s)
 Antiseptic solution
 Cleansing balls
 Water-soluble lubricant
 Urine receptacle
 Specimen container
 For an indwelling catheter:
 Syringe prefilled wit sterile water in
amount specified by the catheter’s
manufacturer.
 Collection bag and tubing
 2% Xylocaine gel (if agency permits)
 Disposable clean gloves
 Supplies for performing perineal cleansing
 Bath blanket or sheet for draping the client
 Adequate lighting – obtain a flashlight or lamp,
if necessary.
4. Perform routine perineal care to cleanse the meatus
from gross contamination.
Procedure
1. Introduce yourself and verify client’s identity.
Explain to the client what you are going to do, why
it is necessary, and how the client can cooperate.
2. Perform hand hygiene, and observe other
appropriate infection control procedures.
3. Provide client privacy.
4. Place the client in the appropriate position, and drape all areas except the perineum.
 Female: supine, with knees flexed, feet about 2 feet
apart, and hips slightly externally rotated
Male: supine, legs slightly abducted.
5. Establish adequate lighting. Stand on the client’s
right if you are right-handed, on the client’s left if
you are left-handed.
6. If using a collecting bag not contained within the
catheterization kit, open the drainage package, and
place the end of the tubing within reach.
7. If agency policy permits, apply clean gloves and
inject 10-15 mL Xylocaine gel into the urethra of
the male client. Wipe the underside of the shaft to
distribute the gel up the urethra. Wait at least 5
minutes for the gel to take effect before inserting
the catheter. Remove gloves.
8. Open the catheterization kit. Place a waterproof
drape under the buttocks (female) or penis (male)
without contaminating the center of the drape
with your hands.
9. Apply sterile gloves.
10. Organize the remaining supplies:
Saturate the cleansing balls with the antiseptic
solution.
Open the lubricant package.
Remove the specimen container, and place it
nearby, with the lid loosely on top.
11. Attach the prefilled syringe to the indwelling
catheter inflation hub, and test the balloon.
12. Lubricate the catheter, and place it with the
drainage end inside the collection container.
13. If desired, place the fenestrated drape over the
perineum, exposing the urinary meatus.
14. Cleanse the meatus.
Note: The nondominant hand is considered contaminated once it touches the client’s skin.
Use your nondominant hand to spread the labia.
Establish a firm but gentle position.
Pick up a cleansing ball with the forceps in your
dominant and, and wipe one side of the labia
majora in an anteroposterior direction
Use a new ball for the opposite side
Repeat for the labia minora.
Use the last ball to cleanse directly over the
meatus.
Male
Use your nondominant hand to grasp the penis
just below the glans. If necessary, retract the
foreskin. Hold the penis firmly upright, with slight
tension.
Pick up cleansing ball with the forceps in your
dominant hand, and wipe from the center of the
meatus in a circular motion around the glans.
Use a new ball, and repeat tree more times.
15. Insert the catheter.
Grasp the catheter firmly 2-3 inches from the tip.
Ask the client to take a slow deep breath, and
insert the catheter as the client exhales.
Advance the catheter 2 inches further after the
urine begins to flow through it or per agency
policy.
If the catheter accidentally contacts the labia or
slips into the vagina, it is considered contaminated,
and a new, sterile catheter must be used. The
contaminated catheter may be left in the vagina
 until the new catheter is inserted to help avoid
mistaking the vaginal opening for the urethral
meatus.
16. Hold the catheter with the nondominant hand. In
males, lay the penis down onto the drape, being
careful that the catheter does not pull out.
17. For an indwelling catheter, inflate the retention balloon with the designated volume.
Without releasing the catheter, hold the inflation
valve between two fingers of your nondominant
and while you attach the syringe (if not left
attached earlier when testing the balloon), and
inflate with your dominant hand.
If the client complains of discomfort, immediately
withdraw the instilled fluid, advance the caterer
further, and attempt to inflate the balloon again.
Pull gently on the caterer until resistance is felt to
insure that the balloon has inflated and to place it
in the trigone of the bladder.
18. Collect the urine specimen, if needed. Allow 20-30
mL to flow into the bottle without touching the
caterer to the bottle.
19. Allow the straight catheter to continue draining. If
necessary, attach the drainage end of an indwelling
catheter to the collecting tubing and bag.
20. Examine and measure the urine. In some cases,
only 750-1,000mL of urine are to be drained from
the bladder at one time. Check agency policy.
21. Remove the straight catheter.
For an indwelling catheter, secure the catheter
tubing to the inner thigh for female clients, or the
upper thigh/abdomen for male clients, with
enough slack to allow usual movement.
Also secure the collecting tubing to the bed linens,
and hang the bag below the level of the bladder.
No tubing should fall below the top of the bag.
22. Wipe the perineal area of any remaining antiseptic
or lubricant. Replace foreskin, if retracted earlier.
Return the client to a comfortable position.
23. Discard all used supplies in appropriate receptacles,
and perform hand hygiene.
24. Document the catheterization procedure including
catheter size and results in the client record.
TOTAL AVERAGE:

Comments:________________________________________________________________________________
__________________________________________________________________________________________
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Clinical Instructor’s signature over printed name/ Date/Time:___________________________________