{"id":1066,"date":"2015-06-18T15:19:37","date_gmt":"2015-06-18T19:19:37","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/10-3-urinary-catheters\/"},"modified":"2019-09-19T17:53:58","modified_gmt":"2019-09-19T21:53:58","slug":"10-4-urinary-catheters","status":"publish","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/10-4-urinary-catheters\/","title":{"raw":"10.4 Urinary Catheters","rendered":"10.4 Urinary Catheters"},"content":{"raw":"Urinary elimination is a basic human function that can be compromised by illness, surgery, and other conditions. Urinary catheterization may be used to support urinary elimination in patients who are unable to void naturally. Urinary catheterization may be required:\r\n<ul>\r\n \t<li>In cases of acute urinary retention<\/li>\r\n \t<li>When intake and output are being monitored<\/li>\r\n \t<li>For postoperative management<\/li>\r\n \t<li>To enhance healing in incontinent patients with open sacral and perineal wounds<\/li>\r\n \t<li>For comfort measures during end-of-life care<\/li>\r\n<\/ul>\r\n<h2>Catheter-Associated Urinary Tract Infections<\/h2>\r\nCatheter-associated urinary tract infections (CAUTI) are a common complication of indwelling urinary catheters\u00a0and have been associated with increased morbidity, mortality, hospital cost, and length of stay (Gould et al., 2009). Urinary drainage systems are often reservoirs for multidrug-resistant organisms (MDROs) and a source of the transmission of microorganisms to other patients (Gould et al., 2009). The most important risk factor for developing a CAUTI, a healthcare-associated infection (HAI), is the prolonged use of a urinary catheter (Centers for Disease Control and Prevention [CDC], 2015). Urinary tract infections (UTIs) are the most commonly reported HAIs in acute care hospitals and account for more than 30% of all reported infections (Gould et al., 2009). Catheters in place for more than a few days place the patient at risk for a CAUTI. A healthcare provider must assess patients for signs and symptoms of CAUTIs and report immediately to the primary healthcare provider. Signs and symptoms of a CAUTI include:\r\n<ul>\r\n \t<li>Fever, chills<\/li>\r\n \t<li>Lethargy<\/li>\r\n \t<li>Lower abdominal pain<\/li>\r\n \t<li>Back or flank pain<\/li>\r\n \t<li>Urgency, frequency of urination<\/li>\r\n \t<li>Painful urination<\/li>\r\n \t<li>Hematuria<\/li>\r\n \t<li>Change in mental status (confusion, delirium, or agitation), most commonly seen in older adults<\/li>\r\n<\/ul>\r\nThe following are practices for preventing CAUTIs (Perry et al., 2018):\r\n<ul>\r\n \t<li>Insert urinary catheters using sterile technique.<\/li>\r\n \t<li>Only insert indwelling catheters when essential, and remove as soon as possible.<\/li>\r\n \t<li>Use the smallest tube size (gauge) possible.<\/li>\r\n \t<li>Provide daily cleansing of the urethral meatus with soap and water or perineal cleanser, following agency policy.<\/li>\r\n \t<li>Ensure a closed drainage system.<\/li>\r\n \t<li>Ensure that no kinks or blockages occur in the tubing.<\/li>\r\n \t<li>Secure the catheter tube to prevent urethral damage.<\/li>\r\n \t<li>Avoid routine use of antiseptic solutions on the urethral meatus and\/or in the urinary bag.<\/li>\r\n \t<li>Ensure urine bags are positioned to allow gravity to drain urine.<\/li>\r\n<\/ul>\r\n<h2>Urinary Catheterization<\/h2>\r\nUrinary catheterization refers to the insertion of a catheter tube through the urethra and into the bladder\u00a0to drain urine. Although not a particularly complex skill, urethral catheterization can be difficult to master. Both male and female catheterizations present unique challenges.\r\n\r\nHaving\u00a0adequate lighting and visualization is helpful, but does not ensure entrance of the catheter into the female urethra. It is not uncommon for the catheter to enter the vagina. Leaving the catheter in the vagina can assist in the correct insertion of a new catheter into the urethra, but you must remember\u00a0to remove the one in the vagina.\r\n\r\nFor some women, the supine lithotomy position can be very uncomfortable or even dangerous. For example, patients\u00a0in the last trimester of pregnancy\u00a0may\u00a0faint with decreased blood supply to the fetus in this position. Patients with arthritis of the knees and hips may also find this position extremely uncomfortable. Catheterization may also be accomplished with the patient in the lateral to Sims position (three-quarters\u00a0prone).