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1. Urethral catheterization
Facilitator: Sir Faraja Mwahayola
(BScN)
7/13/2023 Sir Faraja Mwahayola, BScN 1

2. Objectives:
By the end of this session, students are expected
to be able to:
• Define catheterization
• Explain indications for catheterization
• Identify types, size and type of catheter materials
• Describe procedure for catheterizing a female
and male patient
• Describe lifespan considerations regarding
catheterization
• Describe home care consideration in relation to
catheterization
7/13/2023 Sir Faraja Mwahayola, BScN 2

3. 7/13/2023 Sir Faraja Mwahayola, BScN 3

4. Definition of
Catheterization
Catheterization to patient: The introduction of a sterile
catheter through the urethra into the bladder for the purpose of
removing urine.
7/13/2023 Sir Faraja Mwahayola, BScN 4

5. Indications for Catheterization
Catheterization may be performed for several common
reasons, which include:
• Relieving retention of urine when other nursing
measures have failed.
• Emptying the bladder before giving a bladder irrigation or
instillation.
• Ensuring that the bladder is empty before, during and
after pelvic surgery.
• Obtaining a sterile urine specimen when collection of
‘Mid–stream’ specimen of urine is impractical,
7/13/2023 Sir Faraja Mwahayola, BScN 5

6. Indications for Catheterization
for example when a woman is menstruating or when the patient
is incontinent.
• Splinting the urethra following urethral surgery or trauma.
7/13/2023 Sir Faraja Mwahayola, BScN 6

7. Types, Size and Type of Catheter Materials
Catheters are made of different materials, shapes and sizes.
• Most catheters are made of plastic, latex rubber and
silicone.
• Silicone catheters are used for long-term indication for
catheterization (2 to 3 month duration) because they
create less encrustation.
• Catheters may be non-retaining; there are intended for
intermittent catheterization.
7/13/2023 Sir Faraja Mwahayola, BScN 7

8. Types, Size and Type of Catheter
Materials…
• Self-retaining: Are used if catheter must remain in place for
some days.
• The most commonly used for self-retaining catheter is the
‘Foley’s type’.
• It has balloon which has to be filled with either sterile water or
air after it has been introduced into the bladder.
• Catheter is sized according to the French scale.
A size 8-10 is used for children, 14 – 16 for adult females and 18-20
adult males.
7/13/2023 Sir Faraja Mwahayola, BScN 8

9. Descriptions of Technique of Catheterizing a
Female and Male Patient…
Purposes
• To relieve discomfort due to bladder distention or to provide
gradual decompression of distended bladder.
• To facilitate accurate measurement of urinary output for
critically ill clients whose output needs to be monitored hourly.
Assessment
• Determine the most appropriate method of catheterization
based on the purpose and any criteria specified in the order.
7/13/2023 Sir Faraja Mwahayola, BScN 9

10. Descriptions of Technique of Catheterizing a
Female and Male Patient…
• Assess the client’s overall condition and determine if the
client is able to cooperate.
• Determine if the client can be positioned supine with head
relatively flat
• Determine when the client was last void or was last
catheterized.
• Percuss the bladder to check for fullness or distention.
Planning: Equipment
• Sterile catheter of the appropriate size
7/13/2023 Sir Faraja Mwahayola, BScN 10

11. Descriptions of Technique of Catheterizing a
Female and Male Patient…
• Sterilization kit containing
Water proof drape
Antiseptic solution
Cleansing cotton wool balls
Sterile gloves
Dissecting forceps
Water soluble lubricant
Urine receiver
Specimen container
For Indwelling Catheter
• Syringe pre filled with sterile
water in amount specified by
catheter manufacturer’s
collection bag and tubing 2%,
Xylocaine gel.
• Supplies for performing
perineal cleansing.
7/13/2023 Sir Faraja Mwahayola, BScN 11

