{"id":3637,"date":"2015-06-18T15:19:37","date_gmt":"2015-06-18T15:19:37","guid":{"rendered":"http:\/\/opentextbc.ca\/clinicalskills\/?post_type=chapter&#038;p=3637"},"modified":"2021-05-26T21:17:11","modified_gmt":"2021-05-26T21:17:11","slug":"10-3-urinary-catheters","status":"publish","type":"chapter","link":"https:\/\/opentextbc.ca\/clinicalskills\/chapter\/10-3-urinary-catheters\/","title":{"raw":"10.4 Urinary Catheters","rendered":"10.4 Urinary Catheters"},"content":{"raw":"Urinary elimination is a basic human function that can be compromised by illness, surgery, and other conditions. Urinary catheterization may be used to support urinary elimination in patients who are unable to void naturally. Urinary catheterization may be required:\r\n<ul>\r\n \t<li>In cases of acute urinary retention<\/li>\r\n \t<li>When intake and output are being monitored<\/li>\r\n \t<li>For preoperative management<\/li>\r\n \t<li>To enhance healing in incontinent patients with open sacral and perineal wounds<\/li>\r\n \t<li>For patients on prolonged bedrest<\/li>\r\n \t<li>For patients\u00a0needing end-of-life care<\/li>\r\n<\/ul>\r\n<h2>Catheter-Associated Urinary Tract Infections<\/h2>\r\nCatheter-associated urinary tract infections (CAUTI) are a common complication of indwelling urinary catheters\u00a0and have been associated with increased morbidity, mortality, hospital cost, and length of stay (Gould et al., 2009). Urinary drainage systems are often reservoirs for multidrug-resistant organisms (MDROs) and a source of the transmission of microorganisms to other patients (Gould et al., 2009). The most important risk factor for developing a CAUTI, a health care associated infection (HAI), is the prolonged use of a urinary catheter (Centers for Disease Control and Prevention [CDC], 2015). Urinary tract infections (UTIs) are the most commonly reported HAIs in acute care hospitals and account for more than 30% of all reported infections (Gould et al., 2009). Catheters in place for more than a few days place the patient at risk for a CAUTI. A health care provider must assess patients for signs and symptoms of CAUTIs and report immediately to the primary health care provider. Signs and symptoms of a CAUTI include:\r\n<ul>\r\n \t<li>Fever, chills<\/li>\r\n \t<li>Lethargy<\/li>\r\n \t<li>Lower abdominal pain<\/li>\r\n \t<li>Back or flank pain<\/li>\r\n \t<li>Urgency, frequency of urination<\/li>\r\n \t<li>Painful urination<\/li>\r\n \t<li>Hematuria<\/li>\r\n \t<li>Change in mental status (confusion, delirium, or agitation), most commonly seen in older adults<\/li>\r\n<\/ul>\r\nThe following are practices for preventing CAUTIs (Perry et al., 2014):\r\n<ul>\r\n \t<li>Insert urinary catheters using sterile technique.<\/li>\r\n \t<li>Only insert indwelling catheters when essential, and remove as soon as possible.<\/li>\r\n \t<li>Use the narrowest tube size (gauge) possible.<\/li>\r\n \t<li>Provide daily cleansing of the urethral meatus with soap and water or perineal cleanser, following agency policy.<\/li>\r\n \t<li>Ensure a closed drainage system.<\/li>\r\n \t<li>Ensure that no kinks or blockages occur in the tubing.<\/li>\r\n \t<li>Secure the catheter tube to prevent urethral damage.<\/li>\r\n \t<li>Avoid use of antiseptic solutions on the urethral meatus and\/or in the urinary bag.<\/li>\r\n<\/ul>\r\n<h2>Urinary Catheterization<\/h2>\r\nUrinary catheterization refers to the insertion of a catheter tube through the urethra and into the bladder\u00a0to drain urine. Although not a particularly complex skill, urethral catheterization can be difficult to master. Both male and female catheterizations present unique challenges.\r\n\r\nHaving\u00a0adequate lighting and visualization is helpful, but does not ensure entrance of the catheter into the female urethra. It is not uncommon for the catheter to enter the vagina. Leaving the catheter in the vagina can assist in the correct insertion of a new catheter into the urethra, but you must remember\u00a0to remove the one in the vagina.\r\n\r\nFor some women, the supine lithotomy position can be very uncomfortable or even dangerous. For example, patients\u00a0in the last trimester of pregnancy\u00a0may\u00a0faint with decreased blood supply to the fetus in this position. Patients with arthritis of the knees and hips may also find this position extremely uncomfortable. Catheterization may also be accomplished with the patient in the lateral to Sims position (three-quarters\u00a0prone).\r\n\r\nThe male urinary sphincter may also be difficult to pass, particularly for older men with prostatic hypertrophy.\r\n\r\nThere are two types of\u00a0urethral\u00a0catheterization: intermittent and indwelling.\r\n\r\nIntermittent catheterization (single-lumen catheter) is used for:\r\n<ul>\r\n \t<li>Immediate relief of urinary retention<\/li>\r\n \t<li>Long-term management of incompetent\u00a0bladder<\/li>\r\n \t<li>Obtaining\u00a0a sterile urine specimen<\/li>\r\n \t<li>Assessing\u00a0residual urine in the bladder after voiding (if a bladder scanner is not available)<\/li>\r\n<\/ul>\r\nIndwelling catheterization (double- or triple-lumen catheter) is used for:\r\n<ul>\r\n \t<li>Promoting urinary\u00a0elimination<\/li>\r\n \t<li>Measuring accurate\u00a0urine output<\/li>\r\n \t<li>Preventing skin\u00a0breakdown<\/li>\r\n \t<li>Facilitating wound\u00a0management<\/li>\r\n \t<li>Allowing surgical repair of\u00a0urethra, bladder, or\u00a0surrounding structures<\/li>\r\n \t<li>Instilling irrigation\u00a0fluids or medications<\/li>\r\n \t<li>Assessing abdominal\/pelvic pain<\/li>\r\n \t<li><span style=\"line-height: 1.5;\">Investigating conditions of the genitourinary system<\/span><\/li>\r\n<\/ul>\r\nThe steps for inserting an intermittent or an indwelling catheter are the same, except that the indwelling catheter requires a closed drainage system and inflation of a balloon to keep the catheter in place. Indwelling catheters may have two\u00a0or three lumens (double or triple lumens). Double-lumen catheters comprise one lumen for draining the urine and a second lumen for inflating a balloon that keeps the catheter in place. Triple-lumen catheters are used for continuous bladder irrigation and for instilling medications into the bladder; the additional lumen delivers the irrigation fluid into the bladder.\r\n\r\nIndwelling urinary catheters are made of latex or silicone. Intermittent catheters may be made of rubber or polyvinyl chloride (PVC), making them softer and more flexible than indwelling catheters (Perry et al., 2014). The size of a urinary catheter is based on the French (Fr) scale, which reflects the internal diameter of the tube. Recommended catheter size is 12 to 16 Fr for females, and 14 to 16 Fr for males. Smaller sizes are used for infants and children. The balloon size also varies with catheters:\u00a0smaller for children (3 ml) and larger for continuous bladder irrigation (30 ml). The size of the catheter is usually printed on the side of the catheter port.\r\n\r\nAn indwelling catheter is attached to a drainage bag to allow for unrestricted flow of urine. Make sure that the urinary bag hangs below the level of the patient's bladder so that urine flows out of the bladder. The bag should not touch the floor, and the patient should carry the bag below the level of the bladder when ambulating. To review how to insert an indwelling catheter, see Checklist 80.\r\n<table style=\"border-color: #000000; height: 1221px;\" border=\"1px solid rgb(0, 0, 0)\" width=\"100%\"><caption><a id=\"checklist80\"><\/a>Checklist 80: Insertion of an Intermittent or Indwelling Urinary Catheter<\/caption>\r\n<tbody>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 75px; text-align: center;\" colspan=\"5\">\r\n<h5 style=\"text-align: center;\"><span style=\"color: #000000;\">Disclaimer:\u00a0Always review and follow your hospital policy regarding this specific skill.<\/span><\/h5>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 75px;\" colspan=\"5\">\r\n<h5><span style=\"color: #333333;\">Safety considerations:\u00a0<\/span><\/h5>\r\n<ul>\r\n \t<li>Perform hand hygiene.<\/li>\r\n \t<li><span style=\"color: #333333;\">Check room for additional precautions.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Introduce yourself to patient.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Confirm patient ID using two patient identifiers (e.g., name and date of birth).<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Explain process to patient;\u00a0offer analgesia, bathroom, etc.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Listen and attend to patient cues.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Ensure patient's privacy and dignity.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Assess ABCCS\/suction\/oxygen\/safety.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Apply principles of\u00a0asepsis and safety.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Check vital signs.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Complete necessaryfocused assessments.<\/span><\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px; text-align: center;\" colspan=\"3\">\r\n<h4 style=\"text-align: center;\">Steps<\/h4>\r\n<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px; text-align: center;\" colspan=\"2\">\r\n<h4 style=\"text-align: center;\">\u00a0Additional Information<\/h4>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">1. Verify physician order for catheter insertion. Assess for bladder fullness and pain by palpation or by using a bladder scanner.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Palpation of a full bladder will cause an urge to void and\/or pain.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">2. Position patient prone to semi-upright with knees raised; apply gloves; and inspect perineal region for erythema, drainage, and odour. Also assess perineal\u00a0anatomy.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Assessment of perineal area allows for determination of perineal condition and position of anatomical landmarks to assist with insertion.\r\n\r\n[caption id=\"attachment_5559\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1511.jpg\"><img class=\"wp-image-5559 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1511-150x150.jpg\" alt=\"Apply non-sterile gloves\" width=\"150\" height=\"150\" \/><\/a> Apply non-sterile gloves[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">3. Remove gloves and perform hand hygiene.