PROCEDURE FOR URINARY

CATHETERISATION

First Issue Purpose of Issue/Description of Change Planned Review

Issued Version Date
To promote safe and effective urinary
One catheterisation for patients in a community setting 2013

Named Responsible Officer:- Approved by:- Date

Continence Nurse Specialist Nursing Policy Group March 2010

Impact Assessment Screening Full Impact

Section :- Continence
Complete Assessment
C No 02 Date: March 2010 Required Y/N

UNLESS THIS VERSION HAS BEEN TAKEN DIRECTLY FROM THE NHS WEBSITE
THERE IS NO ASSURANCE THIS IS THE CORRECT VERSION
 PROCEDURE FOR URINARY CATHETERISATION

INDEX

Contents Page Number

Introduction 3

Procedure Aim 3

Target Group 3

Training 3

Related Policies 4

Risk Factors 4

Product Selection 5-6

Equipment 6

Indications and Catheter selection 7-8

Procedure for Female Catheterisation 9-11

Procedure for Male Catheterisation 11

Procedure for Supra - Pubic Catheterisation 14

References 17
Appendix One ( NPSA Alert Poster)
18
Female Urinary Catheters

PROCEDURE FOR URINARY CATHETERISATON

2/16
 PROCEDURE FOR URINARY CATHETERISATION

INTRODUCTION

An indwelling catheter is a hollow tube that is inserted into the bladder to facilitate emptying
of the bladder or instillation of fluids (Association of Continence Advice [ACA] 2007).
Indwelling catheters are retained by inflating an integral balloon within the bladder; they may
be inserted urethrally or supra-pubically (Pomfret 2007).

Intermittent catheters are designed to be inserted then removed after draining the bladder
(National Institute for Health and Clinical Excellence [NICE] 2003) and therefore do not have
a self retaining balloon.

Intermittent Catheterisation should always be considered the first option (Evidence Based
Practice in Infection Control [Epic] 2003). When considering catheterisation for intractable
incontinence, this intervention should only be considered after all other non-invasive
management options have been explored and found to be unsatisfactory (NICE 2003).

Catheter insertion is an aseptic technique which requires full clinical assessment and should
only be performed where there is an identified clinical need or to improve the patients quality
of life. This is important because patients having a catheter inserted as part of their clinical
care are in significant danger of acquiring a urinary tract infection (UTI). The risk of UTI is
associated with the method and duration of catheterisation, the quality of catheter care and
host susceptibility (EPIC 2003).

PROCEDURE AIM

NHS Wirral is committed to providing high quality nursing services to all patients. This
procedure outlines the standards of safe and timely healthcare for patients in the community
setting who require catheterisation of the urinary bladder.

TARGET GROUP

This policy applies to all clinical staff directly employed by NHS Wirral, who are required to
carry out this role.

TRAINING

All nurses will comply with the current NHS Wirral Core Clinical Training Programme, which
includes a mandatory two day Continence Course covering catheterisation and catheter
care, to be attended every three years

Managers will monitor attendance as part of performance reviews and management

supervision.

NHS Wirral Continence Service provides training throughout the year, attendance is also
mandatory if practitioner has:-
Been on long term sickness absence e.g. over 6 months
Identified the need for an update as part of own continuing professional development
Not attended an update within the last three years and if:-
Manager has identified topic as development need

PROCEDURE FOR URINARY CATHETERISATON

3/16
 Manager has identified topic as a development need following a clinical incident
investigation.

DEFINITION OF ADULT

For the purpose of this document an adult is deemed to be a person over the age of 16 years
with the capacity of consent.

RELATED POLICIES

NHS Wirral Health Records Policy

Record Keeping Procedure for Community Nursing
NMC (July 2007) Record Keeping
NMC (2008) The Code: standards of conduct, performance, and Ethics for
Nurses and Midwives
Infection Control Policies
Incident Reporting Policy
Medical Devices Policy
Consent Policy
Chaperone Policy
Continence Procedures
Vulnerable Adults Policy
Clinical Waste Policy
Continence Appliance Formulary

NB Always use most current versions of NHS Wirral and NMC policies as may be
superseded at any time.

