Aims of this guideline
- Standardization of urinary catheterization
- Reduce risk of catheter associated urinary tract infections (CAUTIs) and other complications
- Adherence to non-contact aseptic techniques
- Only qualified persons should perform the catheterization and its maintenance.
- Help of an aide may be needed to maintain aseptic conditions when dealing with uncooperative patients
- Discuss with the patient before inserting an indwelling catheter (IDC). Consider available options and never insert an IDC as a convenient measure.
- Right catheter sizes
- 10mls of sterile water
- Adjustable lamp
- Waterproof sheet
- Sterile gloves
- Water soluble lubricant
- Drainage bag
- Protective apron and goggles/transparent eye shield
- Adhesive tape
- 10mls syringe
- Sterile catheter pack
- Sterile solution of normal saline
- Jug to collect urine drainage.
- Sterile urine specimen bottle
- Waste bin/bag
Insertion of an indwelling catheter
- Fully explain the insertion procedure and how to take care of the catheter after insertion to the patient in a way she is able to understand. This, together with gentle handling, reassures the patient. If there is history of latex allergy, use latex-free gloves.
- To avoid urethral trauma, choose the smallest catheter size that will drain the urine effectively. Keep the packaging with the lot number in case of a problem as the manufacturer needs to be contacted.
- Wash hands with an antiseptic and clean the trolley before gathering the supplies.
Preparing the bedside
- Put on your protective wear. Maintain an aseptic method as you open and place the catheter tray onto a sterile surface.
- Position the adjustable lamp to enable you to clearly see the genitalia
- Let the patient lie supine with flexed knees and feet about 0.6m apart.
- Place the waterproof sheet under the patient’s buttocks.
- Wash your hands again with an antiseptic and put on the sterile gloves.
- Maintain the no-touch technique and draw the 10mls of sterile water.
- Lubricate the catheter insertion end and place it in a kidney dish.
- Drape the patient
Preparing the patient
- Gently part the labia minora to expose the urethral opening.
- Hold gauze swabs with forceps and wipe the urethral opening and the inner sides of the labia minora. Always wipe in a downward motion. Each stroke, one gauze – no repeating.
- Use lubricating gel to minimize catheter trauma.
- Keep the labia minora apart until the catheterization is complete.
- Gently insert 6-8cm of the lubricated catheter into the urethral opening. Use the provided forceps to hold the catheter as you do the insertion. Should the catheter be contaminated during the procedure, discard it and start the process again.
- Ascertain that the catheter fits properly to the urethral opening.
- As soon as urine starts flowing, attach the catheter to the port while using the available sterile water and inflate the catheter balloon. Use a water volume indicated by the manufacturer. Do not use normal saline as it has a tendency to form crystals that make deflating the balloon difficult.
- Take a catheter urine sample if needed and record it.
- Attach the urine bag by non-touch method.
- Undrape the patient and remove the waterproof sheet while ensuring patient comfort. Use adhesive tape to secure the catheter to the anterior mid-thigh.
- Measure and record the urine. Discard the used items and wash your hands.
- Note the following about the procedure and have them in the patient’s notes:
- Date and time catheterization was done.
- Why the catheterization was done – clinical reason.
- Amount and the appearance of the urine.
- Expected time the catheter is to remain in place.
- Expected date of removal.