12. Performance (Technique for Catheterizing a
Female)
• Explain the procedure to the patient in order to gain
cooperation and minimize embarrassment.
• Provide privacy.
• Position the patient supine with her knees flexed and
abducted.
• Turn down the top bedclothes to knee level to expose the
area
• Cover her with a sheet
• Place the mackintosh and towel under her buttocks.
7/13/2023 Sir Faraja Mwahayola, BScN 12

13. Performance (Technique for Catheterizing a
Female) cont’s…..
• Ensure that there is sufficient light in the room.
• An artificial light may be needed.
• Ask your assistant to wash and dry hands and open the
sterile catheterization pack using sterile technique.
• Scrub hands, dry them using the sterile towel provided and
put on the gloves.
• Arrange the sterile equipment for convenience on the sterile
area.
7/13/2023 Sir Faraja Mwahayola, BScN 13

14. Performance (Technique for Catheterizing a
Female) cont’s…..
Ask the assistant to do the following:
• Open the outer wrapper on the catheter and take it out
using sterile forceps and place it on the sterile field.
• Pour Savlon or other antiseptic into the gallipots.
• Squeeze the K Y gel on to a sterile swab. (Or pour a
lubricant into a galipot).
• Open the spigot and drop it on the sterile field.
7/13/2023 Sir Faraja Mwahayola, BScN 14

15. Performance (Technique for Catheterizing a
Female) cont’s…..
• Hold the ampoule or bottle of sterile water while you
disinfect the top of bottle with an antiseptic swab and with
the sterile syringe and needle you draw up 20ml of water
and place it on sterile field.
• Turn back the sheet covering the patient.
• Place the fenestrated drape over the external genitalia so
that the hole on the drape exposes the labia.
• Remove the catheter from the inner wrapper and lubricate
about 3 to 5cm of catheter tip and place it in the sterile
receiver.
7/13/2023 Sir Faraja Mwahayola, BScN 15

16. Performance (Technique for Catheterizing a
Female) cont’s…..
• With your thumb and forefinger of left hand, separate labia
and pull up to identify the meatus.
• Keeping your left hand in place separating the labia, pick
up forceps with your right hand and take antiseptic swab.
• Clean inner folds of labia, the meatus and surrounding
area thoroughly.
• Using the saturated antiseptic cotton wool swabs wipe from
above the meatus downwards with one stroke.
• Discard swab after each stroke.
7/13/2023 Sir Faraja Mwahayola, BScN 16

17. Performance (Technique for Catheterizing a
Female) cont’s…..
• Keep fingers of left hand in place and discard the forceps
with your right hand.
• Place the sterile receiver on the drape between the
patient’s thighs close to buttocks for receiving urine.
• Pick up catheter with your gloved right hand; gently insert
the lubricated end into the urethra about 4 to 5cm until
urine begins to flow.
• If there is some slight resistance during insertion, rotate the
catheter gently and ask the patient to deep-breathe.
7/13/2023 Sir Faraja Mwahayola, BScN 17

18. Performance (Technique for Catheterizing a
Female) cont’s …..
• Release labia and hold catheter securely with your left
hand to prevent it from slipping out.
• If a specimen is needed, pinch catheter with thumb and
forefinger of left hand to stop the flow of urine.
• Place the sterile specimen container at the end of the
catheter without touching it.
• Release the pinch and allow 30-40ml to drain in the
specimen container.
• Re-pinch catheter and place catheter end into the receiver.
7/13/2023 Sir Faraja Mwahayola, BScN 18

19. Performance (Technique for Catheterizing a
Female) cont’s…..
• Release the pinch to allow urine flow from bladder again.
• Allow urine to flow until a bladder is empty.
• In case of intermittent catheterization pinch the catheter and
withdraw the catheter gently.
• Dry perineal area with a gauze swab.
• Remove equipment. Remake the bed and leave the patient
clean, dry and comfortable.
• Record the procedure in the patient’s chart.
• Record the amount of urine passed and it characteristics.
7/13/2023 Sir Faraja Mwahayola, BScN 19

