Catheterization Procedures and Best Practices

Catheterization Procedure for Uncircumcised Male Client

  • Retracting Foreskin

    • Essential to retract the foreskin with your nondominant hand.

    • Post-retraction, the nondominant hand is considered unsterile.

    • The nondominant hand must remain in place until the procedure is complete.

  • Cleaning the Area

    • Use your dominant hand with forceps to clean the genital area.

    • There are two methods to clean:

    • Circular Motion Method:

      • Start at the urethral meatus and work your way down to the base of the glans.

    • This method prevents contamination.

    • Tip Down Method:

      • Start at the tip and clean downward without a circular motion.

      • You must use a new sterile swab soaked in saline for each cleaning.

      • Cannot return to the tip with the same swab, as it’s considered going from clean to dirtier.

  • Catheter Bag with Urometer

    • Comparison of catheter bag with urometer versus a standard large bag.

    • Urometer is beneficial for precise urine output monitoring, especially in clients under close intake and output observation.

    • Urometer connection:

    • It is a hard plastic piece attached to the bag.

    • Spills into a larger collection bag when full.

    • Accurate urine output measurement per hour by emptying the urometer into the larger bag.

  • Urine Output Monitoring

    • Minimum urine output per hour is considered to be 30 ml.

    • Importance of 30 ml:

    • This amount must be produced even if fluids are not taken in orally or intravenously.

    • Less than 30 ml should raise an alert concerning potential renal failure, especially if intervention is required unless the client is DNR (Do Not Resuscitate).

    • Assessment Schedule:

    • Urine output of every client with a catheter should be checked every hour regardless of using a urometer.

  • Removal of Indwelling Catheter

    • Importance of fully deflating the balloon before removal to avoid damage.

    • After removal, document:

    • Any voiding, amount voided, incontinence, or difficulty voiding for 24 to 48 hours.

    • Potential post-removal complications:

    • Abdominal pain, distension, incomplete emptying of bladder, dribbling of urine.

  • Bladder Scanner Use

    • A non-invasive tool used to check for post-void residual urine volume.

    • Essential for clients who have had a catheter for several days as bladder muscles may weaken, leading to incomplete voiding.

    • Normal expectation:

    • It is common not to eliminate 100% of urine; however, excessive residual can cause discomfort and symptomatology.

    • Risks of urinary tract infection (UTI) still present after catheter removal, particularly if an infection developed before removal.

    • Educate clients on UTI signs and symptoms for the first 2 to 3 days post-removal.

  • Interventions for Urine Retention

    • Inability to void 6-8 hours post-catheter removal needs intervention.

    • First intervention: Use a bladder scanner to assess urine accumulation in the bladder.

    • If needed: An in-and-out catheter may be inserted to drain the bladder.

    • Practice using bladder scanners in lab settings, noting variations in models across different institutions.

  • Infection Prevention Techniques

    • Essential to maintain strict hand hygiene during catheter care to minimize infection risk.

    • Avoid allowing the drainage tube to contact contaminated surfaces (e.g., the floor) during bag changes.

    • Always follow sterile techniques for catheter insertion and specimen collection, particularly in acute care.

    • If the drainage tube disconnects, clean catheter ends with alcohol before reattaching.

    • Receptacles for urine must be patient-specific; avoid cross-contamination in shared spaces.

    • Prevent urine pooling in the tubing to avoid reflux, which can lead to infection.