Urinary Catheters:
Catheterization of the bladder involves introducing a rubber or plastic tube
through the urethra and into the bladder. The catheter provides a continuous
flow of urine in clients unable to control micturition or those with
obstructions. It also provides a means of assessing urine output in
hemodynamically unstable clients. Because bladder catheterization carries
the risk of UTI, blockage, and trauma to the urethra, it is preferable to rely
on other measures for either specimen collection or management of
incontinence.
There are two main forms of catheter insertion, intermittent and
indwelling retention catheterizations. With the intermittent technique a
straight single use catheter is introduced long enough to drain the bladder,
usually 5 – 10 minutes. When the bladder is empty, the catheter is
immediately withdrawn. Intermittent catheterization can be repeated as
necessary, but repeated use increases the risks of trauma and infection. An
indwelling or Foley catheter remains in place for a longer period until a
client is able to void completely and voluntarily or as long as accurate
measurements are needed.
The straight single use catheter has a single lumen with a small
opening about 1.3 cm from the tip. Urine drains from the tip, through the
lumen, and to a receptacle. And indwelling Foley catheter has a small
inflatable balloon that encircles the catheter just above the tip. When
inflated, the balloon rests against the bladder outlet to anchor the catheter in
place. The indwelling retention catheter may have two or three lumens
within the body of the catheter. One lumen drains urine through the catheter
to a collecting tube, a second lumen carries sterile water to and from the
balloon when it is inflated or deflated, and a third lumen may be used to
instill fluids or medications into the bladder.
A second type of intermittent catheter has a curved tip. A Coude’
catheter is used on male clients who may have enlarged prostates that partly
obstruct the urethra. The Coude’ catheter is less traumatic during insertion
because it is stiffer and easier to control than the straight tip catheter.
Catheter Insertion
Urethral catheterization requires a physician’s order. Strict
aseptic technique must be utilized. Organizing equipment before the
procedure prevents interruptions. The steps for inserting indwelling and
single-use catheters are basically the same. The difference lies in the
“This product was funded by a grant awarded under the President’s Community-Based Job Training Grants as implemented the U. S. Department of Labor’s Employment &
Training Administration. The information contained in this product was created by a grantee organization and does not necessarily reflect the official position of the U. S.
Department of Labor. All references to non-governmental companies or organizations, their services, products, or resources are offered for informational purposes and should not
be construed as an endorsement by the Department of Labor. This product is copyrighted by the institution that created it and is intended for individual organizational, noncommercial use only.”
procedure taken to inflate the indwelling catheter balloon and secure the
catheter.
Procedure for Straight Urinary Catheter (female patient):
1. Wash hands.
2. Ask patient if she has allergies to latex or iodine. (If allergy
exists use latex-free gloves and catheter, and use hypoallergenic
soap and water for cleaning.)
3. Explain the procedure to the patient
4. Provide for privacy
5. Position the patient in the dorsal recumbent position with knees
flexed, exposing the labia.
6. Drape the patient so that only the perineum is exposed.
7. Assemble the equipment and put on gloves
8. Prepare the items in the kit for use during insertion, maintaining
clean technique
9. With nondominant hand, separate the labia minora, and hold this
position until the catheter is inserted.
10.using cotton balls, cleanse the meatus with the iodine cleansing
solution
a. Making one downward stroke with each cotton ball, begin at
the labia on the side farthest from you, and move toward the
labia nearest you
b. Afterward, wipe once down the center of the meatus
c. Wipe once with each cotton ball, and discard. (The forceps
may be used to hold the cotton ball.)
11.Direct the open end of the catheter into the collection container.
Lubricated and insert the tip of the catheter slowly through the
urethral opening 3 to 4 inches or until urine returns
12.Advance catheter another 0.5 to 1 inches
13.Allow urine to drain until it stops. Collect a sterile urine
specimen if needed. Then remove the catheter slowly allowing
any additional urine to drain
14.Cleanse the perineal area. Reposition the patient for comfort, and
replace the linens
15.Measure the amount of urine in the collection container, and
record
16.Remove and discard gloves; wash hands
17.Document and report the results to the RN.
