Urinary Catheterization (Insertion) Female

Question 1

Basic Concept

Answer 1

Urinary catheterization is the introduction of a catheter tube through the urethra into the bladder.

Question 2

Objectives:

Answer 2

1. Relieves discomfort due to bladder distention or gradual decompression of distended bladder.
2. Assesses the amount of post-void residual urine.
3. Obtain sterile urine specimen.
4. Empties the bladder completely prior to surgery.
5. Promotes urinary elimination.
6. Monitors or measures urine output accurately.
7. Prevents urinary leakage, and keep patient dry, if incontinent.
8. Instills medication or solution into the bladder.
9. Removes blood and blood clots in the urethra or bladder.

Question 3

Materials:
Urinary Catheterization Prepackaged Kit:

Answer 3

Sterile gloves
Waterproof pad
Sterile fenestrated and non-fenestrated drapes
Forceps
Cotton balls and gauze squares
Urine specimen container
Syringe, Prefilled with sterile water
Water-soluble lubricant
Antiseptic cleansing solution
Sterile catheter of appropriate size
Sterile disposable urine collection/drainage bag

Question 4

If kit is not available, prepare the following:

Answer 4

A. A tray containing the sterile package that contains the following:
Tray, optional
Receptacle/kidney basin
Specimen container/bottle
Forcep
Drape (fenestrated)

B. A tray containing the following other items or materials:
Sterile water
5cc syringe
Antiseptic/Betadine solution
Sterile disposable drainage bag/ Foley bag catheter
Sterile gauze squares and cotton balls
Sterile catheter of appropriate size
Water-soluble lubricant
Sterile Gloves

C. Another tray containing the following items:
Clean linen or bath blanket for draping patient
Rubber sheet or waterproof pad
Flashlight or droplight, if necessary
Velcro leg strap or adhesive tape to secure catheter
Clean Gloves
Bandage scissor
Extra sterile catheter and gloves

D. Perineal care set/ tray:
Sterile dry cotton balls and OS/gauze squares
Sterile cotton balls soaked in antiseptic solution
Picking and working forceps

Question 5

Preparation:

Answer 5

1. Review medical record, check doctor’s order and the nursing plan of care.
2. Identify the patient and explain the procedure. Discuss any allergies with patient to iodine or latex.
3. Assess for any movement limitation.
4. Ask the patient when she last voided and if she feels the urge to void.
5. Percuss and palpate bladder for distention.
6. Perform hand hygiene
7. Prepare and bring all needed materials to patient’s room.
8. Provide privacy by drawing curtains or closing the room door upon entering.
9. Instruct the patient remove her underwear.
10. If poor lighting, ask someone to hold a flashlight or place a lamp next to patient’s bed.
11. Raise the bed in a comfortable working height.

Question 6

Procedure
#1

Answer 6

1. Place a waterproof pad under the buttocks.

Question 7

2

Answer 7

2. Drape patient with linen or bath blanket.

Question 8

3

Answer 8

3. Position patient. Place patient in dorsal recumbent with
   knees slightly flexed and apart; and feet flat on bed. If
   patient finds it uncomfortable and if not possible reposition
   patient on a position that is easiest for the nurse and
   comfortable for the patient such as side-lying; flexing only
   one knee and the other leg flat on bed. For elderly female
   client, put a rolled towel or pillow under the buttocks.

Question 9

4

Answer 9

4. Wear gloves.

Question 10

5

Answer 10

5. Perform perineal care.
   a. Serve the bedpan.
   b. Expose the perineal are.
   c. Flush area with lukewarm water.
   d. Clean the perineal area using single sterile cotton balls
   soaked with antiseptic solution in the following order:
   mons pubis (upward, zigzag stroke), urinary meatus,
   farther labia minora, nearer labia minora, farther labia
   majora, nearer labia majora, then the urinary meatus to
   the anus. You can also use sponges with antiseptic
   solution.
   e. Flush with lukewarm water.
   f. Pat dry.
   Note: Check agency or facility policy for perineal care
   procedure.

Question 11

6

Answer 11

6. Cover vaginal orifice with sponge if with discharges.

Question 12

7

Answer 12

7. Remove bed pan. Do after care or keep the area clean.

Question 13

8

Answer 13

8. Remove gloves.

Question 14

9

Answer 14

9. Then, prepare or setup materials or equipment for sterile
   urinary catheter insertion.
   a. Place the sterile set between thigh facing front of bed.
   b. Open sterile pack bringing top edge of cover using
   aseptic technique.
   c. Create a sterile field by opening the sterile pack
   between the thighs of patient.
   d. Carefully place sterile catheter and drainage bag in the
   sterile tray.
   e. Place cotton balls soaked in antiseptic solution in the
   kidney basin/receptacle.
   f. Place sterile gauze square on the sterile field and
   squeeze a small amount of lubricant.
   g. Place a sterile syringe on the sterile field.

