Urology

Urinary catheterization
Definition: the insertion of a hollow, flexible tube through the urethra into the urinary bladder, it is
commonly made of rubber or plastic with different sizes.
Purpose: to drain the bladder urine due to an obstruction or incontinence.
Indications:
• Surgical patients.
• Patients undergoing urological surgery.
• Urinary retention.
• Urinary incontinence.
Types of lower urinary tract catheters:
1. One way catheter
2. Two way catheter (double lumen)
3. Three way catheter (triple lumen)
Preparation:
• Check prescriber’s order to ensure that the procedure specifies a straight or indwelling catheter.
• Determine if the patient is unconscious, hard of hearing, blind, or if there are any restrictive
devices attached, such as restraints, traction, or casts.
• Note on lab form if patient is having a menstrual period if specimen is obtained for diagnostic
study.
• Because the urethra is close to the anus in female patients, thorough and careful cleaning of the
perineum is very important before catheter insertion to reduce the incidence of infection.
Equipment needed:
1. Sterile Foley catheterization/ straight catheterization tray:
2. Sterile gloves.
3. Drape.
4. Lubricant.
5. Antiseptic cleaning wipes.
6. Cotton balls and pickup forceps.
7. Prefilled syringe of sterile water.
8. Catheter of correct size.
9. Tape.
10. Specimen container (optional).
11. Light.
Urology procedures / Dr. Sahar Ali Page 1

12. Bath blanket.
13. Disposable glove, basin of warm water, soap, towel, and disposable wash cloth.
Assessment:
• Level of awareness.
• Mobility and physical limitation.
• Patient's age and gender.
• If patient has distended bladder.

Implementation:
1. Introduce self and verify the patient's identity using agency protocol.
2. Explain to the patient what you are going to do, why it is necessary, and how he or she can
participate.
Rationale: Promote patients' cooperation.
3. Place the patient in the appropriate position and drape all areas except the perineum.
(Dorsal recumbent position with knees flexed, feet about 2 feet apart, and hips slightly externally
rotated).
Rationale: Allow relaxation of muscles and easy access to urinary meatus.
4. Drape patient with bath blanket, covering upper body and shaping over both knees and legs,
leaving genital area exposed.
Rationale: Prepare patient for procedure and provides for privacy.
Dorsal recumbent position

5. Place waterproof absorbent pad under patient's buttocks.
Rationale: Protects bed linens.
6. Arrange supplies and equipment on bedside table. Provide a good light.
Rationale: Easy access prevents possible contamination.
7. Don clean gloves and wash perineal area with mild soap and warm water with disposable wash
cloth.
Rationale: Decreases microorganisms at the site.
8. Remove disposable gloves and place in proper receptacle.

Rationale: Reduces the spread of microorganisms.
9. Facing patient, stand on right side of bed if right handed, on left side if left-handed.
Rationale: Successful catheter insertion requires nurse to assume comfortable position with all
equipment close by.
10. Open packaging using sterile technique. Don sterile gloves.
Rationale: Allows nurse to handle sterile supplies without contamination.
11. If indwelling catheter is used, test balloon by injecting normal saline or sterile water into
balloon lumen until balloon is inflated; then aspirate saline or sterile water.
Rationale: Assesses integrity of balloon. If balloon fails to inflate, another sterile catheter is
necessary.
12. Add antiseptic to cotton balls; open lubricant container. Lubricate catheter about (3.5 to 5 cm).
Rationale: Maintains principles of surgical asepsis and organizes work area. Lubricating
catheter reduces the chance of friction causing trauma to the delicate mucous membranes of the
urethra.
13. Wrap edges of sterile drape around gloved hands and request patient to raise hips; then slide
drape under patient's buttocks.
Rationale: Protects hands from contamination while placing towel under edge of patient's
buttocks.
14. Cleanse perineal area using forceps to hold cotton balls soaked in antiseptic solution.
Rationale: Cleansing reduces number of microorganisms at urethral meatus.
a. Spread labia minora with thumb and index finger of non-dominant hand to expose meatus;
continue to hold throughout insertion of catheter.
b. With other hand, use forceps to hold cotton balls soaked in antiseptic solution.
c. Cleanse area from clitoris toward anus, using a different sterile cotton ball each time first to the
right of the meatus, then to the left of the meatus, then down the center over meatus.
Full separation of labia