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This prevents transmission of microorganisms.\r\n\r\n[caption id=\"attachment_5569\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1528.jpg\"><img class=\"wp-image-5569 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1528-150x150.jpg\" alt=\"Remove non-sterile gloves\" width=\"150\" height=\"150\" \/><\/a> Remove non-sterile gloves[\/caption]\r\n\r\n[caption id=\"attachment_6220\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1093.jpg\"><img class=\"wp-image-6220 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1093-150x150.jpg\" alt=\"Perform hand hygiene\" width=\"150\" height=\"150\" \/><\/a> Perform hand hygiene[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">4. Gather supplies:\r\n<ul>\r\n \t<li>Sterile gloves<\/li>\r\n \t<li>Catheterization kit<\/li>\r\n \t<li>Cleaning solution<\/li>\r\n \t<li>Lubricant (if not in kit)<\/li>\r\n \t<li>Prefilled syringe for balloon inflation as per catheter size<\/li>\r\n \t<li>Urinary bag<\/li>\r\n \t<li>Foley catheter<\/li>\r\n<\/ul>\r\n<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Preparation ahead of time enhances patient comfort and safety.\r\n\r\n[caption id=\"attachment_5677\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1787.jpg\"><img class=\"wp-image-5677 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1787-150x150.jpg\" alt=\"Prepare sterile field\" width=\"150\" height=\"150\" \/><\/a> Prepare sterile field[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">5. Check for size and type of catheter, and use smallest size of catheter possible.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Larger catheter size increases the risk of urethral trauma.\r\n\r\n[caption id=\"attachment_5678\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1788.jpg\"><img class=\"wp-image-5678 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1788-150x150.jpg\" alt=\"Choose smallest catheter size possible\" width=\"150\" height=\"150\" \/><\/a> Choose smallest catheter size possible[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">6. Place waterproof pad under patient.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This step prevents soiling of bed linens.\r\n\r\n[caption id=\"attachment_5675\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1785.jpg\"><img class=\"wp-image-5675 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1785-150x150.jpg\" alt=\"Place waterproof pad under patient\" width=\"150\" height=\"150\" \/><\/a> Place waterproof pad under patient[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">7. Positioning of patient depends on gender.\r\n\r\n<em>Female patient:<\/em> On back with knees flexed and thighs relaxed so that hips rotate to expose perineal area. Alternatively, if patient cannot abduct leg at the hip, patient can be side-lying with upper leg flexed at knee and hip, supported by pillows.\r\n\r\n<em>Male patient:<\/em> Supine with legs extended and slightly apart.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Patient should be comfortable, with perineum or penis exposed, for ease and safety in completing procedure.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">8. Place\u00a0a blanket or sheet to cover patient\u00a0and expose only required anatomical areas.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This step helps protect patient dignity.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">9. Apply clean gloves and wash perineal area with warm water and soap or perineal cleanser according to\u00a0agency policy.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Cleaning removes any secretions, urine, and feces, and reduces risk of CAUTI.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">10. Ensure adequate lighting.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Adequate lighting helps with accuracy and speed of catheter insertion.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">11. Perform hand hygiene.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This reduces the transmission of microorganisms.\r\n\r\n[caption id=\"attachment_5550\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1492.jpg\"><img class=\"wp-image-5550 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1492-150x150.jpg\" alt=\"Perform hand hygiene\" width=\"150\" height=\"150\" \/><\/a> Perform hand hygiene[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">12. Add supplies and cleaning solution to\u00a0catheterization kit, and according to\u00a0agency policy.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This step ensures preparation and organization for procedure.\r\n\r\n[caption id=\"attachment_5684\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1799.jpg\"><img class=\"wp-image-5684 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1799-150x150.jpg\" alt=\"Open sterile catheterization kit and add supplies as necessary\" width=\"150\" height=\"150\" \/><\/a> Add supplies as necessary[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">13. If using indwelling catheter and closed drainage system, attach urinary bag to the bed and ensure that the clamp is closed.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Urinary bag should be closed to prevent urine drainage leaving\u00a0bag.\r\n\r\n[caption id=\"attachment_6386\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_2104.jpg\"><img class=\"wp-image-6386 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_2104-150x150.jpg\" alt=\"Urinary bag\" width=\"150\" height=\"150\" \/><\/a> Urinary bag[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">14. Apply sterile gloves using sterile technique.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This reduces the transmission of microorganisms.\r\n\r\n[caption id=\"attachment_5680\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1791.jpg\"><img class=\"wp-image-5680 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1791-150x150.jpg\" alt=\"Apply sterile gloves\" width=\"150\" height=\"150\" \/><\/a> Apply sterile gloves[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">15. Drape patient with drape found in catheterization kit, either using sterile gloves or using ungloved hands and only touching the outer edges of the drape. Ensure that any sterile supplies touch only the middle of the sterile drape (not the edges), and that sterile gloves do not touch non-sterile surfaces. Drape patient to expose perineum or penis.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">The outer\u00a02.5 cm is considered non-sterile on a sterile\u00a0drape.\r\n\r\n[caption id=\"attachment_5676\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1786.jpg\"><img class=\"wp-image-5676 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1786-150x150.jpg\" alt=\"Cover patient with sterile drape\" width=\"150\" height=\"150\" \/><\/a> Cover patient with sterile drape[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">16. Lubricate tip of catheter using sterile lubricant included in tray, or add lubricant using sterile technique.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Lubrication minimizes urethral trauma and discomfort during procedure.\r\n\r\n[caption id=\"attachment_5683\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1795.jpg\"><img class=\"wp-image-5683 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1795-150x150.jpg\" alt=\"Lubricate tip of catheter\" width=\"150\" height=\"150\" \/><\/a> Lubricate tip of catheter[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">17. Check balloon inflation using a sterile syringe.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This maintains sterility of catheter.\r\n\r\n[caption id=\"attachment_5682\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1794.jpg\"><img class=\"wp-image-5682 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1794-150x150.jpg\" alt=\"Check balloon inflation using a sterile syringe\" width=\"150\" height=\"150\" \/><\/a> Check balloon inflation using a sterile syringe[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">18. Place sterile tray with catheter between patient's legs.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Sterile tray will collect urine once catheter tip is inserted into bladder.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">19. Clean perineal area as follows.\r\n\r\n<em>Female patient<\/em>: Separate labia with fingers of non-dominant hand (now contaminated and no longer sterile). Using sterile technique and dominant hand, clean labia and urethral meatus from clitoris to anus, and from outside labia to inner labial folds and urethral meatus. Use sterile forceps and a new cotton swab with each cleansing stroke.\r\n\r\n<em>Male patient<\/em>: Gently grasp penis at shaft and hold it at right angle to the body throughout procedure with non-dominant hand\u00a0(now contaminated and no longer sterile).\u00a0Using sterile technique and dominant hand, clean urethral meatus in a circular motion working outward from meatus. Use\u00a0sterile forceps and a new cotton swab with each cleansing stroke.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This reduces the transmission of microorganisms.\r\n\r\n[caption id=\"attachment_5685\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1800.jpg\"><img class=\"wp-image-5685 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1800-150x150.jpg\" alt=\"Cleanse perineal area\" width=\"150\" height=\"150\" \/><\/a> Cleanse perineal area[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">20. Pick up catheter with sterile dominant hand 7.5 to 10 cm below the tip of the catheter.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Holding catheter closer to the tip will help to control and manipulate catheter during insertion.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">21. Insert catheter as follows.\r\n\r\n<em>Female patient<\/em>:\r\n<ul>\r\n \t<li>Ask patient to bear down gently (as if to void) to help expose urethral meatus.<\/li>\r\n \t<li>Advance catheter 5 to 7.5 cm until urine flows from catheter, then advance an additional 5 cm.<\/li>\r\n<\/ul>\r\n<em>Male patient<\/em>:\r\n<ul>\r\n \t<li>Hold penis perpendicular to body and pull up slightly\u00a0on shaft.<\/li>\r\n \t<li>Ask patient to bear down gently (as if to void) and slowly insert catheter through urethral meatus.<\/li>\r\n \t<li>Advance catheter 17 to 22.5 cm or until urine flows from catheter.