PATIENTS WHO HAVE ADDITIONAL RISK FACTORS

RISK FACTOR
Clients with a history of sexual abuse
Heart defects for example heart valve
lesion, septal defect, patent ductus or
prosthetic valve
CONSIDERATION
Clients falling into this category may find the procedure
too distressing and consent in all cases can be withdrawn
at any stage. Wherever possible under these
circumstances offer staff of the same gender of patients
choosing to undertake this procedure
Antibiotic prophylaxis may be required when inserting or
changing a urinary catheter (NICE 2003) discuss with
general practitioner or medical practitioner in Out of Hours
Service

DECISIONS TO CATHETERISE

1. Patients must be provided with adequate information in relation to the need, insertion,
maintenance, and removal of their catheter by the practitioner planning their care (EPIC
2003).

2. When Catheterisation is being discussed as a treatment option, intermittent catheterisation

should always be considered for incomplete emptying as the first option rather than
indwelling catheterisation, providing this is a safe acceptable alternative for the individual and
carer(s) (NICE 2003).

PROCEDURE FOR URINARY CATHETERISATON

4/16
3. A full assessment of the individual and their needs should be carried out before
catheterisation, to ensure benefits outweigh disadvantages (Royal College of Nursing [RCN]
2008).

4. Assessment of the patient must include exploration of factors that may impact on the
decision to catheterise these include:

Mental health or cognitive status of the patient, catheterisation of patients who are
cognitively impaired should be avoided wherever possible (RCN 2008).
Patients ability to manage the catheter independently
Carer availability in order to manage/undertake catheter care.

INDICATIONS FOR CATHETERISATION

Patients with a neurological condition or injury who have difficulty in

completely emptying the bladder.
Patients with outlet obstruction who may be unfit for surgical repair
Patients who have intractable incontinence, or where other methods are
inappropriate or unsuccessful.
Palliative care patients, where catheterisation promotes comfort and dignity.
Chronic urinary retention
Tissue viability and preserving skin integrity

EXCLUSIONS FOR FIRST CATHETERISATION

A history of complicated catheterisation or unsuccessful attempts at catheterisation

Advanced prostate cancer
Advanced bladder cancer
Post Urological Surgery
Lymphoedema
Known urethral Congenital Abnormalities/False Passages
Urethral Obstruction
A history of urethral bleeding or undiagnosed Haematuria
Acute Retention

PRODUCT SELECTION

When selecting the correct catheter it is important to consider the following: duration of
catheterisation, catheter material, size, length, balloon volume and drainage system (ACA
2007).

THE DURATION

The duration of catheterisation can be variable and is often related to the reason for
catheterisation. For example, it can be short term (1-28 days) or long term (more than 28
days).

CATHETER MATERIAL
The choice of catheter material will be dependant on the duration of catheterisation (Pellowe
2009).

Short Term Catheters (1-28days)

PROCEDURE FOR URINARY CATHETERISATON
5/16
PTFE (Poly tetrafluorethylene) coated latex catheter
This includes those long term catheterised patients requiring catheter change more
frequently than 4 weekly

Long Term Catheters (more than 28 days)

Hydrogel coated latex catheter
Hydrogel coated silicone catheter
All Silicone catheter

See Continence Appliance Formulary for 1st & 2nd choice

For patients with a latex allergy, only 100% silicone catheters contain no latex (ACA 2007).

CATHETER SIZE

The system of measurement to express catheter diameter is the Charriere (ch). For routine
drainage in an adult select the smallest charriere size that will ensure adequate drainage, to
minimise urethral trauma and irritation of the bladder mucosa (Pellowe 2009).

Female: 10ch 14ch

Male: 12ch - 16ch
Supra pubic: 14ch 16ch (size is determined by surgeon on insertion)

CATHETER LENGTH

A standard length catheter is first choice for all patients

A standard length catheter should always be first choice; a female length catheter should
never be used to catheterise a male patient as there is not enough length to allow the balloon
to clear the urethra, therefore when inflating severe trauma will occur (National Patient Safety
Agency [NPSA] 2009). Female length catheters must be stored separately from other
catheter equipment.

BALLOON VOLUME

Indwelling catheters require the addition of sterile water to inflate the self- retaining balloon. A
10ml balloon should be used in routine catheterisation (NICE 2003 & ACA 2007). The use of
a 30ml balloon in routine catheterisation should always be questioned (ACA 2007)

When selecting the catheter pre-filled balloons are preferable for urethral catheterisation, the
exact amount stated by the manufacturer should be instilled, do not over or under inflate as
this could lead to misshaping of the balloon (ACA 2007).

