PERFORMANCE EVALUATION TOOL FOR

CATHETERIZATION

NAME: ___________________________________________ DATE: ______________ SCORE: _______________

SEC & GRP NO: ________________ FACULTY: _____________________
Direction: Rate the learners based on the competencies listed below.

NUMERICAL RATING DESCRIPTION

3 Performs expected competencies in a very consistent manner.
2 Performs expected competencies in a moderately consistent manner.
1 Performs expected competencies in a rarely consistent manner.
0 Does not perform expected competencies.

A. PREPARATION RATING REMARKS

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 0 1 2 3
do, why it is necessary, and how he or she can participate
2. Perform hand hygiene and observe other appropriate infection prevention
0 1 2 3
procedures.
3. Provide for client privacy. 0 1 2 3
B. PROCEDURE
1. 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 0 1 2 3
slightly externally rotated, if possible
• Male: supine, thighs slightly abducted or apart
2. Establish adequate lighting. Stand on the client's right if you are right-
0 1 2 3
handed, on the client's left if you are left-handed.
3. 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.
0 1 2 3
Rationale: Because one hand is needed to hold the catheter once it is in
place, open the pack- age while two hands are still available.
4. If agency policy permits, apply clean gloves and inject 10 to 15 mL
Xylocaine gel into the urethra of the male client. Wipe the underside of
0 1 2 3
the penile shaft to distribute the gel up the urethra. Wait at least 5 minutes
for the gel to take effect before inserting the catheter.
5. Remove and discard gloves
6. Open the catheterization kit. Place a waterproof drape under the buttocks 0 1 2 3
(female) or penis (male) without contaminating the center of the drape
with your hands.
7. Apply sterile gloves. 0 1 2 3
8. Organize the remaining supplies:
• Saturate the cleansing balls with the antiseptic solution.
• Open the lubricant package 0 1 2 3
• Remove the specimen container and place it nearby with the lid loosely
on top.
9. Attach the prefilled syringe to the indwelling catheter inflation hub. Apply
agency policy and/or manufacturer recommendation regarding pretesting
of the balloon.
0 1 2 3
Rationale: There is little research regarding pretesting of the balloon;
however, some balloons (e.g., silicone) may form a cuff on deflation that
can irritate the urethra on insertion.
10. Lubricate the catheter 2.5 to 5 cm (1to 2 in,) for females. 15 to 17.5 cm (6
to 7in.) for males, and place it with the drainage end inside the collection 0 1 2 3
container.
Name: ______________________________ CATHETERIZATION Page | 2

11. If desired, place the fenestrated drape over the perineum, exposing the
0 1 2 3
urinary meatus
12. Cleanse the meatus.

Note: The nondominant hand is considered contaminated once it touches

the client's skin

• Females: Use your nondominant hand to spread the labia so that the
meatus is visible. Establish firm but gentle pressure on the labia. The
antiseptic may make the tissues slippery but the labia must not be
allowed to return over the cleaned meatus. Note: Location of the urethral
meatus is best identified during the cleansing process. 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 0 1 2 3
for the opposite side. Repeat for the labia minora. Use the last ball to
cleanse directly over the meatus.

Males: 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. Rationale: Lifting the penis in this manner helps straighten
the urethra. Pick up a 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 great care that wiping the client does not contaminate the
sterile hand. Use a new ball and repeat three more times. The antiseptic
may make the tissues slippery but the foreskin must not be allowed to
return over the cleaned meatus nor the penis be dropped.
13. Insert the catheter.
•Grasp the catheter firmly 5 to 7.5 cm (2 to 3 in.) 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
sphincter. If necessary, twist the catheter or hold pressure on the catheter
until the sphincter relaxes

• Advance the catheter 5 cm (2 in.) farther after the urine begins to flow
through it.
0 1 2 3
Rationale: This is to be sure it is fully in the bladder, will not easily fall out,
and the balloon is in the bladder completely. For male clients, some
experts recommend advancing the catheter to the "Y" bifurcation of the
catheter, Check your agency's 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
14. Hold the catheter with the nondominant hand 0 1 2 3
15. For an indwelling catheter, inflate the retention balloon with the
designated volume
• Without releasing the catheter (and, for females, without releasing
the labia), hold the inflation valve between two fingers of your
nondominant hand while you attach the syringe (if not left attached
earlier) and inflate with your dominant hand. If the client complains of 0 1 2 3
discomfort, immediately withdraw the instilled fluid, advance the
catheter farther, and attempt to inflate the balloon again.

• 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.
16. Collect a urine specimen if needed. For a straight catheter, al- low 20
to 30 mL to flow into the bottle without touching the catheter to the
0 1 2 3
bottle. For an indwelling catheter pre-attached to a drainage bag, a
specimen may be taken from the bag this initial time only.
17. Allow the straight catheter to continue draining into the urine
receptacle. If necessary (e.g., open system), attach the drainage end 0 1 2 3
of an indwelling catheter to the collecting tubing and bag
Name: ______________________________ CATHETERIZATION Page | 3

18. 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 0 1 2 3
agency policy for further instructions if this should occur.
19. Remove the straight catheter when urine flow stops. For an
indwelling catheter, secure the catheter tubing to the thigh for female
clients or the upper thigh or lower abdomen for male clients to
prevent movement on the urethra or excessive tension or pulling on
the retention balloon (Fisher, 2010; Herter & Kazer, 2010). Adhesive 0 1 2 3
and non-adhesive catheter-securing devices are available and should
be used to secure the catheter tubing to the client

Rationale: This prevents unnecessary trauma to the urethra

20. Next, hang the bag below the level of the bladder. No tubing should
0 1 2 3
fall below the top of the bag
21. Wipe any remaining antiseptic or lubricant from the perineal area.
Replace the foreskin if retracted earlier. Return the client to a
0 1 2 3
comfortable position. Instruct the client on positioning and moving
with the catheter in place
C. AFTER CARE
1. Discard all used supplies in appropriate receptacles 0 1 2 3
2. Remove and discard gloves
0 1 2 3
• Perform hand hygiene
3. Document the catheterization procedure including catheter size and
results in the client record using forms or checklists supplemented by 0 1 2 3
narrative notes when appropriate

(Score X 50) ÷ (Total Score) 27 + 50 = ________

___________________________________ ____________________________________
Signature of Student Signature of Faculty