\r\n\r\nThe male urinary sphincter may create resistance when passing a urinary catheter, particularly for older men with prostatic hypertrophy.\r\n\r\nUrethral\u00a0catheterization might be intermittent indwelling.\r\n\r\nIntermittent catheterization (single-lumen catheter) is used for:\r\n<ul>\r\n \t<li>Immediate relief of urinary retention<\/li>\r\n \t<li>Long-term management of incompetent\u00a0bladder<\/li>\r\n \t<li>Obtaining\u00a0a sterile urine specimen<\/li>\r\n \t<li>Assessing\u00a0residual urine in the bladder after voiding (if a bladder scanner is not available)<\/li>\r\n<\/ul>\r\nIndwelling catheterization (double- or triple-lumen catheter) is used for:\r\n<ul>\r\n \t<li>Promoting urinary\u00a0elimination for persons requiring prolonged bed rest due to certain other health conditions (i.e., spinal cord injury)<\/li>\r\n \t<li>Measuring accurate\u00a0urine output<\/li>\r\n \t<li>Preventing skin\u00a0breakdown caused by urinary incontinence<\/li>\r\n \t<li>Facilitating wound\u00a0management for wounds in perineum, coccyx<\/li>\r\n \t<li>Allowing surgical repair of\u00a0urethra, bladder, or\u00a0surrounding structures<\/li>\r\n \t<li>Instilling irrigation\u00a0fluids or medications<\/li>\r\n \t<li>Assessing abdominal or pelvic pain<\/li>\r\n \t<li><span style=\"line-height: 1.5\">Investigating conditions of the genitourinary system<\/span><\/li>\r\n<\/ul>\r\nThe steps for inserting an intermittent or an indwelling catheter are the same, except that the indwelling catheter requires a closed drainage system and inflation of a balloon to keep the catheter in place. Indwelling catheters may have two\u00a0or three lumens (double or triple lumens). Double-lumen catheters comprise one lumen for draining the urine and a second lumen for inflating a balloon that keeps the catheter in place. Triple-lumen catheters are used for continuous bladder irrigation and for instilling medications into the bladder; the additional lumen delivers the irrigation fluid into the bladder.\r\n\r\nIndwelling urinary catheters are made of latex or silicone. Intermittent catheters may be made of rubber or polyvinyl chloride (PVC), making them softer and more flexible than indwelling catheters (Perry et al., 2018). The size of a urinary catheter is based on the French (Fr) scale, which reflects the internal diameter of the tube. Recommended catheter size is 12 to 16 Fr for females, and 14 to 16 Fr for males. Smaller sizes are used for infants and children. The balloon size also varies with catheters:\u00a0smaller for children (3 ml) and larger for continuous bladder irrigation (30 to 60 ml). The size of the catheter is usually printed on the side of the catheter port.\r\n\r\nInsertion of a Foley catheter is within the RN scope of practice, and as such an RN can insert a catheter within their independent scope of practice if the agency policy is supportive and the RN is competent to do so (BCCNP, 2018).\r\n\r\nAn indwelling catheter is attached to a drainage bag to allow for unrestricted flow of urine. Make sure that the urinary bag hangs below the level of the patient's bladder so that urine flows out of the bladder. The bag should not touch the floor, and the patient should carry the bag below the level of the bladder when ambulating. To review how to insert an indwelling catheter, see Checklist 82.\r\n<table style=\"border-color: #000000\">\r\n<tbody>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;text-align: center\" colspan=\"5\">\r\n<h3 style=\"text-align: center\"><a id=\"checklist82\"><\/a>Checklist 82: Insertion of an Intermittent or Indwelling Urinary Catheter<\/h3>\r\n<h5 style=\"text-align: center\"><em><span style=\"color: #000000\">Disclaimer:\u00a0Always review and follow your agency policy regarding this specific skill.<\/span><\/em><\/h5>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"5\">\r\n<h5><span style=\"color: #333333\">Safety considerations:\u00a0<\/span><\/h5>\r\n<ul>\r\n \t<li>Some agencies allow nurses to insert catheters within their independent scope of practice (ie. without an order). Check your agency guidelines.<\/li>\r\n \t<li>Perform\u00a0<a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/1-3-hand-hygiene-and-non-sterile-gloves\/\">hand hygiene<\/a>.<\/li>\r\n \t<li><span style=\"color: #333333\">Check room for <a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/1-4-additional-precautions-and-personal-protective-equipment-ppe\/\">additional precautions.