<\/li>\r\n<\/ul>\r\n<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This process helps visualize urethral meatus and relax external urinary sphincter.\r\n\r\n[caption id=\"attachment_5686\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1801.jpg\"><img class=\"wp-image-5686 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1801-150x150.jpg\" alt=\"Insert catheter gently\" width=\"150\" height=\"150\" \/><\/a> Insert catheter gently[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"5\"><strong>Note:<\/strong>\u00a0If urine does not appear in a female patient, the catheter may be in the patient's vagina. You may leave catheter in vagina as a landmark, and insert another sterile catheter.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"5\"><strong>Note:<\/strong> If catheter does not advance in a male patient, do not use force. Ask patient to take deep breaths and try again. If catheter still does not advance, stop procedure and inform physician. Patient may have an enlarged prostate or urethral obstruction.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">22. Place catheter in sterile tray and collect urine specimen if required.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Urine specimen may be required for analysis. Collect as per agency policy.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">23. Slowly inflate balloon for indwelling catheters according to\u00a0catheter size, using\u00a0prefilled syringe.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">The size of balloon is marked on the catheter port.\r\n\r\n[caption id=\"attachment_5687\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1803.jpg\"><img class=\"wp-image-5687 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1803-150x150.jpg\" alt=\"Slowly inflate balloon\" width=\"150\" height=\"150\" \/><\/a> Slowly inflate balloon[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"5\"><strong>Note:<\/strong> If patient experiences pain on balloon inflation, deflate balloon, allow urine to drain, advance catheter slightly, and reinflate balloon.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">24. After balloon is inflated, pull gently on catheter until resistance is felt and then advance the catheter again.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Moving catheter back into bladder will avoid placing pressure on bladder neck.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">25. Connect urinary bag to catheter using sterile technique.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Keep urinary bag below level of patient's bladder.\r\n\r\n[caption id=\"attachment_5688\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1805.jpg\"><img class=\"wp-image-5688 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1805-150x150.jpg\" alt=\"Connect urinary bag to catheter using sterile technique\" width=\"150\" height=\"150\" \/><\/a> Connect urinary bag to catheter using sterile technique[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">26. Secure catheter to patient's leg using securement device at tubing just above catheter bifurcation.\r\n\r\n<em>Female patient<\/em>: Secure catheter to inner thigh, allowing enough slack to prevent tension.\r\n\r\n<em>Male patient<\/em>: Secure catheter to upper thigh (with penis directed downward) or abdomen (with penis directed toward chest), allowing enough slack to prevent tension. Ensure foreskin is not retracted.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Securing catheter reduces risk of CAUTI, urethral erosion, and accidental catheter removal.\r\n\r\n[caption id=\"attachment_5689\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1806.jpg\"><img class=\"wp-image-5689 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1806-150x150.jpg\" alt=\"Secure catheter to patient's leg\" width=\"150\" height=\"150\" \/><\/a> Secure catheter to patient's leg[\/caption]\r\n\r\nFor male patients, leaving the foreskin retracted can cause pain and edema.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">27. Dispose of supplies following\u00a0agency policy.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This reduces the transmission of microorganisms.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">28. Remove gloves and &lt;a href=\"\/clinicalskills\/chapter\/1-6-hand-hygiene\/\"&gt;perform hand hygiene.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This reduces the transmission of microorganisms.\r\n\r\n[caption id=\"attachment_5575\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1581.jpg\"><img class=\"wp-image-5575 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1581-150x150.jpg\" alt=\"Hand hygiene with ABHR\" width=\"150\" height=\"150\" \/><\/a> Hand hygiene with ABHR[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">29. Document procedure according to\u00a0agency policy, including\u00a0patient tolerance of procedure, any unexpected outcomes, and urine output.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Timely and accurate documentation promotes patient safety.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"5\">Data source: BCIT, 2015c; Perry et al., 2014<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<h3><a id=\"video10.2\"><\/a>Video 10.2<\/h3>\r\n<div class=\"textbox shaded\" style=\"text-align: center;\">Watch the video\u00a0<a href=\"https:\/\/barabus.tru.ca\/nursing\/urinary_catherization_male.html\"><em>Urinary Catheterization (Male)<\/em><\/a>\u00a0by <a href=\"\/clinicalskills\/back-matter\/appendix-3\/\">Ren\u00e9e Anderson and Wendy McKenzie<\/a>, Thompson Rivers University.<\/div>\r\n<h3><a id=\"video10.3\"><\/a>Video 10.3<\/h3>\r\n<div class=\"textbox shaded\" style=\"text-align: center;\">Watch the video\u00a0<a href=\"https:\/\/barabus.tru.ca\/nursing\/urinary_catherization_female.html\"><em>Urinary Catheterization (Female)<\/em><\/a>\u00a0by <a href=\"\/clinicalskills\/back-matter\/appendix-3\/\">Ren\u00e9e Anderson and Wendy McKenzie<\/a>, Thompson Rivers University.<\/div>\r\n<h2>Removing a Urinary Catheter<\/h2>\r\nPatients require an order to have an indwelling catheter removed. Although an order is required, it remains the responsibility of the health care provider to evaluate if the indwelling catheter is necessary for the patient's recovery.\r\n\r\nA urinary catheter should be removed as soon as possible when it is no longer needed.\u00a0For post-operative patients who\u00a0require an indwelling catheter, the catheter should be removed preferably within 24 hours. The following are appropriate uses of an indwelling catheter (Gould et al., 2009):\r\n<ul>\r\n \t<li>Improved comfort for end-of-life care<\/li>\r\n \t<li>Assisting in the healing process of an open sacral or perineal pressure ulcer<\/li>\r\n \t<li>Patients requiring prolonged immobilization (unstable thoracic or lumbar fractures, multiple traumatic injuries)<\/li>\r\n \t<li>Select surgical procedures (prolonged procedures, urological surgeries, etc.)<\/li>\r\n \t<li>Intra-operative monitoring of urinary output<\/li>\r\n \t<li>Patients receiving large-volume infusions or diuretic intra-operatively<\/li>\r\n<\/ul>\r\nWhen a urinary catheter is removed, the health care provider must assess if normal bladder function has returned. The health care provider should report any hematuria, inability or difficulty voiding, or any new incontinence after catheter removal. Prior to removing a urinary catheter, the patient requires education on the process of removal, and on expected and unexpected outcomes (e.g.,\u00a0a mild burning sensation with the first void)\u00a0(VCH Professional Practice, 2014). The health care provider should instruct patients to\r\n<ul>\r\n \t<li>Increase or maintain fluid intake (unless contraindicated)<\/li>\r\n \t<li>Void when able and within six to\u00a0eight\u00a0hours after removal of the\u00a0catheter<\/li>\r\n \t<li>Inform the health care provider when he or she has voided, and measure the amount, colour, and any abnormal findings; ensure first void (urine output) is measured as per agency policy<\/li>\r\n \t<li>Report any burning, pain, discomfort, or small amount of urine volume<\/li>\r\n \t<li>Report an inability to void, bladder tenderness, or distension<\/li>\r\n \t<li>Report any signs of a CAUTI<\/li>\r\n<\/ul>\r\nReview the steps in Checklist 81 on how to remove an indwelling catheter.\r\n<table style=\"border-color: #000000; width: 100%;\" border=\"1px solid rgb(0, 0, 0)\"><caption><a id=\"checklist81\"><\/a>Checklist 81: Removing an Indwelling Catheter<\/caption>\r\n<tbody>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 75px; text-align: center;\" colspan=\"4\">\r\n<h5 style=\"text-align: center;\"><span style=\"color: #000000;\">Disclaimer:\u00a0Always review and follow your hospital policy regarding this specific skill.<\/span><\/h5>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 75px;\" colspan=\"4\">\r\n<h5><span style=\"color: #333333;\">Safety considerations:<\/span><\/h5>\r\n<ul>\r\n \t<li>Perform hand hygiene.<\/li>\r\n \t<li><span style=\"color: #333333;\">Check room for additional precautions.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Introduce yourself to patient.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Confirm patient ID using two patient identifiers (e.g., name and date of birth).<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Explain process to patient;\u00a0offer analgesia, bathroom, etc.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Listen and attend to patient cues.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Ensure patient's privacy and dignity.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Assess ABCCS\/suction\/oxygen\/safety.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Apply principles of\u00a0<a style=\"color: #333333;\" title=\"Chapter 1. Infection Control\" href=\"http:\/\/opentextbc.ca\/clinicalskills\/part\/chapter-1-infection-control\/\">asepsis and safet<\/a>y.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Check vital signs.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Complete necessary focused assessments.<\/span><\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">\r\n<h4 style=\"text-align: center;\">Steps<\/h4>\r\n<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">\r\n<h4 style=\"text-align: center;\">\u00a0Additional Information<\/h4>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">1. Verify physician orders, perform hand hygiene, and gather supplies.