“This product was funded by a grant awarded under the President’s Community-Based Job Training Grants as implemented the U. S. Department of Labor’s Employment &
Training Administration. The information contained in this product was created by a grantee organization and does not necessarily reflect the official position of the U. S.
Department of Labor. All references to non-governmental companies or organizations, their services, products, or resources are offered for informational purposes and should not
be construed as an endorsement by the Department of Labor. This product is copyrighted by the institution that created it and is intended for individual organizational, noncommercial use only.”
Procedure for Straight Catheter (male patient):
1. Wash hands.
2. Ask patient if he has allergies to latex or iodine. (If allergy exists use
latex-free gloves and catheter, and use hypoallergenic soap and water
for cleaning.)
3. Explain the procedure to the patient
4. Provide for privacy.
5. Drape the patient with bed linens so that only the penis is exposed.
6. Assemble the equipment and put on gloves
7. Prepare the items in the kit for use during insertion, maintaining clean
technique
8. Remove the fenestrated drape from the kit, and using nondominant
hand, place the penis through the hole in the drape. Keep dominant
hand sterile
9. Pull the penis up at a 90 degree angle to the patient’s supine body
10.With nondominant hand, gently grasp the glans (tip) of the penis;
retract foreskin if uncircumcised
11.Using cotton balls, cleanse the meatus and the glans with the iodine
cleansing solution, beginning at the urethral opening and moving
toward the shaft of the penis; make one complete circle around the
penis with each cotton ball. Direct the open end of the catheter into
the collection container
12.Lubricate and insert the tip of the catheter slowly through the urethral
opening 7 to 9 inches or until urine returns
13.Allow urine to drain until it stops. Collect a sterile urine specimen if
needed. Then remove the catheter slowly allowing any additional
urine to drain.
14.Cleanse the perineal area, and replace the foreskin of the penis.
Reposition the patient for comfort, and replace the linens.
15.Measure the amount of urine in the collection container, and record
16.Remove and discard gloves; wash hands
17.Document and report the results to the RN
“This product was funded by a grant awarded under the President’s Community-Based Job Training Grants as implemented the U. S. Department of Labor’s Employment &
Training Administration. The information contained in this product was created by a grantee organization and does not necessarily reflect the official position of the U. S.
Department of Labor. All references to non-governmental companies or organizations, their services, products, or resources are offered for informational purposes and should not
be construed as an endorsement by the Department of Labor. This product is copyrighted by the institution that created it and is intended for individual organizational, noncommercial use only.”
Procedure for inserting an indwelling catheter (female):
1. Wash hands
2. Ask patient if she has allergies to latex or iodine. (If allergy exists use
latex-free gloves and catheter, and use hypoallergenic soap and water
for cleaning.)
3. Explain the procedure to the patient
4. Provide for privacy
5. Position the patient in the dorsal recumbent position with knees
flexed, exposing the labia.
6. Drape the patient so that only the perineum is exposed.
7. Remove the full drape from the kit with your fingertips, and place,
plastic side down, just under the patient’s buttocks, ask her to raise her
hips
8. Put on sterile gloves
9. Prepare the items in the kit for use during insertion, maintaining
sterile techniques
10.Test the balloon for defects. Deflate the balloon, and leave the
syringe on the catheter. Liberally lubricate the catheter tip.
11.With nondominant hand, separate the labia minora, and hold this
position until the catheter is inserted.
12.using cotton balls, cleanse the meatus with the iodine cleansing
solution
a. Making one downward stroke with each cotton ball, begin at
the labia on the side farthest from you, and move toward the
labia nearest you
b. Afterward, wipe once down the center of the meatus
c. Wipe once with each cotton ball, and discard. (The forceps
may be used to hold the cotton ball.)
13.Direct the open end of the catheter into the collection container.
