Assessment
Check doctor’s order and indication for insertion of urinary catheter — AUR, Strict I/O
Check patient’s needs, the level of consciousness and verify any allergy history (Latex)
Indications for IDC insertion
To drain the bladder prior to, during, or after surgery
For investigations
To accurately measure the urine output
To relieve retention of urine
To relieve urinary incontinence when no other means is practical
Contraindications for IDC insertion
Confirmed or suspected urethral injury
History of difficult catheter placement
History of urethral strictures
Known major abnormalities of the lower urinary tract
Planning and preparatory
Patient:
* Explain the procedure and put patient to a dorsal recumbent position (supine with knees flexed) or a lateral with a knee-chest position (if unable to tolerate supine position or obese)
- If patient is ambulant, encourage her to go to the toilet to wash her perineal area (video)
Environment: Close the curtain to ensure privacy, switch on the light, and adjust bed to the working height
Requisites
- Dressing trolley (disinfect trolley with alcohol wipes)
- Catheterization set
- Urinary catheter appropriate size (12-14F)
- Urine bag
- Urine drainage bag hanger
- Protective sheet
- Water for injection and 10ml syringe (If not available inside the pre-packaged catheterisation set)
- Chlorhexidine cleansing solution 0.05%
- Lubricant gel
- Sterile gloves (If not available inside the pre-packaged catheterization set)
- Micropore tape
- Waste disposal bag
- Intake/output chart
*Check expiry date and integrity of sterile packaged items
Implementation
- Perform 5 moments of hand hygiene and put on
disposable apron. - Identify correct patient using 2 patient identifiers
- Bladder assessment. Gently palpate from the umbilicus downward toward the pelvis, noting for any bladder distension.
- Perform hand hygiene.
- Open the catheterisation set and prepare all the
requisites with aseptic technique: chlorhexidine
cleansing solution, catheter, lubricant gel, urine bag,
water for irrigation and sterile gloves (if not available in
catheterisation set). - Perform surgical hand rub, and don sterile gloves.
- Arrange the items in the sterile field, prepare wet cotton balls in one tray for cleansing, and prepare the forceps, prefilled syringe and the catheter in the other tray for insertion.
- Check balloon integrity with 10 ml water for injection and deflate it completely after testing
- Lubricate the distal part of the catheter about 5 cm,
connect it to a urine bag and ensure the outlet of the
urine bag is closed. - Drape the patient without contamination.
- Use wet cotton ball to clean each side from labia majora→ labia minora → urinary meatus, use a new cotton ball for each downward stroke.
- Keep patient’s labia minora separated after each
cleaning. - Insert catheter through the urethral opening till urine is observed.
- Advance catheter 2-5 cm more to ensure balloon is inside the bladder not the urethra.
- Inflate the balloon with 5-15 mls H2o (based on
manufacturer’s recommendation) for injection, gently
retract the catheter to ensure correct placement,
subsequently push in 1-2 cm to prevent balloon resting in bladder and causing ulcer. - Use Micropore to secure catheter end to patient’s inner thigh(female)
- Place the urine bag below the level of bladder but not touch the floor.
- Perform hand hygiene
Documentation and evaluation
- Evaluate patient’s bladder is emptied without any
complications. - Observe urine output for any hematuria or cloudy urine.
- To document in nursing notes: Patient’s tolerance of
procedure, date and time the catheter was inserted, size and type of catheter used (e.g., latex catheter, silicone-coated catheter or 100% silicone catheter), and the expiry date of the catheter and urine bag; to document in I/O chart about the color and amount of urine drained out.
