XAVIER UNIVERSITY – ATENEO DE CAGAYAN

COLLEGE OF NURSING

Corrales Ave, Cagayan de Oro, 9000 Misamis Oriental

In Partial Fulfillment of the Requirements in

NCM 101.3 RLE

“Enhancement on Male and Female Urinary Catheterization”

Submitted by

Mariann Jean Andrea C. Matalines

BSN 3 NB

Submitted to

Mrs. Rebekah Juris A. Cabinta RN, MAN

August 16, 2017

 Written Report:

Urethral Urinary Catheterization

I. Urinary catheterization
- The introduction of a catheter into the urinary bladder.
- It is usually performed only when absolutely necessary, because the
danger exist of introducing microorganisms into the bladder.
- Strict sterile techniques is used for catheterization.
 Catheter
- Commonly made of rubber or plastic although they may be made from
latex, silicone, or polyvinyl chloride (PVC)
- They are sized by the diameter of the lumen using the French (Fr)
scale: the larger the number, the larger the lumen.
 A 14 to 16 French is used on most adults.
 Larger catheters of 22 French are recommended for
patients with hematuria or clots.
 Pediatric French sizes range from 3 to 14.
 A catheter that is too big can lead to urethral irritation
and difficult placement. A catheter that is too small can
lead to kinking and urinary leakage.
 Types of Catheter:
 Straight Catheter
- Single-lumen tube with a small eye or opening about 1 1/4 cm (1/2 in.)
from the insertion tip.
 Coudé Catheter
- Is a variation of the straight catheter
- It is more rigid than other straight catheter and has a tapered, curved
tip.
- May be used for men with prostatic hypertrophy.
 Foley/Retention Catheter
- It is a double-lumen catheter.
- Larger lumen drains urine from the bladder, a smaller lumen is
used to inflate a balloon near the tip of the catheter to hold the
catheter in place within the bladder.
- Sized by the volume of fluid used to inflate them.
- The two commonly used sized are 10mL and 30mL balloons.

II. Equipment:
 Sterile catheter of appropriate size (an extra catheter should also be at
hand)
 Catheterization kit :
 1-2 pair sterile gloves
  Waterproof drape(s)
 Antiseptic solution
 Cleansing balls
 Forceps
 Water-soluble lubricant
 Urine receptacle
 Specimen container
 For an indwelling catheter:
 Syringe prefilled with sterile water in amount specified by
catheter manufacturer
 2% Xylocaine gel (if agency permits)
 Disposable clean gloves
 Supplies for performing perineal care
 Bath blanket or sheet for draping the client
 Adequate lighting (Obtain a flashlight or lamp if necessary)
III. Procedures

Note: Stand on the client’s right if you are right-handed or on the client’s left if
you are left-handed. Establish adequate lighting.
1. Prior to performing the procedure, introduce self and verify the client’s
identity using agency protocol. Explain to the client what you are going to
do, why it is necessary, and how he/she can cooperate.
2. Perform hand hygiene and observe appropriate infection control
procedure.
3. Provide client’s privacy
4. Place the client in the appropriate position and drape all areas except the
perineum.
a. Female – supine with knees flexed, feet about 2ft. apart, and hips
slightly externally rotated, if possible.
b. Male – supine, thighs slightly abducted or apart.
5. Establish adequate lighting.
 Organizing supplies:
1. If using a collecting bag and it is not contained within the catheterization
kit, open the drainage package and place the end of the tubing within
reach. Rationale: Since one hand is needed to hold the catheter once it
is in place, open the package while two hands are still available.
2. Open the catheterization kit. Place a waterproof drape under the
buttocks (female) and penis (male) without contaminating the center
drape with hands.
3. Put on sterile gloves.
4. Saturate the cleansing balls with the antiseptic solution.
5. Open the lubricant package.
6. Remove the specimen container and place it nearby with lid loosely on
top.
7. Attach the prefilled syringe to the indwelling catheter inflation hub and
test the balloon. Rationale: If the balloon malfunctions, it is important to
replace it prior to use.
8. Lubricate the catheter 1-2 inches for female and 6-7 inches for male and
place it with the drainage end inside the collection container.
9. Remove gloves and wash hands.
10. Open the catheterization kit using aseptic technique; use wrapper to
establish a sterile field.
11. If the catheter is not included in the kit, drop the sterile catheter onto the
field using aseptic technique.
12. Apply sterile gloves.

Cleansing the meatus.