SELECTING THE DRAINAGE SYSTEM

The catheter should always be connected to a sterile closed drainage system or valve (DH
2006). It should be well supported to prevent trauma and kept below the level of the waist.
The closed drainage system should only be broken for valid clinical reasons and a link
system used for overnight drainage if required (DH 2006).

There are a range of drainage bags available; they should be selected on an individual
patient basis to ensure the capacity of the drainage bag and tubing length meets the
individual needs of the patient and avoids complications such as kinking and dragging of the
tubing or overfilling of the bag (ACA 2007).

SELECTING THE DRAINAGE SYSTEM ADVICE

PROCEDURE FOR URINARY CATHETERISATON
6/16
Urine drainage bags Will normally be leg bags for people who are ambulant to
use in the day.
Follow manufacturers instructions that indicate that the
bag will normally be changed every 5 7 days.

For overnight drainage use a link system A 2-litre single use non-drainable night bag is attached to
the leg bag.

For patients who are non-Ambulatory, confined A sterile 2 litre, drainable bag is only used where the
to bed person is non-ambulatory. If this system is used, the bag
will remain attached for 5 7 days with the catheter bag
junction unbroken (as manufacturers instructions)

Advise patient or carer to label bag with date bag has

been attached and date due for changing and document
advice given in the patients health records

Catheter valves (Please see Continence
Appliance Formulary)
Anaesthetic gels (prescribed on community
medicines administration chart)
Will be used following guidance in relation to
manufacturers instructions and following clinical
assessment.
Should be used in Female catheterisation (6mls). Male
catheterisation (11mls) and supra-pubic catheterisation
This is contraindicated in patients with known sensitivities
to the ingredients Lidocaine or Chlorhexadine

EQUIPMENT
Single use disposable apron
Catheter :
Sterile dressing pack
Additional pair of single use disposable sterile gloves
One pair of single use disposable non-sterile gloves
Prescribed single use anaesthetic gel/ lubricant gel - written on Patients Medication
Administration Chart
Drainage bag
10 ml Syringe x 2
single use sachet normal saline 0.9%
If catheter is not prefilled - 10mls sterile water for injection and green needle.
Disposable Non-sterile Kidney dish

PROCEDURE FOR FEMALE URINARY CATHETERISATION

PROCEDURE RATIONALE
Introduce yourself and any colleagues involved at To gain co-operation
the contact.

Verbally confirm the identity of the patient by To avoid mistaken identity

asking for their full name and date of birth. If
patient unable to confirm, check identity with
family/ carer
Explain procedure to patient including risks and To ensure client understands procedure
benefits and gain informed consent. If patient
unable to give consent, act in patients best Use consent form 4 if appropriate
interests by following Consent Policy

