Urinary Catheterization  Appropriate size:

Purposes: o Female – Fr 12-14

• To relieve bladder distention or to provide
gradual decompression of a distended bladder
• To instill medication into the bladder
• To irrigate the bladder
• To measure hourly urine output accurately
• To collect urine specimen
• To measure residual urine Residual Urine, is the
amount of urine retained in the bladder after
forceful voiding
• To maintain continence among incontinent
clients
• To prevent urine from contracting an incision
after perineal surgery
• To promote healing of the genito-urinary
structures postoperatively
Equipment:
o Male - Fr 16 to 18
Assessment
Determine the most appropriate method of catheterization
based on the purpose and any criteria specified in the
order such as total amount of urine to be removed or size
of catheter to be used:
Straight Catheter - use for a spot urine specimen -
amount of residual urine is being measured - temporary
decompression / emptying of the bladder is required.
Indwelling/Retention Catheter - if the bladder must
remain empty or continuous urine measurement and
collection is needed:
 Determine if the client is able to cooperate and
hold still during the procedure and if the client
can be positioned supine with head relatively flat.
 Determine when the client last voided or was last
catheterized.
 Percuss the bladder to check for fullness or
distention.

Procedure
Verify doctor’s order
Identify and inform the To allay anxiety
client and explain, why it is
necessary and how he/she
can cooperate.
Provide privacy To prevent feeling of
embarrassment
Indwelling Wash hands and observe To prevent ascending UTI
appropriate infection
control procedures
Perform routine perineal To minimize
care before the procedure microorganism at the
external genitals
Have adequate lighting To visualize urethral
meatus properly
Place the client in
appropriate position:

Male: Supine, legs

abducted and extended
Female: Dorsal recumbent
Don sterile gloves
Inflate the balloon of
catheter with air to check
that it is intact then deflate.
Locate the urinary meatus
Straight properly:

Urinary Catheterization Male: at the tip of the glans

penis
 Is the introduction of catheter through the urethra Female: between the
into the bladder in order to withdraw urine. clitoris and vaginal orifice

 Tube commonly made of rubber(good for 1wk),

plastic(2-3wks), latex(1-2mons).

 Normal length of urethra:

