Catheterization is the process of drawing urine from the bladder using a catheter inserted through the urethra, performed with aseptic technique. It serves multiple purposes, including relieving urine retention, obtaining specimens, and facilitating urinary drainage in surgical patients. The document details types of catheterization, equipment needed, principles to follow, and specific procedures for both male and female patients.

1. Goma Karki BMS 1

2. Catheterization
Catheterization is a process of drawing urine from the bladder by means of
an instrument called a catheter. It is inserted through the urethra under
aseptic precaution. Or,
Introducing a catheter into the urinary bladder through urethra using aseptic
technique for the purpose of emptying the bladder.
Catheters: it is a tubular instruments that are made of rubber, plastic, metal
and glass.
Goma Karki BMS 2

3. purposes
To relief acute or chronic retention of urine
To keep emptying the bladder in case of surgery
To obtain a clear specimen for diagnostic purpose
To determine amount of residual urine after voiding
To continue drain of urine in urinary incontinence
To measure the urinary output accurately in severe ill and needed
patients. Goma Karki BMS 3

4. Cont’d….
To empty the bladder before irrigation of bladder
To keep the patient clean and avoid over distension to prevent further
damage to the paralyzed muscle of the urinary bladder.
To prevent urine from passing over a wound e.g. After repair of the
perineum
To provide for intermittent or continuous bladder drainage and
irrigation. Goma Karki BMS 4

5. Types of catheter
Goma Karki BMS 5

6. Cont’d….
Condom catheter
Applying a thin condom sheath to penis for
drainage of urine without inserting a catheter
into urethra. It is used in a incontinence men
who still have complete and spontaneous
bladder emptying.
Goma Karki BMS 6

7. Cont’d….
Purpose
-To drain urine incase of an incontinent patient.
-to permit patient’s normal physical activity without
fear of embarrassment caused by incontinence.
Goma Karki BMS 7

8. Types of catheterization
1. Intermittent catheterization
2. Indwelling catheterization
1. Intermittent catheterization
Intermittent catheterization means removing urine from the bladder by
placing a tube into the bladder. This is done when a child or adult is unable
to empty her bladder on her own, when a child's bladder leaks urine, or
when very high pressures have developed in the bladder.
Goma Karki BMS 8

9. Purposes of intermittent catheterization
 To relieve bladder distension
 To assess for residual volume after voiding
 To obtain a sterile specimen
 To empty bladder prior to delivery or abdominal surgery
Goma Karki BMS 9

10. Cont’d….
2. Indwelling catheterization
A drainage tube that is inserted into the
urinary bladder through the urethra, is left
in place and connected to a closed
collection system. It is also called a
foleys catheter.
Goma Karki BMS 10

11. Goma Karki BMS 11

12. Purposes of indwelling catheterization
To facilitate urinary elimination in incontinent patients.
To facilitate continuous bladder drainage after surgery/injury
on urinary tract or other major surgeries.
To splint urethra to promote healing after urological surgery
To relieve acute or chronic urinary retention
To prevent urine from contacting an incision after perineal
surgery.
Goma Karki BMS 12

13. Principles of catheterization
• Pathogenic organism are transmitted from the source to a new host
directly on by contaminated articles.
• Urinary bladder is a sterile cavity and the urinary meatus acts as a portal
of entry for pathogenic organisms
• Cleaning an area minimizes the spread of organism. Do not allow tip of
catheter to touch your hand or labia.
• A break in the integrity of the skin and mucus membrane provides ready
entrance or micro organism.
Goma Karki BMS 13

14. Cont’d….
• Lubrication reduces friction, never use force while introducing the
catheter.
• Systematic ways of doing saves time, energy and material. Make the
patient relaxed.
• Through knowledge of anatomy and physiology of the genitourinary
system facilitates catheterization of the urinary bladder.
• Use sterile technique during catheterization(because it leads Urinary
tract infection)
• Avoid catheterization unless ordered or need.
Goma Karki BMS 14

15. Cont’d….
• Catheter should be selected according to the age of the patient:
Children: 8-10Fr. women: 14-16Fr.
Male: 16-18Fr.
• Change the adhesive tape daily at different part of thigh
• Put(hang) urobag under the bed to prevent infection.
• Never elevate the urobag above the waist level to prevent infection.
Goma Karki BMS 15

