Urinary Catheter Management
Inserting an Indwelling Urinary Catheter in a Male Patient
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- » Inserting an Indwelling Urinary Catheter in a Female Patient
- » Inserting an Indwelling Urinary Catheter in a Male Patient
- » Irrigating a Urinary Catheter
- » Performing Intermittent Straight Catheterization
- » Obtaining a Specimen from an Indwelling Urinary Catheter
- » Removing an Indwelling Urinary Catheter
- » Caring for a Suprapubic Catheter
Take the Review Test:
Safety
- Use a nonlatex catheter if the patient is allergic to latex. Assess the patient for an allergy to the antiseptic, tape, and lubricant.
- Always carry or hang the bag below the level of the bladder, such as on the bed frame or a chair, so that urine will drain down, out of the bladder. Never allow the bag to touch the floor.
- If you feel resistance or the patient reports pain when advancing the catheter, DO NOT USE FORCE. Stop advancing the catheter. Ask the patient to take slow, deep breaths to promote relaxation. Hold the catheter gently in place without forcing it. After a few seconds, the sphincter may relax, and the catheter can be advanced.
- If the patient complains of sudden pain during inflation of a catheter balloon or if you feel resistance when inflating the balloon, stop inflating the balloon, allow the fluid from the balloon to flow back into the syringe, advance the catheter farther, and reinflate the balloon.
- Maintain sterile technique during catheterization.
Equipment
(Roll cursor over items to see labels)
Indwelling catheterization kit (contents may vary)
- Catheter
- Fenestrated drape
- Lubricant
- Cleansing solution
- Cotton Balls
- Forceps
- Sterile drainage tubing with collection bag
- Sterile gloves
Indwelling catheterization kit (contents may vary)
- Catheter
- Fenestrated drape
- Lubricant
- Cleansing solution
- Cotton Balls
- Forceps
- Sterile drainage tubing with collection bag
- Sterile gloves
Syringe
Sterile specimen container with label (optional)
Catheter securement device
Bath blanket
Waterproof pad
Clean gloves
Basin
Soap
Washcloth and towel
Measuring container for urine
PrintableDelegation
The skill of inserting an indwelling urinary catheter cannot be delegated to nursing assistive personnel (NAP). Be sure to inform NAP of the following:
- Explain how to assist with patient positioning, focus lighting for the procedure, maintain privacy, empty urine from the collection bag, and assist with perineal care.
- Instruct NAP to report postprocedure patient discomfort or fever.
- Instruct NAP to report abnormal urine color, odor, or amount, or if the catheter is leaking or causing pain.
Preparation
- Review the patient’s medical record, including the health care provider’s order and nurses’ notes. Note previous catheterizations, including catheter size, response of patient, time of catheterization, and any pathological condition that may impair the passage of the catheter, such as an enlarged prostate gland.
- Ask the patient and check the patient’s medical record for allergies.
- Assess the patient’s gender, age, weight, level of consciousness, developmental level, ability to cooperate, and mobility, his knowledge of and prior experience with catheterization, and his feelings about the procedure.
- Assess for pain and bladder fullness. Palpate the bladder over the symphysis pubis, or use a bladder scanner (if available).
- Perform hand hygiene, and apply gloves. Inspect the perineal region, observing for perineal anatomical landmarks, erythema, drainage or discharge, and odor. Remove gloves, and perform hand hygiene.
- Explain the procedure to the patient.
- Arrange for extra personnel to assist as necessary.
Follow-up
- Palpate the patient’s bladder for distention, or use a bladder scan.
- Ask the patient to describe his level of comfort.
- Observe the character and amount of urine in the drainage system.
- Determine that there is no urine leaking from the catheter or tubing connections.
Documentation
- Record and report the reason for the catheterization; the type and size of the catheter inserted; the amount of fluid used to inflate the balloon; specimen collection (if applicable); characteristics of the urine; amount of urine; and the patient’s response to the procedure, as well as any education provided to him.
- Record the amount of urine on the intake and output (I&O) flow sheet record.
- Report any persistent catheter-related pain and discomfort to the health care provider.