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Supplies include non-sterile gloves, sterile syringe (verify size of balloon on Foley catheter), waterproof pad, garbage bag, and cleaning supplies for perineal care.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">2. Identify patient using two identifiers. Create privacy and explain procedure for catheter removal.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This ensures you have the correct patient and follows agency policy on proper patient identification.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">3. Educate patient on catheter removal and post-urinary catheter care.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Patient must be informed of what to expect after catheter is removed and how to measure urine output, etc.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">4. Perform hand hygiene and set up supplies.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">\r\n\r\n[caption id=\"attachment_6220\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1093.jpg\"><img class=\"wp-image-6220 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1093-150x150.jpg\" alt=\"Perform hand hygiene\" width=\"150\" height=\"150\" \/><\/a> Perform hand hygiene[\/caption]\r\n\r\nRaise bed to working height.\r\n\r\nOrganize supplies.\r\n\r\nPosition patient supine for easy access.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">5. Apply non-sterile gloves.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This reduces the transfer of microorganisms.\r\n\r\n[caption id=\"attachment_5559\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1511.jpg\"><img class=\"wp-image-5559 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1511-150x150.jpg\" alt=\" Apply non-sterile gloves\" width=\"150\" height=\"150\" \/><\/a> Apply non-sterile gloves[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">6. Measure, empty, and record contents of catheter bag. Remove gloves, perform hand hygiene, and apply new non-sterile gloves.\r\n\r\nRemove catheter securement\/anchor device.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Record drainage amount, colour, and consistency according to\u00a0agency policy.\r\n\r\nAlways change gloves after handling a urinary catheter bag.\r\n\r\nRemoving catheter securement device provides easy access to catheter for cleaning and removing.\r\n\r\n[caption id=\"attachment_6310\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1770.jpg\"><img class=\"wp-image-6310 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1770-150x150.jpg\" alt=\"Remove catheter securement device\" width=\"150\" height=\"150\" \/><\/a> Remove catheter securement device[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">7.\u00a0Perform catheter care with warm water and soap or according to\u00a0agency protocol.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This reduces the transfer of microorganisms into the urethra.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">8. Insert syringe in balloon port and drain fluid from balloon. Verify balloon size on catheter to ensure all fluid is removed from balloon.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">A partially deflated balloon will cause trauma to the urethra wall and pain.\r\n\r\n[caption id=\"attachment_6312\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1773.jpg\"><img class=\"wp-image-6312 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1773-150x150.jpg\" alt=\"Insert syringe in balloon port and drain fluid from balloon\" width=\"150\" height=\"150\" \/><\/a> Insert syringe in balloon port and drain fluid from balloon[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">9. Pull catheter out slowly and smoothly. Catheter should slide out slowly and smoothly.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">If resistance is felt, stop removal and reattempt to remove the fluid from the balloon. Attempt removal again. If unable to remove the catheter, stop and notify physician.\r\n\r\n[caption id=\"attachment_6313\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1774.jpg\"><img class=\"wp-image-6313 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1774-150x150.jpg\" alt=\"Pull catheter out slowly and smoothly\" width=\"150\" height=\"150\" \/><\/a> Pull catheter out slowly and smoothly[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">10. Wrap used catheter in waterproof pad or gloves. Unhook catheter tube from urinary bag. Discard equipment and supplies according to\u00a0agency policy.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This prevents accidental spilling of urine from the catheter.\r\n\r\n[caption id=\"attachment_6319\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1779.jpg\"><img class=\"wp-image-6319 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1779-150x150.jpg\" alt=\"Wrap used catheter in waterproof pad or gloves\" width=\"150\" height=\"150\" \/><\/a> Wrap used catheter in waterproof pad or gloves[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">11. Provide perineal care as required and reposition patient to a comfortable position.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This promotes patient comfort.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">12. Review post-catheter care, fluid intake, and expected and unexpected outcomes with patient.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Ensure patient has access to toilet, commode, bedpan, or urinal. Place call bell within reach. Ensure first void (urine output) is measured as per agency policy.\r\nEncourage patient to maintain or increase fluid intake to maintain normal urine output (unless contraindicated).<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">13. Lower bed to safe position, remove gloves, and perform hand hygiene.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Lowering the bed helps prevent falls. Hand hygiene prevents the transmission of microorganisms from patient to health care provider.\r\n\r\n[caption id=\"attachment_5972\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-247.jpg\"><img class=\"wp-image-5972 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-247-150x150.jpg\" alt=\"Hand hygiene with ABHR\" width=\"150\" height=\"150\" \/><\/a> Hand hygiene with ABHR[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">14. Document procedure according to\u00a0agency policy.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Document time of catheter removal, condition of urethra, and any teaching related to post-catheter care and fluid intake.\r\n\r\nDocument time, amount, and characteristics of first void after catheter removal.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"4\">Data source: ATI, 2015d; BCIT, 2015b; Perry et al., 2014; VCH Professional Practice, 2014<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\nIf a patient is unable to void after six to eight\u00a0hours of removing a urinary catheter, or has the sensation of not emptying the bladder, or is experiencing small voiding amounts with increased frequency, a bladder scan may be performed. A bladder scan can assess if excessive urine is being retained. Notify the health care provider if patient is unable to void within six to eight\u00a0hours of removal of a urinary catheter. If a patient is found to have retained urine in the bladder and is unable to void, an intermittent\/straight catheterization should be performed\u00a0(Perry et al., 2014).\r\n<h3><a id=\"video10.4\"><\/a>Video 10.4<\/h3>\r\n<div class=\"textbox shaded\" style=\"text-align: center;\">Watch the video <a href=\"https:\/\/barabus.tru.ca\/nursing\/foley_catheter_removal.html\"><em>Foley Catheter Removal<\/em><\/a> by <a href=\"\/clinicalskills\/back-matter\/appendix-3\/\">Ren\u00e9e Anderson and Wendy McKenzie<\/a>, Thompson Rivers University.<\/div>\r\n<div class=\"textbox shaded\" style=\"text-align: center;\"><a href=\"http:\/\/journals.lww.com\/nursingmadeincrediblyeasy\/Fulltext\/2012\/07000\/To_scan_or_not_to_scan__Detecting_urinary.13.aspx\">Read the <em>To Scan or Not To Scan<\/em> journal article<\/a> for more information on bladder scanning.<\/div>\r\n<div class=\"textbox textbox--exercises\"><header class=\"textbox__header\">\r\n<p class=\"textbox__title\">Critical Thinking Exercises<\/p>\r\n\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n<ol>\r\n \t<li>Describe the different techniques for cleansing a female and a male patient prior to catheterization.<\/li>\r\n \t<li>Your male patient complains of pain while you are inserting a urinary catheter. Describe your next steps.<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>","rendered":"<p>Urinary elimination is a basic human function that can be compromised by illness, surgery, and other conditions. Urinary catheterization may be used to support urinary elimination in patients who are unable to void naturally. Urinary catheterization may be required:<\/p>\n<ul>\n<li>In cases of acute urinary retention<\/li>\n<li>When intake and output are being monitored<\/li>\n<li>For preoperative management<\/li>\n<li>To enhance healing in incontinent patients with open sacral and perineal wounds<\/li>\n<li>For patients on prolonged bedrest<\/li>\n<li>For patients\u00a0needing end-of-life care<\/li>\n<\/ul>\n<h2>Catheter-Associated Urinary Tract Infections<\/h2>\n<p>Catheter-associated urinary tract infections (CAUTI) are a common complication of indwelling urinary catheters\u00a0and have been associated with increased morbidity, mortality, hospital cost, and length of stay (Gould et al., 2009). Urinary drainage systems are often reservoirs for multidrug-resistant organisms (MDROs) and a source of the transmission of microorganisms to other patients (Gould et al., 2009). The most important risk factor for developing a CAUTI, a health care associated infection (HAI), is the prolonged use of a urinary catheter (Centers for Disease Control and Prevention [CDC], 2015). Urinary tract infections (UTIs) are the most commonly reported HAIs in acute care hospitals and account for more than 30% of all reported infections (Gould et al., 2009). Catheters in place for more than a few days place the patient at risk for a CAUTI. A health care provider must assess patients for signs and symptoms of CAUTIs and report immediately to the primary health care provider. Signs and symptoms of a CAUTI include:<\/p>\n<ul>\n<li>Fever, chills<\/li>\n<li>Lethargy<\/li>\n<li>Lower abdominal pain<\/li>\n<li>Back or flank pain<\/li>\n<li>Urgency, frequency of urination<\/li>\n<li>Painful urination<\/li>\n<li>Hematuria<\/li>\n<li>Change in mental status (confusion, delirium, or agitation), most commonly seen in older adults<\/li>\n<\/ul>\n<p>The following are practices for preventing CAUTIs (Perry et al., 2014):<\/p>\n<ul>\n<li>Insert urinary catheters using sterile technique.