EARLY INTERVENTION EARLY CHILDHOOD SPECIAL EDUCATION
Clean Intermittent Catheterization - Male
DOB
FOR
*WRITTEN ON
BY
RN
*To be reviewed by RN at least annually.
1. Gather equipment before procedure:
a. Towel to place under student
b. Calibrated container to collect urine
c. Water soluble lubricant (e.g., K-Y
Jelly,
Surgi-lube, never Vaseline)
d. Soap and water
e. Paper towels
f. Gloves
g. Catheter
2. Provide private area for student.
3. Inform student of your actions as you
proceed.
4. Wash your hands and have student
wash hands also.
5. Assist student as needed with removal
of pertinent clothing.
continue with insertion. Never force the
catheter. Stop immediately if pain
occurs.
10. Inform student when catheterization is
finished. Pinch off catheter while it is
gently removed.
11. Assist student as needed to redress.
12. Measure and record the amount of urine
obtained.
13. Observe and record the urine for color,
clarity, odor, or foreign particles (blood,
mucous.)
14. Wash catheter with soap and water.
Allow to air dry, if possible. Otherwise,
vent storage box until catheter is dry.
6. Apply glove.
15. Properly dispose of urine. Wash
collection container with soap and water.
Dry with paper towels.
7. Set out supplies. Squeeze lubricant
onto tip of catheter; place catheter tip on
clean paper towel, putting large end of
catheter in collection container.
16. Remove gloves and dispose of in
appropriate receptacle.
8. Gently cleanse around the urethral
meatus, rinsing off soapy residue.
Observe the area between the anus and
the genitals for redness, skin eruptions,
swelling, or discharge.
9. Tell the student you are going to insert
the catheter. Ask the student to breathe
deeply; then grasp sides of penis below
glans, retract foreskin if uncircumcised,
and stretch penis upward. Insert
catheter slowly, if you meet resistance,
ask student to breathe deeply again and
17. Wash your hands well with soap and
water and assist student to do likewise.
18. Report promptly any discomfort,
swelling, redness, change in urine color,
clarity/odor, to school nurse if in building;
otherwise parent by note/telephone call.
19. Record procedure on flow sheet.
1
Reviewed 11/13
If PROCEDURE IS IMPLEMENTED: PHOTOCOPY PROCEDURE NOTE TIME,
DATE, AND ACTION. SIGN YOUR LEGAL SIGNATURE. GIVE TO THE DISTRICT NURSE.