Urethral catheterisation

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Introduction

• Wash hands
• Introduce self
• Check Patient’s name, DOB and wrist band
• Explain procedure and obtain consent

Preparation 

• Wash hands and put on apron
• Clean trolley 
• Gather equipment on bottom shelf of trolley (think through what you need in order)

Equipment list

• Sterile catheterisation pack (kits vary – add anything which is not in there)
  • 2 pairs of sterile gloves
  • Sterile drape with hole in centre to extend sterile field
  • Sterile gauze
  • Sterile cotton wool balls
  • Waste bag
  • Sterile bowl
• Sterile anaesthetic lubrication jelly in pre-filled syringe
• Catheter (usually start with 12 French gauge; use a larger size, e.g. 14/16 French gauge, if prostatic hyperplasia) with 10ml sterile water to inflate catheter balloon – CHECK DATE AND KEEP PACKET STICKER FOR PATIENT’S NOTES
• Equipment to be kept outside the sterile field
  • Incontinence pad for spillage
  • Catheter drainage bag with tubing
  • Sterile water sachets

• Walk to patient
• Wash hands
• Open sterile catheterisation pack on top shelf to make a sterile field
• Use the tweezers if present to arrange the equipment in the pack on the sterile field (and then discard)
• Pick up the waste bag from the sterile field without touching anything else and tape to the side of the trolley
• Open other sterile equipment packets (without touching the instruments) and drop them onto the sterile field
• Pour the water sachets into the sterile bowl
• Ensure a catheter collection bag is ready on a stand/hook by the bedside (does not need to be in sterile field)

Procedure

Positioning and exposure

• Expose patient and position them supine with extended legs if male, or in lithotomy position if female
• Place incontinence pad under the patient’s buttocks and thighs 

Part 1 – cleaning

• Wash hands and apply the 1^st pair of sterile gloves

Using your left hand only to handle genitalia, and keeping your right hand sterile to handle sterile equipment:

• If male, hold penis in sling with gauze and retract foreskin using your left hand. If female, use your left hand to part the labia.
• Wet the cotton wool balls and, with your right hand, clean around the urethral meatus. Do one downward stroke only per cotton wool ball and then discard. Do one stroke down each side and one stroke down the middle.
• Remove and discard gloves

Part 2 – catheterising 

• Wash hands and apply the 2^nd pair of sterile gloves
• Keeping hands sterile, place the sterile drape over the patient (with the hole over their genitalia)

Using your left hand only to handle genitalia, and keeping your right hand sterile to handle sterile equipment:

• If male, hold penis in sling with gauze using your left hand. If female, use your left hand to part the labia.
• Insert the nozzle of the lubrication jelly syringe into the urethra and slowly expel the contents into the urethra
• Wait 3-5 minutes for the anaesthetic to take effect
• Using your sterile right hand, remove both ends of the plastic sleeve covering catheter
• Place the bowl near the patient’s genitalia and allow the lower end of the catheter/sleeve to sit in the bowl (to collect urine)
• Using a non-touch technique (i.e. only touching the catheter’s plastic sleeve), advance the catheter into the urethra with your right hand
• Once the catheter is fully inserted, check urine is flowing and then:
  • Slowly inflate the catheter balloon with 10ml sterile water (checking there is no pain)
  • Attach the drainage bag tube
• Retract catheter until you encounter resistance of balloon at top of urethra
• Reposition the foreskin if male (never forget!)
• Clean away any rubbish and ensure there is no residual urine spilt on the patient
• Help the patient get dressed
• Discard waste and clean trolley; then discard gloves and apron; wash hands

To complete

• Thank patient and advise them on catheter care
• Check urine is flowing from the catheter and note residual volume
• Remove a urine sample for analysis if required
• Document in patient’s notes and fill out urinary catheter insertion chart (catheter label, size, indication, volume of water in balloon, complications, residual volume, urinalysis results, if sample sent to lab, date and time, signature)