<\/a><\/span><\/li>\r\n \t<li><span style=\"color: #333333\">Introduce yourself to patient.<\/span><\/li>\r\n \t<li><span style=\"color: #333333\">Confirm patient ID using two patient identifiers (e.g., name and date of birth).<\/span><\/li>\r\n \t<li><span style=\"color: #333333\">Explain process to patient;\u00a0offer analgesia, bathroom, etc.<\/span><\/li>\r\n \t<li><span style=\"color: #333333\">Listen and attend to patient cues.<\/span><\/li>\r\n \t<li><span style=\"color: #333333\">Ensure patient's privacy and dignity.<\/span><\/li>\r\n \t<li>Complete <a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/2-13-quick-priority-assessment-qpa\/\">QPA<\/a> including safety.<\/li>\r\n \t<li><span style=\"color: #333333\">Apply <a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/1-5-principles-of-surgical-asepsis\/\">principles of\u00a0asepsis<\/a>.<\/span><\/li>\r\n \t<li><span style=\"color: #333333\">Complete\u00a0necessary\u00a0<a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/2-5-head-to-toe-systems-approach-to-assessment\/\">focused assessments<\/a>.<\/span><\/li>\r\n \t<li>Recognize the personal nature of this procedure and provide culturally sensitive care.<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 50%;text-align: center\" colspan=\"3\">\r\n<h4 style=\"text-align: center\">Steps<\/h4>\r\n<\/td>\r\n<td style=\"border: 1px solid #000000;width: 50%;text-align: center\" colspan=\"2\">\r\n<h4 style=\"text-align: center\">\u00a0Additional Information<\/h4>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"3\">1. Verify physician order for catheter insertion. Assess for bladder fullness and pain by palpation or by using a bladder scanner.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Palpation of a full bladder will cause an urge to void and\/or pain.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"3\">2. Position patient prone to semi-upright with knees raised; apply gloves; and inspect perineal region for erythema, drainage, and odor. Also assess perineal\u00a0anatomy.\r\n\r\nApply non-sterile gloves. Wash perineal area with warm water and soap or perineal cleanser according to\u00a0agency policy.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Assessment of perineal area allows for determination of perineal condition and position of anatomical landmarks to assist with insertion.\r\n\r\n[caption id=\"attachment_5559\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1511.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/05\/DSC_1511-150x150.jpg\" alt=\"Apply non-sterile gloves\" class=\"wp-image-5559 size-thumbnail\" height=\"150\" width=\"150\" \/><\/a> Apply non-sterile gloves[\/caption]\r\n\r\nWashing the perineum reduces microorganisms and reduces risk of urinary tract infection.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"3\">3. Remove gloves and perform hand hygiene.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">This prevents transmission of microorganisms.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"3\">4. Gather supplies:\r\n\r\n<strong>Note: <\/strong>A catheterization kit may include most of these items.\r\n<ul>\r\n \t<li>Sterile gloves<\/li>\r\n \t<li>Cleaning solution (usually povidone iodine swabs \u00d7 3)<\/li>\r\n \t<li>Lubricant<\/li>\r\n \t<li>Prefilled syringe for balloon inflation as per catheter size<\/li>\r\n \t<li>Sterile drape<\/li>\r\n \t<li>Urinary bag<\/li>\r\n \t<li>Foley catheter (usually 14 to 16)<\/li>\r\n \t<li>Catheter securement device<\/li>\r\n \t<li>Flashlight (helpful to visualize meatus on some women)<\/li>\r\n<\/ul>\r\n<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">When selecting catheter size, consider the patient's history. If hematuria is present, select a larger catheter that will allow clots to pass. If bladder irrigation is necessary select a 3-way Foley.\r\n\r\nLarger catheter size increases the risk of urethral trauma.\r\n\r\nPreparation ahead of time enhances patient comfort and safety.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"3\">5.\u00a0 Ensure adequate lighting.\r\n\r\n&nbsp;<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Adequate lighting helps with accuracy and speed of catheter insertion. If using flashlight, position it to illuminate perineum.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"3\">6. Place waterproof pad under patient.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">This step prevents soiling of bed linens.