Catheterization is the process of inserting a catheter into the urinary tract. It is used to drain urine from the bladder for various clinical reasons like surgery, inability to void, or monitoring urine output. The proper procedure involves preparing the patient and environment, selecting the correct catheter size and type, cleaning the perineal area aseptically, lubricating the catheter, and slowly inserting it into the urethra until urine flows or the catheter is at the proper depth. The balloon is then inflated to retain the catheter and the drainage bag is attached to collect urine. Catheterization must be done aseptically to prevent urinary tract infections.

1. CATHETERIZATIO
N
MANISHA KUMARI
IGIMS CON , PATNA

2. INTRODUCTION:-
• Insertion of an indwelling urethral catheter (IDC) is an invasive
procedure that should only be carried out by a qualified
competent health care professional using aseptic technique.
Catheterization of the urinary tract should only be done when
there is a specific and adequate clinical indication, as it carries
a risk of infection

3. DEFINITION :-
THE ACTION OR PROCESS OF INSERTING A CATHETER INTO
A BODY CAVITY CALLED CATHETERIZATION .

4. PURPOSE :-
• Used to maintain urine output in patients who are
undergoing surgery
• Patient who are confined to the bed and physically unable
to use a bedpan .
• Critically ill patient who require strict monitoring of
urinary output .
• Improve the quality of life to someone who is bed ridden
.
• Relieve urinary retention , bladder distension.
• Obtain sterile urine specimen.
• Measure residual volume

5. INDICATIONS :-
• Prostatic hyperplasia (men)
• Acute or chronic retention
• Hypotonic bladder
• Pre & post pelvic surgery
• Measurement of urine output
• To empty the bladder during labour Investigations
• To obtain an uncontaminated urine specimen
• In Urodynamic investigations
• X-ray investigations Instillation
• To irrigate the bladder
• Chemotherapy Management of intractable incontinence To be used
ONLY when all other methods have been tried

6. PRINCIPLES OF CATHETERIZATION:-
• Meatal /Labia cleansing to remove exudates or smegma in
men
• Aseptic technique – to avoid introducing infection
• Anaesthetic gel (Instillagel)
• Should be used for men and women
• Reduces pain and discomfort
• Provides lubrication
• Has antibacterial properties (contains chlorhexidine)
• Needs time to work (5 minutes)
• Documentation

7. TYPES OF CATHETERIZATION:-
• Indwelling catheters
• Intermittent catheterization

8. TYPES OF CATHETERS :-
• Folley’s catheter
• Robinson’s intermittent catheter
• Turp catheter
• Silicone catheter
• Coude catheter
• Condom c atheter /external catheter
• Suprapubic catheter

9. GENERAL INSTRUCTIONS :-
• Catheter Selection
• It is important to choose the correct catheter for the individual
patient
• Considerations include:
• Material, size, length and balloon infill volume
• The make, type, length, Ch/Fg size and balloon size should be
specified on the prescription
• The Foley catheter is an indwelling catheter that is retained by
inflating an integral balloon
• Catheters without the inflating balloon are usually used for
intermittent catheterization
• The material determines the length of time a catheter can

10. CONTD..
• Catheter Selection – Material
• Short Term (7 to 28 days)
• Plastic/PVC should not be left in for more than 7 days
• Uncoated latex/silicone treated should not be left in situ for
more than 7 days
• Polytetrafluroethylene (PTFE) bonded latex (Teflon) should not
be left in situ for more than 28 days

11. CONTD..
• Catheter Selection - Material
• Long Term (up to 12 weeks)
• Silicone elastomer coated latex (combines advantages of
silicone and latex)
• Hydrogel coated latex (combines advantages of hydrogel and
silicone) – these are the only catheters suitable for patients with
a latex allergy

12. CONTD..
• Catheter Selection – Size and length
• The internal diameter of a catheter is measured in Charriere
(Ch) – one Ch equals 1/3 mm, therefore 12 Ch equals 4 mm
• Usual sizes for men are between 12Ch & 16Ch
• Usual sizes for women are between 8Ch & 12Ch
• The smallest size should be chosen to provide adequate
drainage
• Male catheter length 43cms, female catheter 26cms