Note: the non-dominant is considered contaminated once it is touched the client’s skin.
 Women:
- Use your non-dominant hand to spread the labia. Establish a firm but
gentle position. The antiseptic may make the tissue slippery but the
labia must not be allowed to return over the cleansed meatus. Pick up
a cleansing ball with the forceps in your dominant hand and wipe one
side of the labia majora in an anteroposterior direction. Use great care
that wiping the client does not contaminate this sterile hand. Use a new
ball for the opposite side. Repeat for the labia minora. Use the last ball
to cleanse directly over the meatus. Note: location of the urethral
meatus is best identifies during the cleansing process.
 Men:
 - Use your non-dominant hand to grasp the penis just below the glands.if
necessary retract the foreskin. Hold the penis firmly upright, with slight
tension. Rationale: lifting the penis in this manner helps straighten the
urethra. Pick up a cleansing ball with a forceps in your dominant hand
and wipe from the center of meatus in a circular motion around the
glans. Use great care that wiping the client does not contaminate this
sterile hand. Use a new ball and repeat three more times. The
antiseptic may make the tissue slippery but the foreskin must not be
allowed to return over the cleansed meatus nor the penis be dropped.
Inserting the catheter
1. Insert the catheter.
a. 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. Slight
resistance is expected as the catheter passes through the sphincters. If
necessary, twist the catheter or hold pressure on the catheter until the
sphincter relaxes.
2. Hold the catheter with the non-dominant hand. In males, lay the penis down
onto the drape, being careful that the catheter does not pull out.
3. For indwelling catheter, inflate the retention balloon with the designated
volume.
a. Without releasing catheter, hold the inflation valve between two
fingers of you not-dominant hand while you attach the syringe (if
not left attached earlier when testing the balloon) and inflate with
your dominant hand. If the client complains discomfort, immediately
withdraw the instilled fluid, advance the catheter further, and
attempt to inflate the balloon again
b. Pull gently on the catheter until resistance is felt to ensure that the
balloon has inflated and to place it in the trigone of the bladder.
4. Collect a urine specimen if needed. Allow 20-30mL to flow into the bottle
without touching the catheter to the bottle.
5. Allow the straight catheter to continue draining. If necessary, attach the
drainage end of an indwelling catheter to the collecting tubing or bag.
6. Examine and measure the urine. In some cases, only 750 to 1,000 mL of
urine are to be drained from the bladder at one time. Check agency policy
for further instruction if this should occur.
7. Wipe the perineal area of any remaining antiseptic or lubricant. Replace the
foreskin if retracted earlier. Return the client into a comfortable position.
8. Discard all used supplies in appropriate receptacles and wash your hands
9. Document the catheterization procedure including catheter size and results
in the client record using forms of checklists supplemented by narrative
notes when appropriate.
Terminating the catheter
1. Obtain a receptacle for the catheter; a clean, disposable towel; clean gloves;
and a sterile syringe to deflate the balloon. The syringe should be large
enough to withdraw all the solutions in the catheter balloon. The size of the
balloon is indicated on the label at the end of the catheter.
2. Explain the procedure to the patient and ensure privacy.
3. Conduct a 15-30 seconds antiseptic hand washing
4. Ask the client to assume into a supine position as for a catheterization.
5. Optional: Obtain a sterile specimen before removing the catheter. Check
agency protocol.
6. Remove the tape or the catheter securing device attaching the catheter to
the client, put on gloves, and then place the towel between the legs of the
female client or over the thighs of the male
7. To deflate catheter balloon: Back off luer lock or slip tip of syringe to 0.5mL
and insert into the inflation port. Allow the pressure within the balloon to
force the plunger back and fill the syringe with water (if slow or no deflation
is noticed, re-seat the syringe gently.)
8. Use only gentle aspiration to encourage deflation if needed as vigorous
aspiration may collapse the inflation lumen, preventing balloon deflation
9. If the balloon will deflate and if permitted by hospital protocol, the valve arm
may be severed. If this fails, contact adequately trained professional for
assistance, as directed by hospital protocol.
10. Should balloon rapture occur, care should be taken to assure that all balloon
fragments have been removed for patient
11. Remove the catheter, discard it in the waste receptacle.
12. Dry the perineal area with a towel
13. Remove gloves
14. Measure the urine in the drainage bag, and record the removal of the
catheter. Include in the recording a.) The time the catheter was removed, b.)
The amount, color, and clarity of the urine, c.) The intactness of the catheter,
and d.) Instructions given to the client.

Resources:
Berman, A., Snyder, S., Kozier, B., & Erb, G. (2008). Kozier and Erb’s
Fundamental of Nursing Concept process and practice Vol.2 (8th ed.). Urinary
Elimination pp. 1284-1311. Upper Saddle River, New Jersey: Pearson Prentice
Hall
Foley Catheter Insertion and Removal Sample Procedure. Retrieved from:
http://www.bardmedical.com/media/563680/edu_bestpracticesfoley_brochurepdf.
pdf