\r\n\r\n[caption id=\"attachment_5675\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1785.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_1785-150x150.jpg\" alt=\"Place waterproof pad under patient\" class=\"wp-image-5675 size-thumbnail\" height=\"150\" width=\"150\" \/><\/a> Place waterproof pad under patient[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"3\">7. Positioning of patient depends on gender.\r\n\r\n<em>Female patient:<\/em> On back with knees flexed and thighs relaxed so that hips rotate to expose perineal area. Alternatively, if patient cannot abduct leg at the hip, patient can be side-lying with upper leg flexed at knee and hip, supported by pillows.\r\n\r\n<em>Male patient:<\/em> Supine with legs extended and slightly apart.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Patient should be comfortable as possible, with perineum or penis exposed, for ease and safety in completing procedure.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"3\">8. Place\u00a0a blanket or sheet to cover patient\u00a0and expose only required anatomical areas.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">This step helps protect patient dignity.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"3\">9. Perform hand hygiene.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">This reduces the transmission of microorganisms.\r\n\r\n[caption id=\"attachment_56751\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1492.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_1492-150x150.jpg\" alt=\"Perform hand hygiene\" class=\"wp-image-5550 size-thumbnail aligncenter\" height=\"150\" width=\"150\" \/><\/a> Perform hand hygiene[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"3\">10. If using indwelling catheter and closed drainage system, attach urinary bag to the bed and ensure that the clamp is closed.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Urinary bag should be closed to prevent urine drainage leaving\u00a0bag. A closed system also reduces risk of urinary tract infection\r\n\r\n[caption id=\"attachment_6386\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_2104.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_2104-150x150.jpg\" alt=\"Urinary bag\" class=\"wp-image-6386 size-thumbnail\" height=\"150\" width=\"150\" \/><\/a> Urine drainage bag[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"3\">11. Prepare sterile field following <a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/1-5-principles-of-surgical-asepsis\/\">principles of asepsis<\/a>.\r\n\r\nAdd supplies to\u00a0sterile field.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">This step ensures preparation and organization for procedure.\r\n\r\n[caption id=\"attachment_5678\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1788.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_1788-150x150.jpg\" alt=\"Choose smallest catheter size possible\" class=\"wp-image-5678 size-thumbnail\" height=\"150\" width=\"150\" \/><\/a> Add catheter to the sterile field.[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"3\">12. Apply <a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/1-7-surgical-hand-scrub-applying-sterile-gloves-and-preparing-a-sterile-field\/\">sterile\u00a0gloves<\/a> following principles of asepsis.\r\n\r\nArrange items in the urine collection tray. Attach the water filled syringe to the pigtail of the catheter.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Sterile gloves reduce the transmission of microorganisms.\r\n\r\n[caption id=\"attachment_5680\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1791.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_1791-150x150.jpg\" alt=\"Apply sterile gloves\" class=\"wp-image-5680 size-thumbnail\" height=\"150\" width=\"150\" \/><\/a> Apply sterile gloves[\/caption]\r\n\r\nOrganizing items facilitates a smooth process.\r\n\r\n[caption id=\"attachment_5684\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1799.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_1799-150x150.jpg\" alt=\"Open sterile catheterization kit and add supplies as necessary\" class=\"wp-image-5684 size-thumbnail\" height=\"150\" width=\"150\" \/><\/a> Place supplies into the urine collection tray[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"3\">13.Lubricate tip of catheter. For males lubricate approximately 20 cm; for females lubricate approximately 5 to 10 cm.