13. CONTD..
• Catheter Selection – Balloon Size
• The balloon should always be filled with sterile water
• Catheter balloons should be filled as specified by the
manufacturer - routinely 10mls
• The heavier weight and larger balloon may cause bladder
spasm and irritation of the Trigone
• Over or under filling may interfere with drainage

14. CONTD..
• Safety considerations:
• Perform hand hygiene.
• Check room for additional precautions.
• Introduce yourself to patient.
• Confirm patient ID using two patient identifiers (e.g., name and date
of birth).
• Explain process to patient; offer analgesia, bathroom, etc.
• Listen and attend to patient cues.
• Ensure patient’s privacy and dignity.
• Assess ABCCS/suction/oxygen/safety.
• Apply principles of asepsis and safety.
• Check vital signs.
• Complete necessary focused assessments.

15. PREPARATION OF CHILD AND FAMILY :-
• As per our FICare policy, families/primary care givers should be
given a thorough explanation of the procedure. Nursing staff
should discuss and plan the procedure and use of pain relief
with the family prior to commencing the procedure. Involve the
parents where possible when providing non-pharmalogical pain
relief, distraction and restraint.
• Consider the use of pharmacological pain relief such as
sucrose as appropriate.
• Ensure the patient’s privacy is maintained throughout the
procedure.
• Consider thermoregulation needs, particularly for preterm
neonates

16. PREPARATION OF ENVIRONMENT & EQUIPEMENTS -
• Ensure there is adequate light to perform the procedure
• Prepare the following equipment:
Clean Dressing Trolley Dressing pack Sterile gloves Sterile
Gown Sterile Plastic Drape Sterile Scissors Sterile Kidney
Dish Appropriate sized catheters (see Table 1) Sterile
lubricating jelly 0.2% Chlorhexidine irrigation solution
(Catheterisation preparation solution: Chlorhexidine gluconate
60mg/30mL). IDC drainage bag and connector Sleek tape and
a safety pin (only if no safety clip on IDC bag drainage tubing).
Specimen container Waste Bag Small Hydrocolloid cut to size
for fixation point to skin Small Leukostrips / adhesive tape like
fixomull/Tegaderm. Or large Leukostrips in the premature
neonate

17. ASSESSMENT :-
• Assess the pt’s medical record.
• Access the general status of pt’s.
• Check the time of last urination .
• Check the intake and output chart .
• Check the level of awareness , gender , age and allergy .
• Assess bladder for fullness .
• Assess the pt’s knowledge of catheterization .

18. PROCEDURE :-
• 1. Verify physician order for catheter insertion. Assess for
bladder fullness and pain by palpation or by using a bladder
scanner.
• 2. Position patient prone to semi-upright with knees raised;
apply gloves; and inspect perineal region for erythema,
drainage, and odour. Also assess perineal anatomy.

19. CONTD..
• 3. Remove gloves and perform hand hygiene.
• 4. Gather supplies:
• Sterile gloves
• Catheterization kit
• Cleaning solution
• Lubricant (if not in kit)
• Prefilled syringe for balloon inflation as per catheter size
• Urinary bag
• Foley catheter

20. CONTD..
• 5. Check for size and type of catheter, and use smallest size of
catheter possible.
• 6. Place waterproof pad under patient.
• 7. Positioning of patient depends on gender.
• Female patient: 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.
• Male patient: Supine with legs extended and slightly apart.

21. CONTD..
• 8. Place a blanket or sheet to cover patient and expose only
required anatomical areas.
• 9. Place a blanket or sheet to cover patient and expose only
required anatomical areas.
• 10. Ensure adequate lighting.
• 11. Perform hand hygiene.
• 12. Add supplies and cleaning solution to catheterization kit,
and according to agency policy.
• 13. If using indwelling catheter and closed drainage system,
attach urinary bag to the bed and ensure that the clamp is
closed.

22. CONTD..
• 14. Apply sterile gloves using sterile technique.
• 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.
• 16. Lubricate tip of catheter using sterile lubricant included in
tray, or add lubricant using sterile technique.
• 17. Check balloon inflation using a sterile syringe
• 18. Place sterile tray with catheter between patient’s legs.