Review Questions
1. What is the best reason for the nurse to instruct a male patient to take slow, deep breaths during insertion of an indwelling urinary catheter?
INCORRECT. The nurse would not instruct a male patient to take slow, deep breaths during catheter insertion in order to increase oxygenation.
INCORRECT. The nurse would not instruct a male patient to take slow, deep breaths during catheter insertion in order to reduce blood pressure.
INCORRECT. Taking slow, deep breaths may distract the patient, but that is not the best reason for giving this instruction.
CORRECT. The nurse would instruct a male patient to take slow, deep breaths during catheter insertion if the nurse felt resistance to the advancing catheter or if the patient reported pain. Deep breathing promotes relaxation, which might help to pass the catheter through the urinary sphincter.
2. When preparing to insert an indwelling urinary catheter in a male patient, it is important for the nurse to do what?
Remove the cotton balls from the kit for later use.- Advance the catheter 10 to 12 inches or until urine flows.
Lubricate the first 5 to 7 inches of the catheter.- Hold the penis at a 45-degree angle during insertion.
INCORRECT. The cotton balls will be used for cleansing.
INCORRECT. The catheter should be inserted 7 to 9 inches or until urine flows, not 10 to 12 inches.
CORRECT. The first 5 to 7 inches of the catheter is lubricated to ease insertion.
INCORRECT. The penis is to be held at a 90-degree angle, not a 45-degree angle.
3. Which observation indicates that instruction given to nursing assistive personnel (NAP) in caring for a patient with an indwelling urinary catheter has been effective?
- The collection bag has been placed on the side rail of the bed.
- The excess catheter tubing has been coiled beside the patient’s inner thigh.
- The collection bag has been placed on the bed.
- The collection bag is held above the level of the bladder while ambulating the patient.
INCORRECT. The urine drainage bag should not be placed on a side rail, because the rail is above the level of the patient’s bladder.
CORRECT. The excess drainage tubing should be coiled next to the patient’s inner thigh, to facilitate urine flow.
INCORRECT. The collection bag should not be placed on the bed next to the patient, because this level is above the patient’s bladder.
INCORRECT. NAP must hold the collection bag below, not above, the level of the patient’s bladder so that urine can drain easily into the bag.
4. Which action will the nurse implement to reduce the risk of catheter-associated urinary tract infection (CAUTI) in a male patient with an indwelling urinary catheter?
- Frequently pull on the drainage system tubing.
- Use the largest-size catheter possible.
- Clean the urinary meatus daily.
- Apply antiseptics to the urinary meatus.
INCORRECT. To reduce the risk of CAUTI, the drainage system tubing should not be pulled. Doing so could irritate the tissues, making infection more likely.
INCORRECT. To reduce the risk of CAUTI, the smallest-size catheter should be used, not the largest. A smaller catheter causes less urethral trauma and irritation.
CORRECT. To reduce the risk of CAUTI, daily cleansing of the urinary meatus is necessary.
INCORRECT. To reduce the risk of CAUTI, perineal care should be performed with soap and water. Antiseptic solutions are not effective in preventing infection and should not be used for daily cleansing.
5. While setting up the sterile field in preparation for inserting an indwelling urinary catheter, a male patient is incontinent of urine over most of the supplies. What action would the nurse take to reduce the patient’s risk for infection?
- Rinse off the supplies that were contaminated with urine.
- Cleanse the patient’s urinary meatus.
- Replace all contaminated supplies, and begin the process again.
- Change the patient’s bed linens.
INCORRECT. If the sterile field is contaminated while preparing to insert an indwelling urinary catheter, rinsing off the contaminated supplies will not reduce the patient’s risk for infection.
INCORRECT. If the sterile field is contaminated while preparing to insert an indwelling urinary catheter, cleansing the patient’s urinary meatus is not sufficient to reduce the patient’s risk for infection.
CORRECT. If the sterile field is contaminated while preparing to insert an indwelling urinary catheter, all contaminated supplies must be replaced and the process begun again.
INCORRECT. If the sterile field is contaminated by urine while preparing to insert an indwelling urinary catheter, it is appropriate to change the patient’s bed linens, but doing so does not reduce the patient’s risk for infection.
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