\r\n\r\n&nbsp;\r\n\r\nNote: manufacturers no longer recommend to test the catheter balloon before insertion. In fact doing so may stretch the catheter and cause urethral trauma.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\u00a0Lubrication minimizes urethral trauma and discomfort during procedure.\r\n\r\n[caption id=\"attachment_5683\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1795.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_1795-150x150.jpg\" alt=\"Lubricate tip of catheter\" class=\"wp-image-5683 size-thumbnail\" height=\"150\" width=\"150\" \/><\/a> Lubricate the tip of the catheter[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"3\">14.\u00a0Drape patient with drape found in catheterization kit one under the buttocks and one on top of and exposing the perineum or penis.\r\n\r\n&nbsp;\r\n\r\nEnsure that any sterile supplies only touch the middle of the sterile drape (not the edges), and that sterile gloves do not touch non-sterile surfaces.\r\n\r\n&nbsp;\r\n\r\n&nbsp;<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">The outer\u00a02.5 cm is considered non-sterile on a sterile\u00a0drape.\r\n\r\n[caption id=\"attachment_5676\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1786.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_1786-150x150.jpg\" alt=\"Cover patient with sterile drape\" class=\"wp-image-5676 size-thumbnail\" height=\"150\" width=\"150\" \/><\/a> Cover patient with sterile drape[\/caption]\r\n\r\n**note - some nurses drape before applying sterile gloves, others drape after applying sterile gloves. the principle to remember is sterile to sterile.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"3\">15. Place sterile tray with catheter between patient's legs.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Sterile tray will collect urine once catheter tip is inserted into bladder.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"3\">16. Clean perineal area as follows.\r\n\r\n<em>Female patient<\/em>: Separate labia with fingers of non-dominant hand (now contaminated and no longer sterile). Using sterile technique and dominant hand, clean labia and urethral meatus from clitoris to anus, and from outside labia to inner labial folds and urethral meatus is the last swipe of the swab. If using prepackaged swabs, use a new swab for each cleansing stroke. If using cotton swabs and sterile forceps it is still one wipe one way discard\r\n\r\n<em>Male patient<\/em>: Gently grasp penis at shaft and hold it at right angle to the body throughout procedure with non-dominant hand\u00a0(now contaminated and no longer sterile).\u00a0Using sterile technique and dominant hand, clean urethral meatus in a circular motion working outward from meatus. If using prepackaged swabs, use a new swab for each cleansing stroke. If using cotton swabs and sterile forcepts it is till one wipe one way discard.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">This reduces the transmission of microorganisms.\r\n\r\n[caption id=\"attachment_5685\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1800.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_1800-150x150.jpg\" alt=\"Cleanse perineal area\" class=\"wp-image-5685 size-thumbnail\" height=\"150\" width=\"150\" \/><\/a> Cleanse perineal area[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"3\">17. Pick up catheter with sterile dominant hand 7.5 to 10 cm below the tip of the catheter.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Holding catheter closer to the tip will help to control and manipulate catheter during insertion.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"3\">18. Insert catheter as follows.\r\n\r\n<em>Female patient<\/em>:\r\n<ul>\r\n \t<li>Ask patient to bear down gently (as if to void or cough) to help expose urethral meatus.<\/li>\r\n \t<li>Advance catheter 5 to 7.5 cm until urine flows from catheter, then advance an additional 5 cm.<\/li>\r\n<\/ul>\r\n<em>Male patient<\/em>:\r\n<ul>\r\n \t<li>Hold penis perpendicular to body and pull up slightly\u00a0on shaft.<\/li>\r\n \t<li>Ask patient to take a deep breath and slowly insert catheter through urethral meatus.<\/li>\r\n \t<li>Advance catheter 17 to 22.5 cm or until urine flows from catheter then advance it to the bifurcation.<\/li>\r\n<\/ul>\r\n<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">This process helps visualize urethral meatus and relax external urinary sphincter.\r\n\r\n[caption id=\"attachment_5686\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1801.