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Reason for catheterization.

Type of catheter inserted, gauge and length.

Manufacturer and batch number plus expiry date.

Date and time of insertion.

Size of balloon and volume of sterile water used to inflate it.

Cleansing procedure and type of lubricant used.

Any difficulties experienced or clinical observations noted.

Plan of action, i.e. duration of catheterization/predicted date for change of long-term catheter.

Signed and printed by person performing the procedure.

(NMC 2008b, NMC 2009, RCN 2008)

Problem-solving table 6.2 Prevention and resolution (Procedure guidelines 6.4 and 6.5)

Procedure guideline 6.6 Urinary catheter bag: emptying

Essential equipment

Swabs saturated with 70% isopropyl alcohol

Sterile jug

Disposable gloves

Preprocedure

Action Rationale

1 Explain and discuss the procedure with the patient. To ensure that the patient understands the procedure and gives their valid consent (NMC 2008a, C).

2 Wash hands using bactericidal soap and water or bactericidal alcohol handrub, and put on disposable gloves. To reduce risk of cross-infection (Fraise and Bradley 2009, E).

Procedure

3 Clean the outlet valve with a swab saturated with 70% isopropyl alcohol. To reduce risk of infection (Fraise and Bradley 2009, E).

4 Allow the urine to drain into the jug. To empty drainage bag and accurately measure volume of contents. E

5 Close the outlet valve and clean it again with a new alcohol-saturated swab. To reduce risk of cross-infection (Fraise and Bradley 2009, E).

6 Cover the jug and dispose of contents in the sluice, having noted the amount of urine if this is requested for fluid balance records. To reduce risk of environmental contamination (DH 2005a, C).

7 Wash hands with bactericidal soap and water. To reduce risk of infection (Fraise and Bradley 2009, E).

Procedure guideline 6.7 Urinary catheter removal

Essential equipment

Dressing pack containing sterile towel, gallipot, foam swab or non-linting gauze

Disposable gloves

Needle and syringe for urine specimen, specimen container

Syringe for deflating balloon

Preprocedure

Action Rationale

1 Catheters are usually removed early in the morning. So that any retention problems can be dealt with during the day. E

2 Explain procedure to patient and inform them of potential postcatheter symptoms, such as urgency, frequency and discomfort, which are often caused by irritation of the urethra by the catheter. So that patient knows what to expect, and can plan daily activity.

Procedure

3 Clamp below the sampling port until sufficient urine collects. Take a catheter specimen of urine using the sampling port. To obtain an adequate urine sample and to assess whether postcatheter antibiotic therapy is needed (Fraise and Bradley 2009, E).

4 Wearing gloves, use saline to clean the meatus and catheter, always swabbing away from the urethral opening.

Note: in women, never clean from the perineum/vagina towards the urethra. To reduce risk of infection (Fraise and Bradley 2009, E).

To help reduce the risk of bacteria from the vagina and perineum contaminating the urethra. E

5 Release leg support. For easier removal of catheter. E

6 Having checked volume of water in balloon (see patient documentation), use syringe to deflate balloon. To confirm how much water is in the balloon.

To ensure balloon is completely deflated before removing catheter. E

7 Ask patient to breathe in and then out; as patient exhales, gently (but firmly with continuous traction) remove catheter.

Male patients should be warned of discomfort as the deflated balloon passes through the prostate gland. To relax pelvic floor muscles. E

It is advisable to extend the penis as per the process for insertion to aid removal. E

Postprocedure

8 Clean meatus and make the patient comfortable. To maintain patient comfort and dignity. E

9 Encourage patient to exercise and to drink 2–3 litres of fluid per day. To prevent urinary tract infections. E

Complications

Infections

Catheterization carries an infection risk. Catheter-associated infections