<\/li>\n<li>Only insert indwelling catheters when essential, and remove as soon as possible.<\/li>\n<li>Use the narrowest tube size (gauge) possible.<\/li>\n<li>Provide daily cleansing of the urethral meatus with soap and water or perineal cleanser, following agency policy.<\/li>\n<li>Ensure a closed drainage system.<\/li>\n<li>Ensure that no kinks or blockages occur in the tubing.<\/li>\n<li>Secure the catheter tube to prevent urethral damage.<\/li>\n<li>Avoid use of antiseptic solutions on the urethral meatus and\/or in the urinary bag.<\/li>\n<\/ul>\n<h2>Urinary Catheterization<\/h2>\n<p>Urinary catheterization refers to the insertion of a catheter tube through the urethra and into the bladder\u00a0to drain urine. Although not a particularly complex skill, urethral catheterization can be difficult to master. Both male and female catheterizations present unique challenges.<\/p>\n<p>Having\u00a0adequate lighting and visualization is helpful, but does not ensure entrance of the catheter into the female urethra. It is not uncommon for the catheter to enter the vagina. Leaving the catheter in the vagina can assist in the correct insertion of a new catheter into the urethra, but you must remember\u00a0to remove the one in the vagina.<\/p>\n<p>For some women, the supine lithotomy position can be very uncomfortable or even dangerous. For example, patients\u00a0in the last trimester of pregnancy\u00a0may\u00a0faint with decreased blood supply to the fetus in this position. Patients with arthritis of the knees and hips may also find this position extremely uncomfortable. Catheterization may also be accomplished with the patient in the lateral to Sims position (three-quarters\u00a0prone).<\/p>\n<p>The male urinary sphincter may also be difficult to pass, particularly for older men with prostatic hypertrophy.<\/p>\n<p>There are two types of\u00a0urethral\u00a0catheterization: intermittent and indwelling.<\/p>\n<p>Intermittent catheterization (single-lumen catheter) is used for:<\/p>\n<ul>\n<li>Immediate relief of urinary retention<\/li>\n<li>Long-term management of incompetent\u00a0bladder<\/li>\n<li>Obtaining\u00a0a sterile urine specimen<\/li>\n<li>Assessing\u00a0residual urine in the bladder after voiding (if a bladder scanner is not available)<\/li>\n<\/ul>\n<p>Indwelling catheterization (double- or triple-lumen catheter) is used for:<\/p>\n<ul>\n<li>Promoting urinary\u00a0elimination<\/li>\n<li>Measuring accurate\u00a0urine output<\/li>\n<li>Preventing skin\u00a0breakdown<\/li>\n<li>Facilitating wound\u00a0management<\/li>\n<li>Allowing surgical repair of\u00a0urethra, bladder, or\u00a0surrounding structures<\/li>\n<li>Instilling irrigation\u00a0fluids or medications<\/li>\n<li>Assessing abdominal\/pelvic pain<\/li>\n<li><span style=\"line-height: 1.5;\">Investigating conditions of the genitourinary system<\/span><\/li>\n<\/ul>\n<p>The steps for inserting an intermittent or an indwelling catheter are the same, except that the indwelling catheter requires a closed drainage system and inflation of a balloon to keep the catheter in place. Indwelling catheters may have two\u00a0or three lumens (double or triple lumens). Double-lumen catheters comprise one lumen for draining the urine and a second lumen for inflating a balloon that keeps the catheter in place. Triple-lumen catheters are used for continuous bladder irrigation and for instilling medications into the bladder; the additional lumen delivers the irrigation fluid into the bladder.<\/p>\n<p>Indwelling urinary catheters are made of latex or silicone. Intermittent catheters may be made of rubber or polyvinyl chloride (PVC), making them softer and more flexible than indwelling catheters (Perry et al., 2014). The size of a urinary catheter is based on the French (Fr) scale, which reflects the internal diameter of the tube. Recommended catheter size is 12 to 16 Fr for females, and 14 to 16 Fr for males. Smaller sizes are used for infants and children. The balloon size also varies with catheters:\u00a0smaller for children (3 ml) and larger for continuous bladder irrigation (30 ml). The size of the catheter is usually printed on the side of the catheter port.<\/p>\n<p>An indwelling catheter is attached to a drainage bag to allow for unrestricted flow of urine. Make sure that the urinary bag hangs below the level of the patient&#8217;s bladder so that urine flows out of the bladder. The bag should not touch the floor, and the patient should carry the bag below the level of the bladder when ambulating. To review how to insert an indwelling catheter, see Checklist 80.<\/p>\n<table style=\"border-color: #000000; height: 1221px; width: 100%;\">\n<caption><a id=\"checklist80\"><\/a>Checklist 80: Insertion of an Intermittent or Indwelling Urinary Catheter<\/caption>\n<tbody>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 75px; text-align: center;\" colspan=\"5\">\n<h5 style=\"text-align: center;\"><span style=\"color: #000000;\">Disclaimer:\u00a0Always review and follow your hospital policy regarding this specific skill.<\/span><\/h5>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 75px;\" colspan=\"5\">\n<h5><span style=\"color: #333333;\">Safety considerations:\u00a0<\/span><\/h5>\n<ul>\n<li>Perform hand hygiene.<\/li>\n<li><span style=\"color: #333333;\">Check room for additional precautions.<\/span><\/li>\n<li><span style=\"color: #333333;\">Introduce yourself to patient.<\/span><\/li>\n<li><span style=\"color: #333333;\">Confirm patient ID using two patient identifiers (e.g., name and date of birth).<\/span><\/li>\n<li><span style=\"color: #333333;\">Explain process to patient;\u00a0offer analgesia, bathroom, etc.<\/span><\/li>\n<li><span style=\"color: #333333;\">Listen and attend to patient cues.<\/span><\/li>\n<li><span style=\"color: #333333;\">Ensure patient&#8217;s privacy and dignity.<\/span><\/li>\n<li><span style=\"color: #333333;\">Assess ABCCS\/suction\/oxygen\/safety.<\/span><\/li>\n<li><span style=\"color: #333333;\">Apply principles of\u00a0asepsis and safety.<\/span><\/li>\n<li><span style=\"color: #333333;\">Check vital signs.<\/span><\/li>\n<li><span style=\"color: #333333;\">Complete necessaryfocused assessments.<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px; text-align: center;\" colspan=\"3\">\n<h4 style=\"text-align: center;\">Steps<\/h4>\n<\/td>\n<td style=\"border: 1px solid #000000; width: 250px; text-align: center;\" colspan=\"2\">\n<h4 style=\"text-align: center;\">\u00a0Additional Information<\/h4>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">1. Verify physician order for catheter insertion. Assess for bladder fullness and pain by palpation or by using a bladder scanner.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Palpation of a full bladder will cause an urge to void and\/or pain.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">2. Position patient prone to semi-upright with knees raised; apply gloves; and inspect perineal region for erythema, drainage, and odour. Also assess perineal\u00a0anatomy.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Assessment of perineal area allows for determination of perineal condition and position of anatomical landmarks to assist with insertion.<\/p>\n<figure id=\"attachment_5559\" aria-describedby=\"caption-attachment-5559\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1511.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-5559 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1511-150x150.jpg\" alt=\"Apply non-sterile gloves\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5559\" class=\"wp-caption-text\">Apply non-sterile gloves<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">3. Remove gloves and perform hand hygiene.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This prevents transmission of microorganisms.<\/p>\n<figure id=\"attachment_5569\" aria-describedby=\"caption-attachment-5569\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1528.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-5569 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1528-150x150.jpg\" alt=\"Remove non-sterile gloves\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5569\" class=\"wp-caption-text\">Remove non-sterile gloves<\/figcaption><\/figure>\n<figure id=\"attachment_6220\" aria-describedby=\"caption-attachment-6220\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1093.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-6220 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1093-150x150.jpg\" alt=\"Perform hand hygiene\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-6220\" class=\"wp-caption-text\">Perform hand hygiene<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">4. Gather supplies:<\/p>\n<ul>\n<li>Sterile gloves<\/li>\n<li>Catheterization kit<\/li>\n<li>Cleaning solution<\/li>\n<li>Lubricant (if not in kit)<\/li>\n<li>Prefilled syringe for balloon inflation as per catheter size<\/li>\n<li>Urinary bag<\/li>\n<li>Foley catheter<\/li>\n<\/ul>\n<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Preparation ahead of time enhances patient comfort and safety.<\/p>\n<figure id=\"attachment_5677\" aria-describedby=\"caption-attachment-5677\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1787.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-5677 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1787-150x150.jpg\" alt=\"Prepare sterile field\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5677\" class=\"wp-caption-text\">Prepare sterile field<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">5. Check for size and type of catheter, and use smallest size of catheter possible.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Larger catheter size increases the risk of urethral trauma.<\/p>\n<figure id=\"attachment_5678\" aria-describedby=\"caption-attachment-5678\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1788.