Urinary Catheterisation

Question 1

How do you initiate the procedure?

Answer 1

1. washes hands
2. introduce self
3. identify patient + cross check with patient notes
4. Put on apron
5. check allergies - anaesthetic gel, latex
6. explains what a catheter is and why - we’re going to pass a tube tube that’s going to go into the end of your penis/where you wee from all the way up to your bladder and inflate a small balloon about the size of a grape to help anchor it in place (this also means you want to try to avoid tugging on it as it might hurt). We’re doing this so can empty your bladder before/during surgery or allow us to measure how much you’re weeing
7. Explains complications - the procedure might be a little uncomfortable but we do provide some anaesthetic gel to reduce this and there is also a risk of the tube getting infected but we’re going to be as clean as possible whilst putting it in so we should reduce this risk
8. does that sound okay?any questions?

Question 2

What equipment is required?

Answer 2

• ensure all in date
  1. sterile gloves
  2. drainage bag
  3. catheter pack
  4. instillagel (anaesthetic)
  5. saline solution for cleaning
  6. two way Foley catheter in sterile pack with prefilled syringe of water for balloon inflation
  7. Medical waste bin

Question 3

How do you prepare the procedure?

Answer 3

1. clean the trolley, place equipment on bottom shelf
2. draw curtains around patients bed
3. lie patient down with legs extended; raise bed to appropriate height
4. ask patient to retract foreskin (if necessary) and wash genitalia - to try and reduce infection risk
5. open the cath pack onto the top shelf of trolley and unfold aseptically
6. aseptically unpackage the remaining equipment onto the sterile field
7. Retain the sticker to record residual volume
8. Pour cleaning solution into container
9. Make sure trolley and bin are appropriately placed on the correct side of patient to make the process easier

Question 4

How do you conduct the first half of the procedure?

Answer 4

1. wash hands with alcohol gel
2. don sterile gloves
3. ask patient to expose themselves
4. form a sterile field by draping drape across patients thighs, ask to lift bum on female to wedge beneath
5. male: form a sling around the penis using sterile gauze and hold upright; female: spread superior aspects of labia
6. clean using saline with three swabs in a downward motion across the left, right and centre
7. inform patient you are going to insert anaesthetic gel - may feel a cold sensation - break seal on gel by pushing down on plunger. Remove cap and insert syringe into urethral meatus and squeeze all into the urethra (sometimes 2 syringes may be required for a male patient)
8. allow 5 mins for anaesthetic gel to take affect - tell patient you’re going to change your gloves

Question 5

How do you conduct the second half of the procedure?

Answer 5

1. Remove gloves
2. Wash hands with hand gel
3. Don second pair of sterile gloves
4. Open catheter from green wrapping - open with port end first and whist body of catheter is in the wrapping, attach saline filling syringe (break seal in same way as anaesthetic gel), also remove cap of and attach cath bag, remove catheter completely
5. Wrap catheter around fingers to avoid letting it dangle everywhere
6. Take catheter w/bag and syringe to sterile field near patient
7. Part labia or lift penis using gauze sling, I nform patient you are about to insert the catheter, insert catheter into urethra (avoid contamination) and advance with clean hand
8. Resistance may be experienced due to sphincter spasm or through prostate in men
9. Insert catheter the appropriate distance - male: all the way up to the bifurcation; female: only about half way; when entering the bladder urine will begin to pass into cath bag - once this occurs, insert and additional 5cm (or more) to ensure balloon is within bladder
10. Inflate balloon using the entire syringe of saline - remove immediately once emptied or balloon will deflate
11. Gently withdraw the catheter until the balloon stops further progress
12. Fix the catheter to the patients thigh and ensure that drainage bag is placed on a stand or hung from the bed (lower than the patient) - this helps ensure patient comfort and reduce chance of infection and trauma

Question 6

How do you conclude the procedure?

Answer 6

1. Ensure patient is comfortable and dry; return foreskin to normal position if required (if not done - paraphimosis)
2. Dispose of waste in clinical waste bag (orange)
3. Remove gloves and apron and wash hands
4. Record amount of residual urine on the fluid balance chart and document procedure on medical notes - including adding a completed catheter sticker
5. Recording - state the indication for catheterisation; indicate time and date; catheter type, size, length, manufacturer batch number used; how much instillagel used; volume of water injected into the balloon; review date; any problems experienced during the procedure
6. Reposition patients bed as appropriate
7. Check patients welfare
8. Inform patient to let staff know of any pain or discomfort