15. Pick up catheter with free sterile gloved hand near the tip; lubricate the catheter; hold remaining
part of catheter coiled in hands; place distal end in basin.
Rationale: Placing distal end of catheter in basin allows for urine collection. Coiling catheter in
hand and holding near the tip allows easier manipulation during insertion.
16. Insert catheter gently, about 5 to 10 cm.
17. If, when inserting an indwelling catheter, urine flow is established, insert catheter 3.5 cm
farther.
18. Inflate balloon with 10 mL sterile water, watching patient's face for grimacing (a sign that
balloon is inflating in urethra); if this occurs, deflate balloon and reposition catheter as above.
19. Gently pull back on catheter until resistance is felt as balloon rests at orifice of urethra.
Inflate balloon with 10 mL sterile water

20. Collect urine specimen, if needed, by placing open lumen end of catheter into specimen
container.
Rationale: Allows for sterile specimen to be obtained for culture and sensitivity.
21. For an indwelling catheter:
a. Attach end of catheter to collecting tube of drainage system, holding drainage bag below
bladder level.
b. Attach collection bag to side of bed.
c. Secure catheter to patient.
Rationale: Minimizes tension and trauma to urethral opening.
22. Tape catheter to inner thigh
23. Dry perineal area.
24. Label urine specimen with patient's name, date, physician's name. And transport to laboratory.
25. Assess flow of urine and drainage tubing setup.
26. Documentation:
a. Type and size of catheter.
b.Amount of solution to inflate balloon.
c. Characteristics of urine.
d.Amount of urine.
e. Reason for catheterization.
f. Specimen collected.

27. Report any unusual findings immediately:
 No urine output.
 Bladder discomfort despite catheter patency.
 Leakage of urine from catheter.
 Inability to insert catheter.
 Nurse must assess; discomfort could indicate infection, leakage around catheter could indicate
improper catheter placement or inflation of balloon.

Catheter care
Definition: Perineal care practices for patients with indwelling catheters to reduce the chance of
developing a urinary tract infection.
Purpose: to decrease the chance of acquiring urinary tract infection.
Preparation:
• Determine patient’s ability to understand and cooperate in the procedure.
• Assess for signs and symptoms of urinary infection.
• Determine an appropriate time for catheter care.

Special Considerations:
• Catheter care is most beneficial if performed after defecation if patient is incontinent.
• Note if patient is having menstrual period or vaginal discharge and, because the urethra is close
to the anus, thorough and careful cleaning of the perineum is very important.
Equipment needed:
1. Sterile package.
2. Disposable gloves.
3. Bed protector.
4. Bath blanket.
5. Basin of warm water and mild soap.
6. Towel and disposable washcloth.
7. Sterile swabs (to apply ointment).
8. Small plastic bag for trash.
Assessment:
• How long catheter has been in place.
• For any discharge around urethral meatus.
• For complaints of pain.
• Patient's temperature; Assess temperature every 4 hours for 24 hours if odor or exudate is
present.
• Patient's intake; Maintain adequate fluid intake.