PROCEDURE FOR URINARY CATHETERISATON

7/16
Offer patient a chaperone and document decision
in health records
Ensure all equipment is gathered before
commencing the procedure
Check the catheter size and type against the
written instructions in the patients health records
If not first catheterisation ask the patient to empty
their drainage bag.
Check for any allergies e.g. latex or anaesthetic
gels
Decontaminate hands prior to procedure
Open sterile dressing pack onto a clean field and
place all sterile single use equipment required
within sterile field
Use aseptic principle to ensure that only sterile
single use items are used to keep exposure of the
susceptible site to a minimum
In the event the patient requires assistance with
personal hygiene apply single use disposable
non-sterile apron and gloves
Ask or assist the patient to position themselves in
a supine position, with knees bent and hips flexed
and feet comfortably apart.(If able)
Decontaminate hands prior to procedure
Apply single use disposable apron and gloves
If not first catheterisation remove existing catheter
attach empty syringe to catheter port. Do not draw
back on the syringe; allow the catheter balloon to
deflate using gravity. Place a piece of gauze
around the catheter and slowly withdraw the
catheter
Using sterile gauze, separate the labia and
identify urethral meatus, clean around the urethral
orifice with normal saline 0.9% using downward
strokes
Insert prescribed single use anaesthetic /
lubricating gel with dominant hand to urethra and
leave for recommended manufacturers time/ 5
minutes
Remove and dispose of PPE to comply with waste
management policy
Arrange sterile towel to cover the surrounding
area and maintain dignity
PROCEDURE FOR URINARY CATHETERISATON
8/16
It is the patients choice to have a chaperone if
wanted. Discuss with line manger if nurse
considers a chaperone is needed as part of risk
assessment
To prevent contamination of sterile equipment
and to ensure the procedure is not commenced
without all necessary equipment
To reduce risk of using the incorrect device
To avoid spillages of urine during procedure
To reduce risk of anaphylaxis
To reduce the risk of transfer of transient micro -
organisms on the health care workers hands
To maintain asepsis and prevent contamination
of sterile equipment
To prevent contamination of a susceptible site by
organisms that could cause infection
To prevent cross infection
To maintain dignity and comfort
To reduce the risk of transfer of transient micro -
organisms on the health care workers hands
To prevent cross infection and environmental
contamination.
To avoid vacuuming of the bladder mucosa
Inadequate preparation of the urethral orifice is a
major cause of infection following catheterisation.
To reduce risk of cross infection (DH 2005)
To ensure full effectiveness of
anaesthetic/lubricant gel, to minimise discomfort
and help prevent urethral trauma (Woodward
2005)
To prevent cross infection and environmental
contamination
To create sterile field and help prevent
contamination
Apply single use disposable sterile apron and To maintain asepsis, reduce the risk of microbial
gloves in a manner which prevents the outer contamination and prevent the spread of infection
surface of the sterile glove being touched by a
non-sterile item
Insert the catheter approximately 5-6cms. Once To ensure the balloon is in the bladder
urine has started draining insert a further 3-5cms.
If at any time the patient experiences any undue
pain or there is resistance when passing the
catheter, stop and seek advice.
If Prefilled balloon: Release clamp of balloon To retain catheter in bladder
and allow slow release of water. (Over inflation of the balloon may cause irritation
of the bladder trigone inducing bladder spasm
If not prefilled balloon: which in turn causes by passing of urine around
Slowly inflate the balloon with 10mls of sterile the urethral orifice)
water according to manufactures instructions.
Balloon inflation should be pain free. If the patient
is experiencing any pain or discomfort during
balloon inflation, the balloon might be positioned
in the urethra. Deflate the balloon and advance
the catheter a few more centimetres before trying
again. Attach the catheter to a previously selected
drainage system or catheter valve.

Attach sterile drainage bag. To maintain closed circuit system

Measure the amount of urine To be aware of bladder capacity for patients who
have presented with urinary retention. To monitor
renal function and fluid balance

Ensure the patient is comfortable and the genital If the area is left wet or moist, secondary
area is dry infection and skin irritation may occur
On completion of procedure remove and dispose To prevent cross infection and environmental
of PPE to comply with waste management policy contamination

Decontaminate hands following removal of PPE
Record information in patients health records
Catheter material/ expiry date
Charrire size and length
Balloon size
Batch number
Cleansing and anaesthetic agents
Urine drainage system
Planned date for the next catheter change
Reinforce management of catheter and ongoing
care, document patient catheter booklet explained
and given to patient/carer contact details given
To remove any accumulation of transient skin
flora that may have built up under gloves and
possible contamination following removal of PPE
To document event and have a permanent
record for reference and monitoring of future care
planning.
Date of catheter change essential for safety of
patient
Promotes independence and reduces incidence
of problems/infections
Promoting self-care

PROCEDURE FOR URINARY CATHETERISATON

9/16
Fully document all intervention and any follow up To comply with NHS Wirral record keeping
care required in the patients care plan policies.
Record patients/carers comments or any concerns To record patients perspective.
following the procedure To provide safe and effective continuity of care

PROCEDURE FOR MALE URINARY CATHETERISATION

PROCEDURE RATIONALE
Introduce yourself and any colleagues involved at To gain co-operation
the contact.
Verbally confirm the identity of the patient by To avoid mistaken identity
asking for their full name and date of birth. If
patient unable to confirm, check identity with
family/ carer
Explain procedure to patient, including risks and To ensure client understands procedure and
benefits and gain informed consent. If patient enable patient to make informed decisions
unable to give consent, act in patients best
interests by following Consent Policy Use consent form 4 if appropriate