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-5678 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1788-150x150.jpg\" alt=\"Choose smallest catheter size possible\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5678\" class=\"wp-caption-text\">Choose smallest catheter size possible<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">6. Place waterproof pad under patient.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This step prevents soiling of bed linens.<\/p>\n<figure id=\"attachment_5675\" aria-describedby=\"caption-attachment-5675\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1785.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-5675 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1785-150x150.jpg\" alt=\"Place waterproof pad under patient\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5675\" class=\"wp-caption-text\">Place waterproof pad under patient<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">7. Positioning of patient depends on gender.<\/p>\n<p><em>Female patient:<\/em> On back with knees flexed and thighs relaxed so that hips rotate to expose perineal area. Alternatively, if patient cannot abduct leg at the hip, patient can be side-lying with upper leg flexed at knee and hip, supported by pillows.<\/p>\n<p><em>Male patient:<\/em> Supine with legs extended and slightly apart.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Patient should be comfortable, with perineum or penis exposed, for ease and safety in completing procedure.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">8. Place\u00a0a blanket or sheet to cover patient\u00a0and expose only required anatomical areas.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This step helps protect patient dignity.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">9. Apply clean gloves and wash perineal area with warm water and soap or perineal cleanser according to\u00a0agency policy.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Cleaning removes any secretions, urine, and feces, and reduces risk of CAUTI.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">10. Ensure adequate lighting.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Adequate lighting helps with accuracy and speed of catheter insertion.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">11. Perform hand hygiene.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This reduces the transmission of microorganisms.<\/p>\n<figure id=\"attachment_5550\" aria-describedby=\"caption-attachment-5550\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1492.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-5550 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1492-150x150.jpg\" alt=\"Perform hand hygiene\" width=\"150\" height=\"150\" srcset=\"https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1492-150x150.jpg 150w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1492-65x66.jpg 65w\" sizes=\"auto, (max-width: 150px) 100vw, 150px\" \/><\/a><figcaption id=\"caption-attachment-5550\" class=\"wp-caption-text\">Perform hand hygiene<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">12. Add supplies and cleaning solution to\u00a0catheterization kit, and according to\u00a0agency policy.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This step ensures preparation and organization for procedure.<\/p>\n<figure id=\"attachment_5684\" aria-describedby=\"caption-attachment-5684\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1799.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-5684 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1799-150x150.jpg\" alt=\"Open sterile catheterization kit and add supplies as necessary\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5684\" class=\"wp-caption-text\">Add supplies as necessary<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">13. If using indwelling catheter and closed drainage system, attach urinary bag to the bed and ensure that the clamp is closed.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Urinary bag should be closed to prevent urine drainage leaving\u00a0bag.<\/p>\n<figure id=\"attachment_6386\" aria-describedby=\"caption-attachment-6386\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_2104.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-6386 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_2104-150x150.jpg\" alt=\"Urinary bag\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-6386\" class=\"wp-caption-text\">Urinary bag<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">14. Apply sterile gloves using sterile technique.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This reduces the transmission of microorganisms.<\/p>\n<figure id=\"attachment_5680\" aria-describedby=\"caption-attachment-5680\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1791.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-5680 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1791-150x150.jpg\" alt=\"Apply sterile gloves\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5680\" class=\"wp-caption-text\">Apply sterile gloves<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">15. Drape patient with drape found in catheterization kit, either using sterile gloves or using ungloved hands and only touching the outer edges of the drape. Ensure that any sterile supplies touch only the middle of the sterile drape (not the edges), and that sterile gloves do not touch non-sterile surfaces. Drape patient to expose perineum or penis.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">The outer\u00a02.5 cm is considered non-sterile on a sterile\u00a0drape.<\/p>\n<figure id=\"attachment_5676\" aria-describedby=\"caption-attachment-5676\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1786.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-5676 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1786-150x150.jpg\" alt=\"Cover patient with sterile drape\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5676\" class=\"wp-caption-text\">Cover patient with sterile drape<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">16. Lubricate tip of catheter using sterile lubricant included in tray, or add lubricant using sterile technique.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Lubrication minimizes urethral trauma and discomfort during procedure.<\/p>\n<figure id=\"attachment_5683\" aria-describedby=\"caption-attachment-5683\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1795.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-5683 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1795-150x150.jpg\" alt=\"Lubricate tip of catheter\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5683\" class=\"wp-caption-text\">Lubricate tip of catheter<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">17. Check balloon inflation using a sterile syringe.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This maintains sterility of catheter.<\/p>\n<figure id=\"attachment_5682\" aria-describedby=\"caption-attachment-5682\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1794.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-5682 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1794-150x150.jpg\" alt=\"Check balloon inflation using a sterile syringe\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5682\" class=\"wp-caption-text\">Check balloon inflation using a sterile syringe<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">18. Place sterile tray with catheter between patient&#8217;s legs.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Sterile tray will collect urine once catheter tip is inserted into bladder.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">19. Clean perineal area as follows.<\/p>\n<p><em>Female patient<\/em>: Separate labia with fingers of non-dominant hand (now contaminated and no longer sterile). Using sterile technique and dominant hand, clean labia and urethral meatus from clitoris to anus, and from outside labia to inner labial folds and urethral meatus. Use sterile forceps and a new cotton swab with each cleansing stroke.<\/p>\n<p><em>Male patient<\/em>: Gently grasp penis at shaft and hold it at right angle to the body throughout procedure with non-dominant hand\u00a0(now contaminated and no longer sterile).\u00a0Using sterile technique and dominant hand, clean urethral meatus in a circular motion working outward from meatus. Use\u00a0sterile forceps and a new cotton swab with each cleansing stroke.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This reduces the transmission of microorganisms.<\/p>\n<figure id=\"attachment_5685\" aria-describedby=\"caption-attachment-5685\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1800.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-5685 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1800-150x150.jpg\" alt=\"Cleanse perineal area\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5685\" class=\"wp-caption-text\">Cleanse perineal area<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">20. Pick up catheter with sterile dominant hand 7.5 to 10 cm below the tip of the catheter.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Holding catheter closer to the tip will help to control and manipulate catheter during insertion.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">21. Insert catheter as follows.<\/p>\n<p><em>Female patient<\/em>:<\/p>\n<ul>\n<li>Ask patient to bear down gently (as if to void) to help expose urethral meatus.<\/li>\n<li>Advance catheter 5 to 7.5 cm until urine flows from catheter, then advance an additional 5 cm.<\/li>\n<\/ul>\n<p><em>Male patient<\/em>:<\/p>\n<ul>\n<li>Hold penis perpendicular to body and pull up slightly\u00a0on shaft.<\/li>\n<li>Ask patient to bear down gently (as if to void) and slowly insert catheter through urethral meatus.<\/li>\n<li>Advance catheter 17 to 22.5 cm or until urine flows from catheter.<\/li>\n<\/ul>\n<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This process helps visualize urethral meatus and relax external urinary sphincter.<\/p>\n<figure id=\"attachment_5686\" aria-describedby=\"caption-attachment-5686\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1801.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-5686 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1801-150x150.jpg\" alt=\"Insert catheter gently\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5686\" class=\"wp-caption-text\">Insert catheter gently<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"5\"><strong>Note:<\/strong>\u00a0If urine does not appear in a female patient, the catheter may be in the patient&#8217;s vagina. You may leave catheter in vagina as a landmark, and insert another sterile catheter.