20. Performance (Technique for Catheterizing a
Female) cont’s…..
• Label specimen and send to the laboratory promptly.
• If it is retention catheterization (indwelling catheter) inflate
the balloon with sterile water or air after the bladder is
emptied.
• The amount of water required is indicated on the catheter.
• Connect the drainage bag to the end of Foley’s catheter
without contaminating.
• If a drainage bag is not necessary cover end of catheter
with a sterile spigot.
7/13/2023 Sir Faraja Mwahayola, BScN 20

21. Performance (Technique for Catheterizing a
Female) cont’s…..
• Fix the catheter to inner thigh with a plaster strapping.
• Wash and dry perineum.
• Remove equipment.
• Assist the patient to a comfortable position.
• Record data on appropriate charts.
• Check for the important anatomical landmarks during
catheterization of female patient.
• Foley catheter inserted in the bladder.
• The balloon is inflated.
7/13/2023 Sir Faraja Mwahayola, BScN 21

22. Female Catheterization
7/13/2023 Sir Faraja Mwahayola, BScN 22

23. Female Catheterization
7/13/2023 Sir Faraja Mwahayola, BScN 23

24. Performance (Technique for Catheterizing a Male
Patient)
• Equipment: Same as for female catheterization
• The technique: Similar to that described for catheterizing
female patient except for the following points:
• Position patient supine with knees slightly abducted
• Place drape or towel so that the penis goes through the hole making
sure the genital area is well covered
• Lubricate the catheter for about 15 to 18 cm
• With your left hand place a sterile swab over the neck of the penis,
hold the penis and retract the foreskin (if is uncircumcised) clean the
head of the penis with antiseptic swab moving from the meatus
towards the base of the penis.
7/13/2023 Sir Faraja Mwahayola, BScN 24

25. Performance (Technique for Catheterizing a Male
Patient)
• Slight traction to the penis helps to straighten the urethra.
• Insert the catheter into the urethra advance the catheter 15
to 25 cm (6 to 10 inches) until urine flows.
• If resistance is felt at the external sphincter, slightly increase
the traction on the penis and apply steady, gentle pressure
on the catheter.
• Ask patient to strain gently (as if passing urine) to have help
relax sphincter.
• NEVER use force if catheter resists entering.
7/13/2023 Sir Faraja Mwahayola, BScN 25

26. Performance (Technique for Catheterizing a Male
Patient)…..
• Try to rotate it gently and if resistance continues stop and
report to the supervising nurse or doctor.
• When urine begins to flow, advance the catheter another
2.5cm (1 inch).
• Lower the penis and allow the urine to flow into the receiver.
Secure the penis with your left hand.
• When the patient is having an indwelling catheter it is
normally connected to closed drainage system which
consists of: an indwelling catheter, a connecting tube, and
collecting bag.
7/13/2023 Sir Faraja Mwahayola, BScN 26

27. Performance (Technique for Catheterizing a Male
Patient)…..
• There is a drainage valve which enables the collecting bag to
be emptied usually the collection bag is a disposable plastic
bag which is calibrated in order to make measuring of the
urine easy.
• The presence of an indwelling catheter causes irritation to
the urethra.
• Urethral secretion is increased and if the secretion is left to
dry it causes damage to the mucous membrane which can
lead to urethral stricture.
7/13/2023 Sir Faraja Mwahayola, BScN 27

28. Performance (Technique for Catheterizing a Male
Patient)…..
• If care of the indwelling catheter is inadequate the patient will
develop a urinary tract infection.
• The following are nursing measures appropriate for a patient
with an indwelling catheter.
The connecting tube should be long enough to allow the patient
move freely in bed. It should be hang below the level of the collecting
bag.
The collecting bag is attached to the bed frame and the tubing fixed
to the bedding in order to keep it in place.
The collecting bag should always be lower than the patient’s bladder
to prevent reflux of urine.
7/13/2023 Sir Faraja Mwahayola, BScN 28

