The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [182]
4 Do not expose the patient at this stage of the procedure. To maintain patient’s dignity and comfort (NMC 2008b, C).
5 Wash hands using bactericidal soap and water or bactericidal alcohol handrub. To reduce risk of infection (Fraise and Bradley 2009, E).
6 Put on a disposable plastic apron and two pairs of sterile gloves To reduce risk of cross-infection from micro-organisms on uniform (Fraise and Bradley 2009, E).
7 Prepare the trolley, placing all equipment required on the bottom shelf. The top shelf acts as a clean working surface. E
8 Take the trolley to the patient’s bedside, disturbing screens as little as possible. To minimize airborne contamination (Fraise and Bradley 2009, E).
Procedure
9 Open the outer cover of the catheterization pack and slide the pack onto the top shelf of the trolley. To prepare equipment. E
10 Using an aseptic technique, open the supplementary packs. To reduce the risk of introducing infection into the bladder (NICE 2003, C).
11 Remove cover, maintaining the patient’s privacy, and position a disposable pad under the patient’s buttocks and thighs. To ensure urine does not leak onto bedclothes. E
12 Remove top pair of gloves and dispose. Gloves may have become contaminated by handling outer packs (Bardsley and Kyle 2008, E).
13 Place sterile towels across the patient’s thighs and under buttocks. To create a sterile field. E
14 Wrap a sterile topical swab around the penis. Retract the foreskin, if necessary, and clean the glans penis with 0.9% sodium chloride or sterile water. To reduce the risk of introducing infection to the urinary tract during catheterization. E
15 Insert the nozzle of the lubricating jelly into the urethra. Squeeze the gel into the urethra, remove the nozzle and discard the tube. Massage the gel along the urethra. Adequate lubrication helps to prevent urethral trauma. Use of a local anaesthetic minimizes the discomfort experienced by the patient (Bardsley 2005, P).
16 Squeeze the penis and wait approximately 5 minutes. To prevent anaesthetic gel from escaping. To allow the anaesthetic gel to take effect. E
17 Grasp the penis behind the glans, raising it until it is almost totally extended. Maintain grasp of penis until the procedure is finished. This manoeuvre straightens the penile urethra and facilitates catheterization (Stoller 2004, P). Maintaining a grasp of the penis prevents contamination and retraction of the penis.
18 Place the receiver containing the catheter between the patient’s legs. Insert the catheter for 15–25 cm until urine flows. The male urethra is approximately 18 cm long (Bardsley 2005, P).
19 If resistance is felt at the external sphincter, increase the traction on the penis slightly and apply steady, gentle pressure on the catheter. Ask the patient to strain gently as if passing urine. Some resistance may be due to spasm of the external sphincter. Straining gently helps to relax the external sphincter. E
20 When urine begins to flow, advance the catheter almost to its bifurcation. Advancing the catheter ensures that it is correctly positioned in the bladder. E
21 Gently inflate the balloon according to the manufacturer’s direction, having ensured that the catheter is draining properly beforehand. Inadvertent inflation of the balloon in the urethra causes pain and urethral trauma (Getliffe and Dolman 2003, E).
22 Withdraw the catheter slightly and attach it to the drainage system. To ensure that the balloon is inflated and the catheter is secure. E
23 Support the catheter, if the patient desires, either by using a specially designed support, for example Simpla G-Strap, or by taping the catheter to the patient’s leg. Ensure that the catheter does not become taut when patient is mobilizing or when the penis becomes erect. Ensure that the catheter lumen is not occluded by the fixation device or tape. To maintain patient comfort and to reduce the risk of urethral and bladder neck trauma. Care must be taken in using adhesive tapes