Question 15

10

Answer 15

10. Open a vial of sterile water aseptically.

Question 16

11

Answer 16

11. Place other needed items/articles within proximity but
    not within the sterile field.
    a. Waste receptacle
    b. Velcro leg strap or adhesive and pre-cut plaster/ tape
    c. Sterile water for injection

Question 17

12

Answer 17

12. Glove dominant hand.

Question 18

13

Answer 18

13. Check the balloon of the catheter and the urobag/
    drainage bag.
    a. With gloved dominant hand, get the syringe and fill
    the syringe of the required amount of sterile water
    enough to inflate the balloon.
    b. Return the filled syringe in the sterile field.
    c. Glove non-dominant hand or ungloved hand.
    d. Introduce syringe into the balloon/ injection port and
    inject the required amount of sterile water.
    e. Withdraw the fluid introduced, but do not remove the
    syringe from the injection port.
    f. Close the urine port of the urobag/ drainage bag.

Question 19

14

Answer 19

14. Perform the final perineal care.
    a. Use the sterile forcep to hold the cotton balls soaked in
    antiseptic solution.
    b. Clean the perineal area using the single downward
    stroke in the following order: urinary meatus, farther
    labia minora, nearer labia minora, farther labia majora,
    nearer labia majora, then the urinary meatus to the anus

Question 20

15

Answer 20

15. Drape perineum with the fenestrated sheet.

Question 21

16

Answer 21

16. Lubricate the tip of the catheter

Question 22

17

Answer 22

17. Using gloved dominant hand, place distal end of
    catheter in urine receptacle unless already attached to
    drainage bag

Question 23

18

Answer 23

18. Encourage patient to relax and breath through mouth

Question 24

19

Answer 24

19. Insert catheter gently into the urethra using upwarddownward stroke for 2-3 inches or until urine flows. If the patient complains of pain during insertion or if resistance is met, encourage patient to breathe through the mouth, continue insertion. If resistance is still felt, do not force insertion. Remove catheter and report to physician,

Question 25

20

Answer 25

20. Collect sterile urine specimen, if needed. Cover urine
    specimen container

Question 26

21

Answer 26

21. If catheter is to be indwelled:
    a. Do not withdraw catheter after insertion.
    b. Advance catheter 1 in. after urine flows.
    c. Have the non- dominant hand hold inserted catheter
    in place.
    d. Clamp drainage port using the forcep
    e. Inflate the balloon.
    f. Pull gently the catheter and feel for resistance.
    g. Remove the syringe

Question 27

22

Answer 27

22. Cleanse/dry area of discharges, if present.

Question 28

23

Answer 28

23. Connect catheter to drainage bag.

Question 29

24

Answer 29

24.Remove catheterization sheet/ fenestrated drape. Clean
the working area.

Question 30

25

Answer 30

25. Remove gloves

Question 31

26

Answer 31

26. Straighten patient’s leg and secure catheter to patient’s
    thigh with adhesive tape catheter to inside part of thigh
    with strip of hypo-allergenic plaster allow for slack so
    that movement of thigh does not create tension on the
    catheter. Or use the Velcro leg strap if available.

Question 32

27

Answer 32

27. Instruct patient on ways to lie in bed with catheter.

Question 33

28

Answer 33

28. Caution patient against pulling the catheter

Question 34

29

Answer 34

29. Attach and secure drainage bag below the level of the
    bladder

Question 35

30

Answer 35

30. Make the patient comfortable

Question 36

31

Answer 36

31. Remove bath blanket then replace the top sheet

Question 37

32

Answer 37

32. Palpate bladder and ask patient if still uncomfortable

Question 38

33

Answer 38

33. Observe character and amount of urine in drainage
    system

Question 39

34

Answer 39

34. Do after care of equipment used and dispose urine and
    other materials according to agency policy.

Question 40

35

Answer 40

35. Wash hands

Question 41

36

Answer 41

36. Put on clean gloves, label specimen and send urine
    immediately to the laboratory.

Question 42

37

Answer 42

37. Remove gloves

Question 43

38

Answer 43

38. Document assessment and observation/ patient’s
    condition, care rendered, include also the type and size
    of catheter, amount of sterile water used in inflating the
    balloon, character and amount of urine and reaction of
    patient.