Implementation:
1. Position patient (dorsal recumbent position in bed).
2. Place waterproof disposable pad under patient's buttocks and to the side from which catheter
care given.
3. Drape patient with bath blanket, exposing only perineal area.
Rationale: Maintain privacy.
4. Open separate sterile packages observing sterile technique.
5. Don clean gloves.
Rationale: Prevents accidental contamination if supplies are close by.
6. Arrange refuse bag (small plastic bag).
7. Cleans the perineal area with mild soap and warm water and pat dry.
Female: Gently retract labia away from urinary meatus and hold in position.
8. Release labia of female patient.
9. Observe meatus, catheter, and surrounding tissue to determine presence or absence of
inflammation, edema, malodorous exudates, color of tissue, and burning sensation.
10. Dispose of equipment and linen, remove gloves and dispose of in proper receptacle.
11. Wash hands.
Rationale: Reduces spread of microorganisms.
12. Re-tape catheter to thigh.
Rationale: Prevents trauma and pain from tension and pulling.
13. Assess flow of urine through tubing.
14. Empty drainage bag at least every 8 hours or as necessary to prevent backup of urine into the
tubing (and up into the bladder).
15. Documentation:
a. Time.
b.Procedure.
c. Assessment of urinary meatus.
d.Character of urine.
e. Patient response.
16. Report any unusual findings immediately, may require further therapy.

Catheter removal
Purpose: to decrease the chance of developing urinary tract infection.
Preparation: Provide privacy.
Equipment needed:
1. Disposable gloves.
2. 10-mL syringe without a needle.
3. Water proof pad.
4. Small plastic bag for trash.
Assessment:
• Note length of time catheter has been in place. The longer the catheter has been in place, the
greater the risk for decreased bladder muscle tone and inflammation of the urethra.
• Assess the patient's knowledge of what to expect, many patients anticipate discomfort or fear of
ability to void successfully after removal of the catheter.
Implementation:
1. Insert hub of syringe into inflation valve (balloon port) aspirate until tubing collapses.
Rationale: Indicates that entire contents of balloon have been removed.
2. Remove catheter steadily and smoothly.
3. If any resistance is noted, repeat step 1 to remove remaining water.
Rationale: Prevents trauma to the urethra.
4. Wrap catheter in waterproof pad. Unhook collection bag and drainage tubing from the bed.
Rationale: Prevents any leakage from the catheter onto the patient, nurse, or bed linens.
5. Measure urine, and empty drainage bag.
6. Record output.
7. Cleans the perineum with soap and water, and dry area thoroughly.
Rationale: Promotes comfort and a feeling of cleanliness.
8. Explain to patient:
a. It is important to have a fluid intake of 1.5 to 2 L/day unless contraindicated.
b. Explain that many patients experience mild burning or discomfort with first voiding which
soon subsides.
c. Inform the patient to report any signs of urinary tract infection. (Urgency, burning,
frequency, excreting small amount and pain/discomfort, which are most likely to develop in
2 to 3 days.)

9. Documentation and report:
a. Time catheter was removed.
b. Teaching related to increasing fluid intake and signs and symptoms of urinary tract infection.
c. Time, amount, and characteristics of first voiding.
d. Complete intake and output record.

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Urinary catheterization

• Patients undergoing urological surgery.

Urology procedures / Dr. Sahar Ali Page 1

• Mobility and physical limitation.

• Patient's age and gender.

• If patient has distended bladder.

Dorsal recumbent position

Urology procedures / Dr. Sahar Ali Page 2

Full separation of labia

Inflate balloon with 10 mL sterile water

Urology procedures / Dr. Sahar Ali Page 4

Urology procedures / Dr. Sahar Ali Page 5

• Determine patient’s ability to understand and cooperate in the procedure.

• Assess for signs and symptoms of urinary infection.

• Determine an appropriate time for catheter care.

• Catheter care is most beneficial if performed after defecation if patient is incontinent.

• How long catheter has been in place.

• For any discharge around urethral meatus.

• For complaints of pain.

• Patient's intake; Maintain adequate fluid intake.

Urology procedures / Dr. Sahar Ali Page 6

Urology procedures / Dr. Sahar Ali Page 7

Urology procedures / Dr. Sahar Ali Page 8

Urology procedures / Dr. Sahar Ali Page 9

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