o Female – 3 to 4 inches

o Male – 6 to 9 inches

 Cleanse urinary meatus with antiseptic solution
Note: The nondominant hand is considered
contaminated once it touches the client skin.
Male: - Use your nondominant
hand to grasp the penis just below
the glans. - Hold the penis firmly
upright with slight tension - Pick
up a cleansing ball with the forceps
and wipe from the center of the
meatus in circular motion
Note: The foreskin must not be
allowed to return over the cleanse
meatus nor the penis be dropped
Female: - Use your nondominant
hand to spread the labia
 Pick up a cleansing ball
with the forceps in your
dominant hand and wipe
one side of the labia in an
anteroposterior direction.
 When cleansing the
urinary meatus, move the
swab downward
Lubricate catheter with water
soluble lubricant before insertion
Male: 6 – 7 inches
Female: 1 – 2 inches
Insert catheter gently in rotating
motion. Instruct the client to take
slow deep breaths to relax
sphincter or strain as if attempting
to void to opens urinary meatus.
During insertion of catheter in
male, hold the penis at 90 degree
angle or perpendicular to the body
For indwelling or retention
catheter, inflate the balloon with 5
– 10 ml. of PNSS
Placement of indwelling / retention
catheter and inflated balloon
Gently pull on the catheter.
If resistance is felt, the
catheter balloon is properly
inflated in the bladder.
Anchor catheter properly:
Male: laterally or upward To prevent penoscrotal
over the lower abdomen / pressure
upper thigh Female: inner
aspect of the thigh
Attach drainage bag to the
bed frame, ensuring that
tubing should fall below the
top of the bag.
Keep client comfortable
Lifting the penis Do after-care
firmly and upright Do relevant documentation
prevents possible
erection and helps
strengthen the
urethra
Note: If the purpose of catheterization is to relieve bladder
To prevent friction distention, practice GRADUAL DECOMPRESSION, to
and prevent trauma prevent shock, hemorrhage or bladder atony.
Gradual Decompression may be done by the following
actions:
• Empty the bladder slowly by pinching the
catheter to reduce the size of the lumen.
• Elevate urine receptacle at the level of symphysis
pubis to slow down expulsion of urine.
• Do not remove more than 1000 ml of urine at a
time
To straighten the
urethra and Nursing Interventions for Client with
facilitate insertion
Indwelling/Retention Catheter
• Practice asepsis. Proper handwashing should be
done before and after manipulating the device.
To prevent infection
• Increase fluid intake. To enhance excretion of
microorganism and body wastes
• Acidify urine ( diet: meat,fish.eggs and cereals)
Acidic urine inhibits proliferation of
microorganism.
• Maintained closed drainage system. Do not
detach catheter from the connecting tubing,
unnecessarily.
• Meticulous perineal care. To prevent ascending
UTI
• Ensure patency of urinary catheter. Avoid kinks.
Irrigate with sterile PNSS as ordered.
• Ensure that gravity drainage of urine is
maintained. Hold the urinary drainage bag below
the level of bladder when ambulating
• Monitor I & O
• Change urinary catheter, tubing and bag when
sediments accumulates, if leakage is present or if
a strong odor is evident.
Removal of Indwelling / Retention Catheter
• Check doctor’s order
• Wash hands. Remove the tape that secured the
catheter to the client’s body
• Don clean disposable gloves. Handwashing and
gloving prevent transfer of microorganism
• Insert hub of the syringe into balloon inflation
port and draw out all the liquid. The balloon must
be completely deflated to prevent trauma to the
urethra as the catheter is remove.
Nursing Interventions for Clients with Urinary
Incontenence
• Bladder Retraining Program. Determine the
client’s voiding pattern or establish a regular
voiding time.
• Lengthen the intervals of voiding once the
client’s voiding can be controlled.
• Regulate fluid intake
• Avoid large amounts of fruit juices and
carbonated beverages.
• Avoid stimulants at bedtime
• Schedule diuretics in the morning.
• Adequate fluid intake in the morning.
• Kegel’s Exercise ( alternating tension and
relaxation of the pubococcygeal muscles )
Nursing Interventions to Induce Voiding/Urination
• Provide privacy
• Provide fluids to drink
• Assist the patient in the anatomical position of
voiding
• Serve clean, warm and dry bedpan (female) or
urinal (male)
• Allow the client to listen to the sound of running
water
• Dangle fingers in warm water
• Pour warm water over the perineum
• Promote relaxation
• Provide adequate time for voiding
• Perform Crede’s Maneuver as ordered ( this is
done by applying pressure on the suprapubic
area)
• Administer cholinergics as ordered
• Last resort: URINARY CATHETERIZATION

• Instruct the client to inhale and then pinch and

remove the catheter slowly and carefully as the
clients exhales. Breathing provides distraction
and exhalation prevents tightening of abdominal
and perineal muscles as the catheter is withdraw.
Pinching catheter prevents urine from dribbling
onto the bed linens.
• After removal of catheter, allow the urine to drain
into collection bag. Measure and record the
amount of urine remaining in the collection bag.
• Assess client’s perineum and meatus for any
signs of redness or irritation.
• Assist client to do perineal care and dry genitals.
To ensure client comfort.

• Discard contaminated equipment and articles in

appropriate containers. To prevent contamination
of the environment.
• Make relevant document

NOTE:
• Voiding should be expected within 6 – 8 hours
from the time of removal of catheter. Some
dribbling of urine may be experienced.
• Continue to assess I & O
• If the client has not voided in 8 hours, assess for
urinary retention
• If the client has difficulty establishing voluntary
control of voiding, notify the physician. It may be
necessary to reinsert the catheter or to perform in
and out ( intermittent ) catheterization