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"5\"><strong>Note:<\/strong> If catheter does not advance in a male patient, do not use force. Ask patient to take deep breaths and try again. If catheter still does not advance, stop procedure and inform physician. Patient may have an enlarged prostate or urethral obstruction.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">22. Place catheter in sterile tray and collect urine specimen if required.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Urine specimen may be required for analysis. Collect as per agency policy.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">23. Slowly inflate balloon for indwelling catheters according to\u00a0catheter size, using\u00a0prefilled syringe.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">The size of balloon is marked on the catheter port.<\/p>\n<figure id=\"attachment_5687\" aria-describedby=\"caption-attachment-5687\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1803.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-5687 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1803-150x150.jpg\" alt=\"Slowly inflate balloon\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5687\" class=\"wp-caption-text\">Slowly inflate balloon<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"5\"><strong>Note:<\/strong> If patient experiences pain on balloon inflation, deflate balloon, allow urine to drain, advance catheter slightly, and reinflate balloon.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">24. After balloon is inflated, pull gently on catheter until resistance is felt and then advance the catheter again.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Moving catheter back into bladder will avoid placing pressure on bladder neck.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">25. Connect urinary bag to catheter using sterile technique.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Keep urinary bag below level of patient&#8217;s bladder.<\/p>\n<figure id=\"attachment_5688\" aria-describedby=\"caption-attachment-5688\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1805.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-5688 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1805-150x150.jpg\" alt=\"Connect urinary bag to catheter using sterile technique\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5688\" class=\"wp-caption-text\">Connect urinary bag to catheter using sterile technique<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">26. Secure catheter to patient&#8217;s leg using securement device at tubing just above catheter bifurcation.<\/p>\n<p><em>Female patient<\/em>: Secure catheter to inner thigh, allowing enough slack to prevent tension.<\/p>\n<p><em>Male patient<\/em>: Secure catheter to upper thigh (with penis directed downward) or abdomen (with penis directed toward chest), allowing enough slack to prevent tension. Ensure foreskin is not retracted.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Securing catheter reduces risk of CAUTI, urethral erosion, and accidental catheter removal.<\/p>\n<figure id=\"attachment_5689\" aria-describedby=\"caption-attachment-5689\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1806.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-5689 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1806-150x150.jpg\" alt=\"Secure catheter to patient's leg\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5689\" class=\"wp-caption-text\">Secure catheter to patient&#8217;s leg<\/figcaption><\/figure>\n<p>For male patients, leaving the foreskin retracted can cause pain and edema.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">27. Dispose of supplies following\u00a0agency policy.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This reduces the transmission of microorganisms.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">28. Remove gloves and &lt;a href=&#8221;\/clinicalskills\/chapter\/1-6-hand-hygiene\/&#8221;&gt;perform hand hygiene.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This reduces the transmission of microorganisms.<\/p>\n<figure id=\"attachment_5575\" aria-describedby=\"caption-attachment-5575\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1581.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-5575 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1581-150x150.jpg\" alt=\"Hand hygiene with ABHR\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5575\" class=\"wp-caption-text\">Hand hygiene with ABHR<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"3\">29. Document procedure according to\u00a0agency policy, including\u00a0patient tolerance of procedure, any unexpected outcomes, and urine output.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Timely and accurate documentation promotes patient safety.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"5\">Data source: BCIT, 2015c; Perry et al., 2014<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h3><a id=\"video10.2\"><\/a>Video 10.2<\/h3>\n<div class=\"textbox shaded\" style=\"text-align: center;\">Watch the video\u00a0<a href=\"https:\/\/barabus.tru.ca\/nursing\/urinary_catherization_male.html\"><em>Urinary Catheterization (Male)<\/em><\/a>\u00a0by <a href=\"\/clinicalskills\/back-matter\/appendix-3\/\">Ren\u00e9e Anderson and Wendy McKenzie<\/a>, Thompson Rivers University.<\/div>\n<h3><a id=\"video10.3\"><\/a>Video 10.3<\/h3>\n<div class=\"textbox shaded\" style=\"text-align: center;\">Watch the video\u00a0<a href=\"https:\/\/barabus.tru.ca\/nursing\/urinary_catherization_female.html\"><em>Urinary Catheterization (Female)<\/em><\/a>\u00a0by <a href=\"\/clinicalskills\/back-matter\/appendix-3\/\">Ren\u00e9e Anderson and Wendy McKenzie<\/a>, Thompson Rivers University.<\/div>\n<h2>Removing a Urinary Catheter<\/h2>\n<p>Patients require an order to have an indwelling catheter removed. Although an order is required, it remains the responsibility of the health care provider to evaluate if the indwelling catheter is necessary for the patient&#8217;s recovery.<\/p>\n<p>A urinary catheter should be removed as soon as possible when it is no longer needed.\u00a0For post-operative patients who\u00a0require an indwelling catheter, the catheter should be removed preferably within 24 hours. The following are appropriate uses of an indwelling catheter (Gould et al., 2009):<\/p>\n<ul>\n<li>Improved comfort for end-of-life care<\/li>\n<li>Assisting in the healing process of an open sacral or perineal pressure ulcer<\/li>\n<li>Patients requiring prolonged immobilization (unstable thoracic or lumbar fractures, multiple traumatic injuries)<\/li>\n<li>Select surgical procedures (prolonged procedures, urological surgeries, etc.)<\/li>\n<li>Intra-operative monitoring of urinary output<\/li>\n<li>Patients receiving large-volume infusions or diuretic intra-operatively<\/li>\n<\/ul>\n<p>When a urinary catheter is removed, the health care provider must assess if normal bladder function has returned. The health care provider should report any hematuria, inability or difficulty voiding, or any new incontinence after catheter removal. Prior to removing a urinary catheter, the patient requires education on the process of removal, and on expected and unexpected outcomes (e.g.,\u00a0a mild burning sensation with the first void)\u00a0(VCH Professional Practice, 2014). The health care provider should instruct patients to<\/p>\n<ul>\n<li>Increase or maintain fluid intake (unless contraindicated)<\/li>\n<li>Void when able and within six to\u00a0eight\u00a0hours after removal of the\u00a0catheter<\/li>\n<li>Inform the health care provider when he or she has voided, and measure the amount, colour, and any abnormal findings; ensure first void (urine output) is measured as per agency policy<\/li>\n<li>Report any burning, pain, discomfort, or small amount of urine volume<\/li>\n<li>Report an inability to void, bladder tenderness, or distension<\/li>\n<li>Report any signs of a CAUTI<\/li>\n<\/ul>\n<p>Review the steps in Checklist 81 on how to remove an indwelling catheter.<\/p>\n<table style=\"border-color: #000000; width: 100%;\">\n<caption><a id=\"checklist81\"><\/a>Checklist 81: Removing an Indwelling Catheter<\/caption>\n<tbody>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 75px; text-align: center;\" colspan=\"4\">\n<h5 style=\"text-align: center;\"><span style=\"color: #000000;\">Disclaimer:\u00a0Always review and follow your hospital policy regarding this specific skill.<\/span><\/h5>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 75px;\" colspan=\"4\">\n<h5><span style=\"color: #333333;\">Safety considerations:<\/span><\/h5>\n<ul>\n<li>Perform hand hygiene.<\/li>\n<li><span style=\"color: #333333;\">Check room for additional precautions.<\/span><\/li>\n<li><span style=\"color: #333333;\">Introduce yourself to patient.<\/span><\/li>\n<li><span style=\"color: #333333;\">Confirm patient ID using two patient identifiers (e.g., name and date of birth).<\/span><\/li>\n<li><span style=\"color: #333333;\">Explain process to patient;\u00a0offer analgesia, bathroom, etc.<\/span><\/li>\n<li><span style=\"color: #333333;\">Listen and attend to patient cues.<\/span><\/li>\n<li><span style=\"color: #333333;\">Ensure patient&#8217;s privacy and dignity.<\/span><\/li>\n<li><span style=\"color: #333333;\">Assess ABCCS\/suction\/oxygen\/safety.<\/span><\/li>\n<li><span style=\"color: #333333;\">Apply principles of\u00a0<a style=\"color: #333333;\" title=\"Chapter 1. Infection Control\" href=\"http:\/\/opentextbc.ca\/clinicalskills\/part\/chapter-1-infection-control\/\">asepsis and safet<\/a>y.<\/span><\/li>\n<li><span style=\"color: #333333;\">Check vital signs.<\/span><\/li>\n<li><span style=\"color: #333333;\">Complete necessary focused assessments.<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">\n<h4 style=\"text-align: center;\">Steps<\/h4>\n<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">\n<h4 style=\"text-align: center;\">\u00a0Additional Information<\/h4>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">1. Verify physician orders, perform hand hygiene, and gather supplies.