23. CONTD..
• 19. Clean perineal area as follows.
• Female patient: 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.
• Male patient: Gently grasp penis at shaft and hold it at right
angle to the body throughout procedure with non-dominant
hand (now contaminated and no longer sterile). Using sterile
technique and dominant hand, clean urethral meatus in a
circular motion working outward from meatus. Use sterile
forceps and a new cotton swab with each cleansing stroke.

24. CONTD.
• 20. Pick up catheter with sterile dominant hand 7.5 to 10 cm
below the tip of the catheter.
• 21. Insert catheter as follows.
• Female patient:
• Ask patient to bear down gently (as if to void) to help
expose urethral meatus.
• Advance catheter 5 to 7.5 cm until urine flows from
catheter, then advance an additional 5 cm.

25. CONTD..
• Male patient:
• Hold penis perpendicular to body and pull up slightly on shaft.
• Ask patient to bear down gently (as if to void) and slowly insert
catheter through urethral meatus.
• Advance catheter 17 to 22.5 cm or until urine flows from
catheter.
• Note: If 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.
• Note: 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

26. CONTD.
• 22. Place catheter in sterile tray and collect urine
specimen if required.
• 23. Slowly inflate balloon for indwelling catheters
according to catheter size, using prefilled syringe.
• Note: If patient experiences pain on balloon inflation,
deflate balloon, allow urine to drain, advance catheter
slightly, and reinflate balloon.
• 24. After balloon is inflated, pull gently on catheter
until resistance is felt and then advance the catheter
again.

27. CONTD..
• 26. Secure catheter to patient’s leg using securement device at
tubing just above catheter bifurcation.
• Female patient: Secure catheter to inner thigh, allowing enough
slack to prevent tension.
• Male patient: 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.
• 27. Dispose of supplies following agency policy.
• 28. Remove gloves and perform hand hygiene.
• 29. Document procedure according to agency policy,
including patient tolerance of procedure, any unexpected

28. REMOVAL OF CATHETER:-
• Removal of urinary catheter
• Explain procedure to child and family.
• Perform hand hygiene & don gloves.
• Deflate balloon completely.
• Gently withdraw catheter, with rotation movements if necessary.
• Bear in mind that once inflated, the balloon won’t deflate to its total initial flat
state and the balloon portion of the catheter will remain larger than the catheter
itself.
• If resistance felt and catheter cannot be easily removed do not force, leave
catheter in situ and consult medical team.
• Consider cutting the catheter at the balloon inflation point to ensure the

29. AFTER CARE :-
• Drainage system
• Adherence to a sterile continuously closed method of urinary drainage has
been shown to markedly reduce the risk of acquiring a catheter associated
infection. Therefore breaches to the closed system should be avoided.
• Consider changing the catheter tube and/or bag based on clinical indicators
including infection, contamination, obstruction or if system disconnects, if
the equipment is damaged or leaks. Replace system and/or catheter using
aseptic technique and sterile equipment.
• Hygiene
• Routine hygiene should be maintained with routine bathing/showering,
including daily clean IDC insertion site with warm soapy water and more
frequently if build-up of secretions is evident.
• Uncircumcised boys should have the foreskin gently eased down over the
catheter after cleaning.

30. CONTD..
• Perform hand hygiene.
• Document catheter removal in the LDA activity.
• Observe for urine output post catheter removal.
• If the patient has not passed urine 6 – 8hours post catheter
removal assess the patient’s hydration status and consider the
need to perform a bladder scan. Discuss findings with the
treating medical team.

31. CATHETER LEAKAGE:-
• Catheter leaking
• Ensure the catheter is still draining and that the urine is not
overflowing around a blocked catheter. See above for tips regarding
catheters not draining.
• Make sure the balloon is still inflated. Hold the catheter tubing
securely in the same position and empty the balloon to make sure
the amount that has been placed initially in the balloon is still
present. If not, reinflate the balloon to its initial volume with water.
Deflation of the balloon happens easily with a 6Fr catheter.
• Check catheter size is correct for age/size of the child. Use of a
balloon catheter in neonates should only be with consultation with
the treating medical team.