Offer patient a chaperone and document decision It is the patients choice to have a chaperone if
in health records wanted. Discuss with line manger if nurse
considers a chaperone is needed as part of risk
assessment
Ensure all equipment is gathered before To prevent contamination of sterile equipment
commencing the procedure and to ensure the procedure is not commenced
without all necessary equipment
Check the catheter size and type against the To reduce risk of using the incorrect device.
written instructions in the patients health records

Check for any allergies e.g. latex or anaesthetic To reduce risk of anaphylaxis
gels
If not first catheterisation ask the patient to empty To avoid spillages of urine during procedure
their drainage bag.
Decontaminate hands prior to procedure To reduce the risk of transfer of transient micro -
organisms on the health care workers hands
Open sterile dressing pack onto a clean field and To maintain asepsis and prevent contamination
place all sterile single use equipment required of sterile equipment
within sterile field including catheter and drainage
system
Use aseptic principle to ensure that only sterile To prevent contamination of a susceptible site by
single use items are used to keep exposure of the organisms that could cause infection
susceptible site to a minimum
In the event the patient requires assistance with To prevent cross infection
personal hygiene apply single use disposable
non-sterile apron and gloves
Ask or assist the patient into a supine position To ensure abdominal muscles relaxed
PROCEDURE FOR URINARY CATHETERISATON
10/16
Decontaminate hands
Apply sterile single use disposable apron and
gloves
If not first catheterisation, remove existing catheter
attach empty syringe to catheter port. Do not draw
back on the syringe; allow the catheter balloon to
deflate using gravity. Place a piece of sterile
gauze around the catheter and slowly withdraw
the catheter, whilst supporting the penis
Retract foreskin (if not circumcised), clean around
the Glans and urethral orifice with normal saline
0.9%
Insert prescribed single use anaesthetic /
lubricating gel slowly into urethra and leave for
recommended manufacturers time/ 5 minutes
Remove and dispose of PPE to comply with waste
management policy
Decontaminate hands and apply new sterile single
use disposable apron and gloves
Arrange sterile towel to cover the surrounding
area and maintain dignity
Wrap sterile folded gauze around the penis and
use to support the penis at a 90 degree angle
Whilst maintaining an angle of 90 degrees, insert
the catheter slowly into urethra.
There may be a slight resistance at the external
sphincter, ask the patient to cough or try to pass
water and the catheter should pass easily.
If resistance felt and unable to progress the
catheter, stop and seek help, do not force.
Insert catheter until urine has started to drain, then
insert a further 5cm or almost up to the bifurcation.
If Prefilled balloon: Release clamp of balloon
and allow slow release of water.
If not prefilled balloon:
Slowly inflate the balloon with 10mls of sterile
water according to manufactures instructions.
Balloon inflation should be pain free. If the patient
is experiencing any pain or discomfort during
balloon inflation, the balloon might be positioned
in the urethra. Deflate the balloon and advance
the catheter a few more centimetres before trying
again. Attach the catheter to a previously selected
sterile drainage system or catheter valve.
PROCEDURE FOR URINARY CATHETERISATON
11/16
To reduce the risk of transfer of transient micro -
organisms on the health care workers hands
To prevent cross infection and environmental
contamination.
To avoid vacuuming of bladder mucosa
Inadequate preparation of the urethral orifice is a
major cause of infection following catheterisation.
To reduce risk of cross infection (DH 2005)
To ensure full effectiveness of
anaesthetic/lubricant gel, to minimise discomfort
and help prevent urethral trauma (Woodward
2005)
To prevent cross infection and environment
contamination
To reduce the risk of transfer of transient micro -
organisms on the health care workers hands
To create sterile field and help prevent
contamination
This straightens out the first curve of the urethra;
the gauze will contain any excess gel.
To aid insertion
This will help relax the pelvic floor and sphincters
to aid insertion of the catheter.
To prevent trauma as there could be an
obstruction.
Ensures the catheter is within the bladder.
To retain catheter in bladder
(Over inflation of the balloon may cause irritation
of the bladder trigone inducing bladder spasm
which in turn causes by passing of urine around
the urethral orifice)
10ml balloon catheters are now recommended
for urine routine use.
Measure the amount of urine
Attach sterile drainage bag.
Ensure the patient is comfortable and the genital
area is dry
On completion of procedure remove and dispose
of PPE to comply with waste management policy
Decontaminate hands following removal of PPE
Record information in patients health records
Catheter material/ expiry date
Charrire size and length
Balloon size
Batch number
Cleansing and anaesthetic agents
Urine drainage system
Planned date for the next catheter change
Reinforce management and ongoing care of
catheter and contact details should any problems
arise. Patient catheter booklet explained and
updated with date of change
Fully document all intervention and any follow up
care required in the patients care plan
Record patients/carers comments or any concerns
following the procedure
PROCEDURE FOR URINARY CATHETERISATON
12/16
To be aware of bladder capacity for patients who
have presented with urinary retention. To monitor
renal function and fluid balance
To maintain closed circuit system
If the area is left wet or moist, secondary
infection and skin irritation may occur
To prevent cross infection and environmental
contamination
To remove any accumulation of transient skin
flora that may have built up under gloves and
possible contamination following removal of PPE
To document event and have a permanent
record for reference and monitoring of future care
planning.
Date of catheter change essential for safety of
patient
Promotes independence and reduces incidence
of problems/infections
Promoting self-care
To comply with NHS Wirral record keeping
policies.
To record patients perspective.
To provide safe and effective continuity of care
 PROCEDURE FOR SUPRA - PUBIC URINARY CATHETERISATION