29. Performance (Technique for Catheterizing a Male
Patient)…..
Always ensure that the tubes are not kinked or twisted as this may
allow pools of drainage to collect in the loops of the tubing.
The collecting bag should be emptied at least every 8 hours or
whenever it is full.
The urine should be measured and any abnormalities noted and
recorded.
The catheter must be cleaned at least twice daily or as often as
necessary.
Starting from the urethral meatus and moving downwards.
Use warm soapy water, rinse and dry.
7/13/2023 Sir Faraja Mwahayola, BScN 29

30. Performance (Technique for Catheterizing a Male
Patient)…..
 Some authorizes recommend cleaning the area around the urethral
meatus with povidone iodine (Betaldine).
If not contraindicated encourage the patient to be up and about.
Encourage fluid intake and record the intake and output in the
patient’s fluid balance chart
Assist the patient in personal hygiene e.g. hands washing after
contaminating the hands or after bowel movement.
The doctor will order when to change the indwelling catheter.
7/13/2023 Sir Faraja Mwahayola, BScN 30

31. Performance (Technique for Catheterizing a Male
Patient)…..
Usually is it changed on weekly basis if the catheter material is not
silicone.
Always maintain the catheter free from tension.
Fix the drainage tubing to abdomen or upper thigh to male patients.
Maintain the integrity of the closed drainage system.
7/13/2023 Sir Faraja Mwahayola, BScN 31

32. Male Catheterization
7/13/2023 Sir Faraja Mwahayola, BScN 32

33. Male Condom Catheter
7/13/2023 Sir Faraja Mwahayola, BScN 33

34. Lifespan Considerations regarding Catheterization
Infants and children
• Adapt the size of the catheter for pediatric clients.
• Ask a family member to assist in holding the child during
catheterization, if appropriate.
Elders
• When catheterizing older adults, be very attentive to
problems of limited movement especially in the hips.
7/13/2023 Sir Faraja Mwahayola, BScN 34

35. Lifespan Considerations regarding Catheterization
Infants and children
For intermittent catheterization, instruct the client to:
• Follow instructions for clean technique.
• Wash hands well with warm water and soap prior to
handling equipment or performing catheterization.
• Monitor for signs and symptoms for Urine Tract Infect (UTI)
• Ensure adequate intake of fluid
For indwelling catheter, instruct the client to:
o Never pull on the catheter.
o Ensure that there are no kinks or twists in the tubing.
o Keep the urine draining bag below the level of the bladder.
7/13/2023 Sir Faraja Mwahayola, BScN 35

36. Key Points
-Urinary catheterization is frequently required for clients
with urinary retention but is only performed when all other
measures to facilitate voiding fail.
-Sterile technique is essential to prevent ascending
urinary infections.
-Selection of the appropriate catheter material is important
to prevent complications.
7/13/2023 Sir Faraja Mwahayola, BScN 36

37. Evaluation
 What is catheterization?
 What are the indications for catheterization?.
 What are the types and sizes of catheters for
the females, males and children
7/13/2023 Sir Faraja Mwahayola, BScN 37

38. Evaluation
 Adams, M. P. et al. (2008). Pharmacology for Nurses. A
Pathophysiologic Approach. (2nd ed.). New Jersey:
Pearson.
 Kozier, B. et al. (2004). Fundamentals of Nursing.
Concepts Process and Practice. (7th ed.). New Jersey:
Pearson Education, Inc.
 MOHSW (2008). Basic Nursing Procedures. A manual
for Nursing Practice in Tanzania. (3rd ed.). Dar es
Salaam, Tanzania: Ministry of Health and Social
Welfare.
 Rice, J. (2006). Principles of Pharmacology for Medical
Assisting (4th ed.). Delmar Cengage Learning.
 Wong, D.L. et al. (2003). Nursing Care of Infants and
Children (7thed.) Mosb
7/13/2023 Sir Faraja Mwahayola, BScN 38