When inserting an indwelling urinary catheter, follow these steps.
Check the healthcare provider’s order to determine the type of catheterization to be performed.
Assess the patient for allergies to latex, povidone iodine, or tape.
Apply clean gloves and drape the patient for privacy.
Provide perineal care and examine the urinary meatus.
Then, remove gloves and perform hand hygiene.
Position the male patient with knees flexed and feet wide apart, or have the patient lie flat with the legs close together.
Remove the catheter kit from the outside plastic packaging.
Turn the edges of the plastic bag to the outside without contaminating the inside of the bag.
Place toward the end of the bed for use as a trash receptacle.
The inside of the bag is still sterile, so if your gloves or forceps accidentally touch the inside as you discard items, they will not be contaminated.
Position the catheterization tray on the bed between the patient’s legs or on the patient’s lap, on top of the thighs.
Open the distal flap of the tray first, then both side flaps,
and the flap closest to you last.
Touch only the 1-inch outer margin of the sterile wrapper with your bare hands to prevent contamination of your sterile field.
Remove the sterile drape from the catheter kit without contaminating the contents of the tray.
Place the sterile drape over the patient’s lap or thighs. Hold it by the 1-inch outer margin.
Remove the fenestrated drape with the diamond-shaped opening in the middle and place it carefully around the penis.
Put on the sterile gloves.
Lift out the plastic tray, and place it on the sterile field, avoiding the 1-inch unsterile outer margin.
From the kit, pick up and open the lubricant and squeeze it onto a section of sterile plastic tray.
Open the package of Betadine, and empty the contents over the cotton balls.
Some kits may be packaged with Betadine swabs instead of cotton balls and liquid Betadine.
Use another type of antiseptic cleanser if the patient is allergic to Betadine.
Lift out the sterile catheter.
Carefully remove the plastic cover from the catheter, maintaining strict asepsis of the catheter.
Drop the plastic off to the side of your sterile field.
Using your dominant hand, pick up the syringe containing sterile water, and screw the Luer-Lok tip
to the colored port on the second lumen of the catheter and leave it attached for inflating the balloon later.
Now place the catheter with attached syringe into the sterile kit box within your sterile field.
Use caution while you position the catheter.
Place the catheter so that the tip is in the lubricant that you opened earlier
Using your non-dominant hand, grasp the penis shaft.
Avoid using one or two fingers and the thumb; apply a full-handed grasp, retracting the foreskin if the man is uncircumcised.
This hand is now unsterile because you have touched the patient’s skin.
Hold the penis at a 90-degree angle to the body while applying gentle traction.
With your dominant hand, pick up the Betadine swab or use the sterile forceps to pick up the Betadine-soaked cotton ball.
Begin cleansing at the urinary meatus, moving in concentric circles until the entire glans penis is cleansed.
Drop the now-contaminated cotton ball or swab in the plastic bag you set up beyond your sterile field.
Use caution to avoid touching the sterile forceps or gloves to any potentially contaminated surface.
Repeat the same cleansing motion three times with three separate cotton balls or swabs.
Remember to use each antiseptic wipe only once, moving in a concentric circle over the meatus and entire glans.
Do not remove your non-dominant hand from the penis after cleaning it to prevent contamination.
Pick up the sterile catheter with your dominant hand, dipping the tip in the lubricant you squirted onto the plastic tray.
Lubricate approximately 5 to 7 inches of the catheter to facilitate insertion and decrease discomfort to the patient.
Some catheter kits include a sterile syringe containing lubricant rather than a package of lubricant.
The tip of the syringe can be gently inserted into the urethra and the plunger depressed to fill the urethra with lubricant.
Follow facility policy.
With your dominant hand, insert the catheter into the urinary meatus.
Advance the catheter 7 to 9 inches until you see urine flowing into the drainage tubing.
Advance the catheter another 1 to 2 inches to ensure that the catheter is fully in the bladder.
If you inadvertently inflate the balloon while it is still in the urethra, you may damage the urethra.
Keep your dominant hand on the catheter
Do not force the catheter if you are unable to gently advance it.
Release the penis and, with your non-dominant hand, inflate the balloon by depressing the plunger on the syringe completely.
Twist the syringe off of the connection port and dispose of it in the plastic bag.
Pull gently on the catheter to seat it at the cystourethral junction.
Replace the foreskin if it was retracted.
If the foreskin is left in the retracted position, particularly with an indwelling catheter in place,
it can cause a stricture-like effect, resulting in edema and possible necrosis of the head of the penis.
Cleanse all Betadine or other cleanser from the urinary meatus and surrounding area.
Secure the indwelling catheter to the patient’s thigh with a leg strap or tape.
Some males may prefer to secure it to the lower abdomen.
If you are not certain, simply ask the patient for his preference.
To ensure adequate catheter length for patient movement, secure the catheter at the Y-junction.
Hang the catheter drainage bag from a part of the bed that moves with the patient when raised or lowered, avoiding using the bed rails.
If the drainage bag is hung on the bed rails, it can be elevated above the level of the bladder when the rails are raised.
Hanging the drainage bag on the side of the bed nearest the door allows you to do a quick visual assessment of the amount and color of urine in the bag.
The drainage bag should not be elevated above the level of the patient’s bladder,
to prevent urine from draining from the catheter tubing back into the bladder.
When you finish the procedure, remember the Universal Steps that apply after all procedures.
For example, leave the patient in a safe, comfortable position with the call device in easy reach.
Document the procedure in the electronic health record.