Lubricated and insert the tip of the catheter slowly through the
urethral opening 3 to 4 inches or until urine returns
14.Advance catheter another 0.5 to 1 inches
15.Inflate the balloon with the attached syringe, and gently pull back on
the catheter until it stops or catches. Catch the urine in the collection
tray or in the specimen cup if needed.
16.Measure the amount of urine in the drainage bag and record
17.Remove and discard gloves; wash hands
“This product was funded by a grant awarded under the President’s Community-Based Job Training Grants as implemented the U. S. Department of Labor’s Employment &
Training Administration. The information contained in this product was created by a grantee organization and does not necessarily reflect the official position of the U. S.
Department of Labor. All references to non-governmental companies or organizations, their services, products, or resources are offered for informational purposes and should not
be construed as an endorsement by the Department of Labor. This product is copyrighted by the institution that created it and is intended for individual organizational, noncommercial use only.”
18.Document and report the results to the RN
Procedure for inserting an indwelling catheter (male):
1. Wash hands
2. Ask patient if he has allergies to latex or iodine. (If allergy exists use
latex-free gloves and catheter, and use hypoallergenic soap and water
for cleaning.)
3. Explain the procedure to the patient
4. Provide for privacy.
5. Assemble the equipment and put on gloves
6. Prepare the items in the kit for use during insertion, maintaining
sterile technique
7. Test the balloon for defects. Deflate the balloon, and leave the
syringe on the catheter. Liberally lubricate the catheter tip.
8. Remove the fenestrated drape from the kit, and using nondominant
hand, place the penis through the hole in the drape. Keep dominant
hand sterile
9. Pull the penis up at a 90 degree angle to the patient’s supine body
10.With nondominant hand, gently grasp the glans (tip) of the penis;
retract foreskin if uncircumcised
11.Using cotton balls, cleanse the meatus and the glans with the iodine
cleansing solution, beginning at the urethral opening and moving
toward the shaft of the penis; make one complete circle around the
penis with each cotton ball. Direct the open end of the catheter into
the collection container
12.Insert the tip of the catheter slowly through the urethral opening to the
bifurcation (Y) of the catheter.
13.Inflate the balloon with the attached syringe, and gently pull back on
the catheter until it stops, or catches
14.Replace the foreskin of the penis on uncircumcised males
15.Measure the amount of urine in the drainage bag and record
16.Position the collection back lower than the bladder.
17.Remove and discard gloves; wash hands
18.Document and report the results to the RN
“This product was funded by a grant awarded under the President’s Community-Based Job Training Grants as implemented the U. S. Department of Labor’s Employment &
Training Administration. The information contained in this product was created by a grantee organization and does not necessarily reflect the official position of the U. S.
Department of Labor. All references to non-governmental companies or organizations, their services, products, or resources are offered for informational purposes and should not
be construed as an endorsement by the Department of Labor. This product is copyrighted by the institution that created it and is intended for individual organizational, noncommercial use only.”
Discontinuing an Indwelling Catheter:
1. Wash hands
2. Explain the procedure to, and provide privacy for, the patient
3. Gather the supplies
4. Tuck a protective pad or towel under the patient’s hips to catch any
urine that may drip during the procedure.
5. Put on gloves
6. Attach the syringe to the urinary catheter port, and draw back 10 cc of
sterile saline solution. Be sure to remove all of the solution from the
port to allow the balloon to collapse and the catheter to slip easily out
of the urethra
7. Tell the patient that you are ready to gently but firmly pull the catheter
out. Encourage the patient to take a deep breath
8. Clean up any urine that may have dripped.
9. Empty the drainage bag, and record the amount and characteristics of
the urine.
10.Discard the catheter and the empty drainage bag in the trash
11.Remove and discard gloves; wash hands
12.Document and report the results to the RN
Routine Catheter Care
Clients with indwelling catheters have a number of special care needs.
Nursing measures are directed at preventing infection and maintaining
unobstructed flow of urine through the catheter drainage system.
1. Personal hygiene. Buildup of secretions or encrustation at the catheter
insertion site is a source of irritation and potential infection. Perineal
hygiene needs to be provided at least twice daily or as needed for a
client with a retention catheter. Soap and water are effective in
reducing the number of organisms around the urethra. Do not
accidentally advance the catheter up into the bladder during cleansing
or you risk introducing bacteria.