16. Indications of catheterization
Goma Karki BMS 16

17. Articles required for catheterization
A sterile tray with
-sterile gloves
-sterile drape
-small bowl
-cotton swabs
-catheter as ordered(type, size)
Goma Karki BMS 17
-kidney tray
-artery forceps
-dissecting forceps
-sterile syringe 10 or 20 ml

18. Cont’d….
Screen
A clean tray containing
- Disposable gloves
- mackintosh/rubber sheet
- Kidney tray
- Antiseptic solution
- Distilled water(incase of retention catheter)
- Urobag or collection bag(in case of retention catheter)
Goma Karki BMS 18
-Adhesive tape and scissors(in case of
retention catheter)
-Specimen container if required
-Water soluble lubricant(xylocaine jelly)
-Flash light or spot light

19. Catheterization procedure in female
• Check the order, patient’s identification and condition
• Explain procedure to patient emphasizing how he/she has to
cooperate.
• Maintain privacy
• Wash hands with soap and water
• Prepare all required equipment
• Raise bed to appropriate working level stand on right side of the
patient and shift patient closure to you
• Position patient, dorsal recumbent with knees flexed, and thighs
externally rotated.
Goma Karki BMS 19

20. Goma Karki BMS 20

21. Cont’d….
• Drape the patient in the dorsal recumbent position with draw sheet or bath
blanket.
• Place the mackintosh and draw sheet under the hip and put kidney tray in
convenient area.
• Open the catheter tray
• Wash and dry hands, wear sterile gloves
• Keep a sterile towel ready and place the perineal sheet over genital area.
Place the kidney tray to receive sterile urine specimen and sterile bottle
within reach.
• Separate labia majora with two fingers(thumb and index) of the left hand.
Goma Karki BMS 21

22. Cont’d….
• Using sponge forceps, take a cotton balls in the right hand
and swab the area right of the meatus, with downward stroke
once and discard it in the bin. Take another cotton ball, clean
the area left of the meatus, take the third and fourth balls and
clean directly over the meatus from top to bottom, use more
cotton balls if necessary.
• With gauze in the right hand, grasp the catheter, with 9-10
cm from the tip pinching after the outlet. Moisten the tip
with sterile glycerine or paraffin oil or water carefully, so as
not to contaminate the tip.
Goma Karki BMS 22

23. Cont’d….
• Insert 4-5 cm of the catheter gently into the meatus until urine
flows freely. When urine starts to flow, hold the catheter in
place with the left hand to prevent the catheter from slipping
out.
Goma Karki BMS 23

24. Cont’d….
• If sterile specimen is ordered, lower the
distal end of the catheter into a kidney
tray. Discard first few ml of urine, and
then collect urine into the specimen bottle.
• Collect 120-18- ml or as required. Then
direct the flow into the kidney tray.
• When urine ceases to flow, pinch the
catheter well and withdraw it gently.
Goma Karki BMS 24

25. Goma Karki BMS 25
• If continual drainage is
needed, attach a urinary bag
to the distal end and fix the
catheter in place.
• Push 10-15 ml distilled
water in another tip of the
catheter for fixing.
• Pull catheter outward lightly
to ascertain stability.

26. Cont’d….
• Connect catheter to urobag tied to
bed below level of bladder.
• Fix catheter to thigh using adhesive
tapes. Ensure adequate length to
avoid traction.
• Place the patient in comfortable
position.
Goma Karki BMS 26

27. Cont’d….
• Collect all equipments
• Measure urine before discarding it, note color, odor, sediment etc.
• In utility room, clean equipments first with soap and water, dry and
return it to the central supply for re-sterilization.
• Record and report the following things about the procedure:
-Date and time -type of catheter used
-Amount of urine drained -Any abnormality -Signature
• Report the senior staff
Goma Karki BMS 27

28. Goma Karki BMS 28

29. Catheterization in a male patient
Goma Karki BMS 29
Explain the procedure to the
patient.
Bring the required equipment near
to the bed side.
Position the patient in supine
position.
Cover the patient’s chest with a
bath blanket.
Place the mackintosh under the
buttock and thigh.