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Supplies include non-sterile gloves, sterile syringe (verify size of balloon on Foley catheter), waterproof pad, garbage bag, and cleaning supplies for perineal care.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">2. Identify patient using two identifiers. Create privacy and explain procedure for catheter removal.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This ensures you have the correct patient and follows agency policy on proper patient identification.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">3. Educate patient on catheter removal and post-urinary catheter care.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Patient must be informed of what to expect after catheter is removed and how to measure urine output, etc.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">4. Perform hand hygiene and set up supplies.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">\n<figure id=\"attachment_6220\" aria-describedby=\"caption-attachment-6220\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1093.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-6220 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1093-150x150.jpg\" alt=\"Perform hand hygiene\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-6220\" class=\"wp-caption-text\">Perform hand hygiene<\/figcaption><\/figure>\n<p>Raise bed to working height.<\/p>\n<p>Organize supplies.<\/p>\n<p>Position patient supine for easy access.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">5. Apply non-sterile gloves.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This reduces the transfer of microorganisms.<\/p>\n<figure id=\"attachment_5559\" aria-describedby=\"caption-attachment-5559\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1511.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-5559 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1511-150x150.jpg\" alt=\"Apply non-sterile gloves\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5559\" class=\"wp-caption-text\">Apply non-sterile gloves<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">6. Measure, empty, and record contents of catheter bag. Remove gloves, perform hand hygiene, and apply new non-sterile gloves.<\/p>\n<p>Remove catheter securement\/anchor device.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Record drainage amount, colour, and consistency according to\u00a0agency policy.<\/p>\n<p>Always change gloves after handling a urinary catheter bag.<\/p>\n<p>Removing catheter securement device provides easy access to catheter for cleaning and removing.<\/p>\n<figure id=\"attachment_6310\" aria-describedby=\"caption-attachment-6310\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1770.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-6310 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1770-150x150.jpg\" alt=\"Remove catheter securement device\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-6310\" class=\"wp-caption-text\">Remove catheter securement device<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">7.\u00a0Perform catheter care with warm water and soap or according to\u00a0agency protocol.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This reduces the transfer of microorganisms into the urethra.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">8. Insert syringe in balloon port and drain fluid from balloon. Verify balloon size on catheter to ensure all fluid is removed from balloon.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">A partially deflated balloon will cause trauma to the urethra wall and pain.<\/p>\n<figure id=\"attachment_6312\" aria-describedby=\"caption-attachment-6312\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1773.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-6312 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1773-150x150.jpg\" alt=\"Insert syringe in balloon port and drain fluid from balloon\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-6312\" class=\"wp-caption-text\">Insert syringe in balloon port and drain fluid from balloon<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">9. Pull catheter out slowly and smoothly. Catheter should slide out slowly and smoothly.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">If resistance is felt, stop removal and reattempt to remove the fluid from the balloon. Attempt removal again. If unable to remove the catheter, stop and notify physician.<\/p>\n<figure id=\"attachment_6313\" aria-describedby=\"caption-attachment-6313\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1774.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-6313 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1774-150x150.jpg\" alt=\"Pull catheter out slowly and smoothly\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-6313\" class=\"wp-caption-text\">Pull catheter out slowly and smoothly<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">10. Wrap used catheter in waterproof pad or gloves. Unhook catheter tube from urinary bag. Discard equipment and supplies according to\u00a0agency policy.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This prevents accidental spilling of urine from the catheter.<\/p>\n<figure id=\"attachment_6319\" aria-describedby=\"caption-attachment-6319\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1779.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-6319 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1779-150x150.jpg\" alt=\"Wrap used catheter in waterproof pad or gloves\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-6319\" class=\"wp-caption-text\">Wrap used catheter in waterproof pad or gloves<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">11. Provide perineal care as required and reposition patient to a comfortable position.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This promotes patient comfort.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">12. Review post-catheter care, fluid intake, and expected and unexpected outcomes with patient.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Ensure patient has access to toilet, commode, bedpan, or urinal. Place call bell within reach. Ensure first void (urine output) is measured as per agency policy.<br \/>\nEncourage patient to maintain or increase fluid intake to maintain normal urine output (unless contraindicated).<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">13. Lower bed to safe position, remove gloves, and perform hand hygiene.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Lowering the bed helps prevent falls. Hand hygiene prevents the transmission of microorganisms from patient to health care provider.<\/p>\n<figure id=\"attachment_5972\" aria-describedby=\"caption-attachment-5972\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-247.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-5972 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-247-150x150.jpg\" alt=\"Hand hygiene with ABHR\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5972\" class=\"wp-caption-text\">Hand hygiene with ABHR<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">14. Document procedure according to\u00a0agency policy.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Document time of catheter removal, condition of urethra, and any teaching related to post-catheter care and fluid intake.<\/p>\n<p>Document time, amount, and characteristics of first void after catheter removal.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"4\">Data source: ATI, 2015d; BCIT, 2015b; Perry et al., 2014; VCH Professional Practice, 2014<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>If a patient is unable to void after six to eight\u00a0hours of removing a urinary catheter, or has the sensation of not emptying the bladder, or is experiencing small voiding amounts with increased frequency, a bladder scan may be performed. A bladder scan can assess if excessive urine is being retained. Notify the health care provider if patient is unable to void within six to eight\u00a0hours of removal of a urinary catheter. If a patient is found to have retained urine in the bladder and is unable to void, an intermittent\/straight catheterization should be performed\u00a0(Perry et al., 2014).<\/p>\n<h3><a id=\"video10.4\"><\/a>Video 10.4<\/h3>\n<div class=\"textbox shaded\" style=\"text-align: center;\">Watch the video <a href=\"https:\/\/barabus.tru.ca\/nursing\/foley_catheter_removal.html\"><em>Foley Catheter Removal<\/em><\/a> by <a href=\"\/clinicalskills\/back-matter\/appendix-3\/\">Ren\u00e9e Anderson and Wendy McKenzie<\/a>, Thompson Rivers University.<\/div>\n<div class=\"textbox shaded\" style=\"text-align: center;\"><a href=\"http:\/\/journals.lww.com\/nursingmadeincrediblyeasy\/Fulltext\/2012\/07000\/To_scan_or_not_to_scan__Detecting_urinary.13.aspx\">Read the <em>To Scan or Not To Scan<\/em> journal article<\/a> for more information on bladder scanning.<\/div>\n<div class=\"textbox textbox--exercises\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\">Critical Thinking Exercises<\/p>\n<\/header>\n<div class=\"textbox__content\">\n<ol>\n<li>Describe the different techniques for cleansing a female and a male patient prior to catheterization.<\/li>\n<li>Your male patient complains of pain while you are inserting a urinary catheter. Describe your next steps.<\/li>\n<\/ol>\n<\/div>\n<\/div>\n","protected":false},"author":5,"menu_order":4,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-3637","chapter","type-chapter","status-publish","hentry"],"part":3632,"_links":{"self":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapters\/3637","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/wp\/v2\/users\/5"}],"version-history":[{"count":29,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapters\/3637\/revisions"}],"predecessor-version":[{"id":10178,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapters\/3637\/revisions\/10178"}],"part":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/parts\/3632"}],"metadata":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapters\/3637\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/wp\/v2\/media?parent=3637"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapter-type?post=3637"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/wp\/v2\/contributor?post=3637"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/wp\/v2\/license?post=3637"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}