2. Catheter Care. In addition to routine perineal hygiene, many
institutions recommend that clients with catheters receive special care
3 times a day and after defecation or bowel incontinence to help
minimize discomfort and infection
“This product was funded by a grant awarded under the President’s Community-Based Job Training Grants as implemented the U. S. Department of Labor’s Employment &
Training Administration. The information contained in this product was created by a grantee organization and does not necessarily reflect the official position of the U. S.
Department of Labor. All references to non-governmental companies or organizations, their services, products, or resources are offered for informational purposes and should not
be construed as an endorsement by the Department of Labor. This product is copyrighted by the institution that created it and is intended for individual organizational, noncommercial use only.”
3. Fluid intake. All clients with catheters should have a daily intake of
2000 to 2500 ml if permitted. This can be met through oral intake or
intravenous infusion. A high fluid intake produces a large volume of
urine that flushes the bladder and keeps catheter tubing free of
sediment.
4. Preventing infection. Maintaining a closed urinary drainage system is
important in infection control. A break in the system can lead to
introduction of microorganisms. Sites at risk are the site of catheter
insertion, the drainage bag, the spigot, the tube junction, and the
junction of the tube and the bag. In addition, the patency of the
system must be monitored to prevent pooling of urine within the
tubing. Urine in the drainage bag is and excellent medium for
microorganism growth. Bacteria can travel up drainage tubing to
grow in pools of urine. If this urine flows back into the client’s
bladder, and infection will likely develop.
Tips for Preventing Infection in Catheterized Patients:
 Follow good hand-hygiene techniques
 Do not allow the spigot on the drainage system to touch a
contaminated surface
 Only use sterile technique to collect specimens from a closed
drainage system
 If the drainage tube becomes disconnected, do not touch the
ends of the catheter or tubing. Wipe the end of the tubing and
catheter with an antimicrobial solution before reconnecting
 Ensure that each client has a separate receptacle for measuring
urine to prevent cross contamination
 Prevent pooling of urine in the tubing and reflux of urine into
the bladder
 Avoid raising the drainage bag above the level of the bladder
 If it becomes necessary to raise the bag during transfer of the
client to a bed or stretcher, clamp the tubing or empty the
tubing contents to the drainage bag first
 Provide for drainage of urine form the tubing to the bag by
positioning the tubing
 Before exercise or ambulation drain all urine from the tubing
into the drainage bag
 Avoid prolonged kinking or clamping of the tubing
“This product was funded by a grant awarded under the President’s Community-Based Job Training Grants as implemented the U. S. Department of Labor’s Employment &
Training Administration. The information contained in this product was created by a grantee organization and does not necessarily reflect the official position of the U. S.
Department of Labor. All references to non-governmental companies or organizations, their services, products, or resources are offered for informational purposes and should not
be construed as an endorsement by the Department of Labor. This product is copyrighted by the institution that created it and is intended for individual organizational, noncommercial use only.”
 Empty the drainage bag at least every 8 hours. If large outputs
are noted, empty more frequently.
 Encourage fluid intake (if not contraindicted). Inclusion of
cranberry juice has been shown to decrease the adherence of
bacteria to the bladder wall and to catheter lumen
 Remove the catheter as soon as clinically warranted
 Tape or secure the catheter appropriately for the client
 Perform routine perineal hygiene per agency policy and after
defecation or bowel incontinence
“This product was funded by a grant awarded under the President’s Community-Based Job Training Grants as implemented the U. S. Department of Labor’s Employment &
Training Administration. The information contained in this product was created by a grantee organization and does not necessarily reflect the official position of the U. S.
Department of Labor. All references to non-governmental companies or organizations, their services, products, or resources are offered for informational purposes and should not
be construed as an endorsement by the Department of Labor. This product is copyrighted by the institution that created it and is intended for individual organizational, noncommercial use only.”