32. DISCHARGE INFORMATION:-
• Some children will be discharged from the hospital with their IDC in situ.
It is important to teach the families how to care for the catheter, how to
perform hygiene, how to monitor the output and how to troubleshoot.
Discuss the following with the child and family:
• Assess the catheter insertion site at least once per day.
• Clean the site of insertion once per day if accessible with warm soapy water
when attending to their normal bath or shower.
• Regularly check the tubing is not kinked or leaking, if any concerns contact
the treating team.
• The family should have enough supplies to take home to last until they
return for removal of the catheter or until their supplies organised with
stomal therapy department have commenced. This includes leg bags,
overnight bag and securement devices.

33. CONTD..
• In the home each catheter bag can last up to a week. If using leg bags and
overnight bags when they are swapped over rinse the bag through with
warm soapy water and allow to air dry.
Troubleshooting at home:
No drainage: ensure the catheter has not fallen out, tubing is not kinked,
and your child is adequately hydrated. Flush the catheter otherwise if taught
how to do so and/or attend your nearest emergency department if
necessary.
• Leaking: try to ascertain where the leak is coming from, if it is a connecting
point ensure it is firmly connected, check the tap is closed. If it is the tubing
or the bag that is damaged it will need to be replaced.
• Catheter by–passing: Attempt to flush the catheter if taught how to do so, if
it continues speak with your child’s doctors.
• Catheter accidently removed: Ring the hospital to speak with your child’s
doctors as you may need to be assessed in emergency.

34. COMPLICATION:-
• Inability to catheterize: ensure appropriate catheter size has been
selected based on the age/size of the child. Ensure adequate
procedural pain relief and distraction is in place during the
procedure.
• Escalate to the treating medical team and consider the need for a referral to
the urology team.
• In young girls, the urethra can be difficult to localise and the catheter can go
directly in the vagina. In this case, leave the first catheter in the vagina and
use another one to place immediately above, which will be more likely to go
in the urethra.
• Urethral injury may occur from trauma sustained during insertion or
balloon inflation in incorrect position: it is very important to ensure
the catheter is in the bladder before inflating the balloon, this can be
confirmed by visualising the stream of urine prior to balloon
inflation.

35. CONTD..
• False passage (catheter pushed through urethral wall): The risk of false
passage is actually higher when using a smaller catheters, ensure catheter
size utilised is appropriate for child’s age and size.
• Infection
• To minimise risk of infection insertion of IDC’s must be performed using
surgical aseptic technique with single use sterile gloves.
Regular hygiene should be maintained whilst IDC is in situ.
• Psychological trauma
• Paraphimosis due to failure to return foreskin to normal position following
catheter insertion:
• To minimise risk remember to replace the foreskin in non-circumcised
patients and check at catheter care or nappy change that the foreskin is
in place.

36. SPECIMEN COLLECTION:-
• Urine for urinalysis or culture should be collected fresh from
the needleless sampling port of catheter tubing (not drainage
bag), this should be completed in line with the Aseptic
Technique Procedure.
• Clamp below the sampling point.
• Scrub sampling point vigorously with 70% alcohol and chlorhexidine
(0.5% or 2%) soaked gauze or swabs for at least 15 seconds and allow to
air dry prior to accessing port with a 10ml syringe to collect sample.
• Large volumes e.g. 24hr collection, can be collected from
drainage bag.

37. SOME DO’S OF CATHETERIZATION:-
• Do perform peri-care using only soap and water
• Do keep the catheter and tubing from kinking and
becoming obstructed
• Do keep catheter systems closed when using urine
collection bags or leg bags
• Do replace catheters and collection bags that become
disconnected
• Do ensure the resident's identifier/implementation date is
on their urine collection containers
• Do make sure to disinfect the sampling port before
obtaining a sample

38. SOME DON’T:-
• Don't change catheters or drainage bags at routine, fixed
intervals
• Don't administer routine antimicrobial prophylaxis
• Don't use antiseptics to cleanse the periurethral area while a
catheter is in place
• Don't clean the periurethral area vigorously
• Don't irrigate the bladder with antimicrobials
• Don't instill antiseptic or antimicrobial solutions into drainage
bags
• Don't routinely screen for asymptomatic bacteriuria
• Don't contaminate the catheter outlet valve during collection
bag emptying

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