PROCEDURE RATIONALE
Verbally confirm the identity of the patient by asking for To avoid mistaken identity
their full name and date of birth. If patient unable to
confirm, check identity with family/ carer
Introduce yourself and any colleagues involved at the To gain co-operation
contact.
Explain procedure to patient including risks and benefits To ensure client understands
and gain informed consent. If patient unable to give procedure and enable patient to make
consent, act in patients best interests by following informed decisions
Consent Policy
Use consent form 4 if appropriate
Offer patient a chaperone and document decision in It is the patients choice to have a
health records chaperone if wanted. Discuss with
line manger if nurse considers a
chaperone is needed as part of risk
assessment
Ensure all equipment is gathered before commencing the To prevent contamination of sterile
procedure equipment and to ensure the
procedure is not commenced without
all necessary equipment
Check the catheter size and type against the written To reduce risk of using the incorrect
instructions in the patients health records device
Check for any allergies e.g. latex or anaesthetic gels To reduce risk of anaphylaxis
If not first catheterisation ask the patient to empty their To avoid spillages of urine during
drainage bag. procedure
Decontaminate hands prior to procedure To reduce the risk of transfer of
transient micro - organisms on the
health care workers hands
Open sterile dressing pack onto a clean field and place all To maintain asepsis and prevent
sterile single use equipment required within sterile field contamination of sterile equipment
including catheter and drainage system
Use aseptic principle to ensure that only sterile single use To prevent contamination of a
items are used to keep exposure of the susceptible site to susceptible site by organisms that
a minimum could cause infection
In the event the patient requires assistance with personal To prevent cross infection
hygiene apply single use disposable non-sterile apron and
gloves
Ask or assist the patient into a supine position To relax abdominal muscles
Decontaminate hands prior to procedure To reduce the risk of transfer of
transient micro - organisms on the
health care workers hands
Apply single use disposable apron and gloves To prevent cross infection and
environmental contamination
Using dominant hand wrap a piece of sterile gauze around The gauze will act as a marker to
existing catheter at the point it enters the cystostomy ensure correct length of new catheter
inserted
To remove existing catheter attach empty syringe to To avoid vacuuming of bladder
catheter port. Do not draw back on the syringe; allow the mucosa
catheter balloon to deflate using gravity.
Slowly remove, noting length and angle of removed .
catheter.
Place old catheter into non-sterile kidney dish For later comparison and inspection
of the catheter
Cleanse around the cystostomy site using normal saline To reduce risk of cross infection
0.9%
Observe the cystostomy site for discharge, inflammation May indicate signs of infection that
or over granulation require intervention
Insert prescribed single use anaesthetic lubricating gel
and wait for three to five minutes
remove and dispose of PPE to comply with waste
management policy
Decontaminate hands prior to procedure and apply new
single use disposable sterile apron and gloves
Visually compare length of new catheter with length of old
catheter (the inner wrapper can be used to mark the
length of catheter to be inserted)
Gently insert new catheter to same length and angle as
previous catheter (this should be done as soon as
possible after removal of old catheter to maintain patency
of the cystostomy).
Wait for urine to appear
Inflate balloon slowly with the volume of sterile water
recommended for balloon size, observing the patient for
signs of pain or discomfort.
Attach sterile drainage bag.
Apply keyhole dressing if required to catheter site
Inspect the removed catheter, checking that it is intact,
check for encrustation and its extent.
on completion of procedure remove and dispose of PPE to
comply with waste management policy
Decontaminate hands prior to procedure and apply new
single use disposable sterile gloves
Record information in patients health records
Catheter material/ expiry date
Charrire size and length
Balloon size
Batch number
Cleansing and anaesthetic agents
Urine drainage system
Planned date for the next catheter change
Reinforce management and ongoing care of catheter and
contact details should any problems arise. Patient catheter
booklet explained and updated with date of change
Fully document all intervention and any follow up care
required in the patients care plan
Record patients/carers comments or any concerns
following the procedure
PROCEDURE FOR URINARY CATHETERISATON
14/16
To ensure area is lubricated and
anaesthetised
to prevent cross infection and
environmental contamination
To reduce the risk of transfer of
transient micro - organisms on the
health care workers hands
To ensure catheter inserted to the
correct length
Ensures catheter is inserted to clients
own requirements
Confirms intravesical positioning
Ensures intravesical inflation of
balloon
To maintain closed circuit system
Dressings should only be used if
discharge present or patient finds it
more comfortable with a dressing in
place
Encrustation is a sign of infection
To prevent cross infection and
environmental contamination.
To reduce the risk of transfer of
transient micro - organisms on the
health care workers hands
To document event and have a
permanent record for reference and
monitoring of future care planning.
Promotes independence and reduces
incidence of problems/infections
Promoting self-care
To comply with NHS Wirral record
keeping policies.
To record patients perspective.
To provide safe and effective
continuity of care
 PATIENT EDUCATION
Patient and carers (both formal and informal) should be educated in the following:
(NICE 2003, Getcliffe & Dolman 2007).
Hand decontamination and meatal hygiene
Changing and emptying of leg bags/valves
How to attach night bags
Possible signs and symptoms of infection
Dietary and fluid advice
How to order supplies
How to access help if difficulties arise