30. Cont’d….
Wash hands, dry and open sterile set with aseptic technique.
Put on sterile gloves
Lubricate the catheter well about 1 inch
Retract the fore skin of the penis so that the meatus in exposed,
clean the area with antiseptic solution using forceps to hold
cleansing sponges, use one swab for each wipe.
In order to straighten the urethra, lift the penis to an angle of
about 60 degree.
Goma Karki BMS 30

31. Cont’d….
Insert the catheter gently for about 18 cm or until begins to flow. The
size of the catheter and length of insertion determined by individual
patient separately.
Goma Karki BMS 31

32. Cont’d….
If the passage seems to be obstructed, remove the catheter and
report this to the doctor, do not force. Never use metal catheter.
When urine begins to flow, advance the catheter another 1inch.
Allow the bladder empty completely as instructed.
Reposition the foreskin.
Remove the catheter slowly and gently(if it is foleys catheter,
deflate the balloon before removing).
Goma Karki BMS 32

33. Cont’d….
Clean and dry the patient and
leave him comfortable.
Replace the equipment in proper
place after decontamination and
cleansing.
Record and report in the patient’s
chart.
Goma Karki BMS 33

34. Care of patient with foleys(indwelling)
catheter
Catheter care
It is cleansing the urethral meatus,
the skin surrounding the catheter
insertion site and perineum for
patients with retention catheter
who are bed ridden.
Goma Karki BMS 34

35. Cont’d….
Articles:
Catheter care sate
Clean tray containing:
-warm water and soap -kidney tray
-antiseptic solution -mackintosh and draw sheets
-Normal saline -adhesive tape and scissor
-sterile gloves -prescribed medicine
Screen
Waste bin
Goma Karki BMS 35

36. procedure
Check order or need of catheter care
Explain procedure to patient, offer opportunity for self care if
possible.
Prepare necessary equipment and supplies and bring near to the
patient
Provide privacy
Wash hands
Position patient:
Female: dorsal recumbent position with leg flexed
Male : supine position
Goma Karki BMS 36

37. Cont’d….
Place mackintosh and draw sheet under patient
Drape sheet over patient exposing only perineal area.
Don clean gloves
Remove anchor tapes to free catheter tubing.
Expose the urethral meatus( with non dominant hand)
Female: gently retract labia to fully expose urethral meatus and catheter
insertion site. Maintain position of hand throughout procedure.
Male: retract foreskin if patient is not circumcised and hold penis at shaft
just below glans, maintain position of hand throughout procedure.
Goma Karki BMS 37

38. Cont’d….
Assess urethral meatus and surrounding tissue for
inflammation, swelling and discharge. Note amount, color,
odor and consistency of discharge. Ask patient if burning or
discomfort is felt.
Cleanse perineal tissue:
female: use clean cloth, soap and water and clean towards
anus. Cleanse catheter first and then meatus, labia minora and
majora. Be sure cleansing each side and dry area well.
Male: cleanse catheter first and then clean from urethral
meatus till glans penis is in circular motion.
Goma Karki BMS 38

39. Cont’d….
Reassess urethral meatus for any discharge.
Remove clean gloves and wash hands
Open sterile catheter set with aseptic technique
Don sterile gloves
Clean the perineal area with disinfectant:
female: retract labia and wipe using sterile cotton swabs dipped in
antiseptic solution from center to periphery in straight strokes from front
to back, using one cotton ball for each stroke.
Male: retract foreskin and wipe using swabs from center to periphery in
circular motion.
Goma Karki BMS 39

40. Cont’d….
Clean the perineal area using cotton swabs soaked in sterile
water/ normal saline.
Goma Karki BMS 40

41. Cont’d….
Goma Karki BMS 41
Apply antiseptic: ointment at urethral meatus and along 2.5 cm
of catheter.
Anchor catheter

42. Cont’d….
Place patient in safe and comfortable. Position.
Remove gloves, dispose of contaminated supplies and wash
hands.
Record and report condition of perineal tissue, the time of
procedure was performed, patient’s response and abnormalities
noted.
Goma Karki BMS 42

43. Contraindications of catheterization
• Traumatic urethral injury - High riding prostate
• History of urethral stricture - known bladder tumor
• Resistance to passage - infection at insertion site
• Perineal hematoma -Allergy to latex
• Blood at meatus
Goma Karki BMS 43

44. Complications
Goma Karki BMS 44

45. Goma Karki BMS 45

46. Goma Karki BMS 46

47. Goma Karki BMS 47