CLINICAL INCIDENTS
Any related incidents arising from carrying out these procedures which may involve clinical
error or near miss must be reported following the NHS Wirral incident reporting policy.

REFERENCES / BIBLIOGRAPHY

Association for Continence Advice (2007) Notes on good practice Association for Continence Advice. London

Department of Health (2005) Saving Lives A Delivery Programme to Reduce HCAI (including MRSA) Retrieved
from:http://www.dh.gov.uk
Department of Health (2006) Essential Steps to Safe, Clean Care: Reducing Healthcare-Associated Infections.
Retrieved from:
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4136212

Evidence Based Practice in Infection Control (2003) Infection control: Prevention of healthcare-associated infection in
primary and community care. Retrieved from:
http://www.epic.tvu.ac.uk/Downloads/epic%202a%20download%20page.html

Getcliffe, K & M. Dolman (2007) Promoting Continence A Clinical and Research Resource. Bailliere Tindall. London

National Institute of Health and Clinical Excellence (2003) Infection Control: Prevention of Health- Care Associated
Infections in Primary Care. Retrieved from: http://www.nice.org.uk/nicemedia/pdf/Infection_control_fullguideline.pdf

National Patient Safety Agency (2009) Female Urinary Catheters Rapid Response Report. Retrieved From:
http://www.nrls.npsa.nhs.uk/resources/type/alerts/?entryid45=59897

Pellowe, C. (2009) Using Evidence-Based Guidelines to Reduce Catheter Related Urinary Tract
Infections in England. Journal of Infection Prevention.10 (2) 44-48
Pomfret, I. (2007) Urinary Catheterization: Selection and Clinical Management. British Journal of Community Nursing.
12(8) 348-354
Royal College of Nursing (2008) Catheter Care: RCN Guidance for Nurses. Retrieved From:
http://www.rcn.org.uk/__data/assets/pdf_file/0018/157410/003237.pdf
Woodward, S. (2005) Use of Lubricant in Female Urethral Catheterisation. British Journal of Nursing. 14(19) 1022-
1023

CONSULTATION
Nursing Policy Group
Continence Service
Infection Control Team
PROCEDURE FOR URINARY CATHETERISATON
15/16
 Appendix One

PROCEDURE FOR URINARY CATHETERISATON

16/16