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_1801-150x150.jpg\" alt=\"Insert catheter gently\" class=\"wp-image-5686 size-thumbnail\" height=\"150\" width=\"150\" \/><\/a> Insert catheter gently[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"5\"><strong>Note:<\/strong>\u00a0If urine does not appear in a female patient, the catheter may be in the patient's vagina. Leave catheter in vagina as a landmark, and insert another sterile catheter.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"5\"><strong>Note:<\/strong> If catheter does not advance in a male patient, do not use force. Ask patient to take deep breaths while holding steady pressure with the tip of the catheter. Sometimes the catheter will pass via the prostate. If catheter still does not advance, reposition the penis toward the abdomen while holding steady pressure with the tip of the catheter. If the catheter still does not advance, stop procedure and inform physician. Patient may have an enlarged prostate or urethral obstruction and may require a coud\u00e9 tip catheter or the expertise of someone else.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"3\">19. Place catheter in sterile tray and collect urine specimen if required.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Urine specimen may be required for analysis. Collect as per agency policy.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"3\">20. While holding the catheter in place, slowly inflate balloon for indwelling catheters according to\u00a0catheter size, using\u00a0prefilled syringe. Observe the patient's facial expression during inflating noting any evidence of discomfort. If discomfort, STOP and deflate the balloon. The catheter balloon may be in the urethra.\r\n\r\nLikewise, if every indication suggests the balloon is in the bladder, keep gentle pressure on the syringe plunger with thumb, gently pull back on the catheter to confirm the balloon is inflated and the catheter will remain insitu.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">The size of balloon is marked on the catheter port.\r\n\r\n[caption id=\"attachment_5687\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1803.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_1803-150x150.jpg\" alt=\"Slowly inflate balloon\" class=\"wp-image-5687 size-thumbnail\" height=\"150\" width=\"150\" \/><\/a> Slowly inflate balloon[\/caption]\r\n\r\nInflating a balloon in a urethra can cause severe trauma.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"5\"><strong>Note:<\/strong> If patient experiences pain on balloon inflation, deflate balloon, allow urine to drain, advance catheter, and reinflate balloon.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"3\">21. After balloon is inflated, pull gently on catheter until resistance is felt, and then advance the catheter again.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Moving catheter back into bladder will avoid placing pressure on bladder neck.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"3\">22. Connect urinary bag to catheter using principles of asepsis.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Keep urinary bag below level of patient's bladder.\r\n\r\n[caption id=\"attachment_5688\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1805.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_1805-150x150.jpg\" alt=\"Connect urinary bag to catheter using sterile technique\" class=\"wp-image-5688 size-thumbnail\" height=\"150\" width=\"150\" \/><\/a> Connect urinary bag to catheter using sterile technique[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"3\">23. Secure catheter to patient's leg using securement device at tubing just above catheter bifurcation.\r\n\r\n&nbsp;\r\n\r\n<em>Female patient<\/em>: Secure catheter to inner thigh, allowing enough slack to prevent tension.\r\n\r\n&nbsp;\r\n\r\n<em>Male patient<\/em>: Secure catheter to upper thigh (with penis directed downward). Some patients require catheters to be secured to the abdomen (with penis directed toward chest). Always allow enough slack to prevent tension on the urinary meatus. Ensure foreskin is not left retracted.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Securing catheter reduces risk of CAUTI (catheter acquired urinary tract infection), urethral erosion, and accidental catheter removal.\r\n\r\n[caption id=\"attachment_5689\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1806.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_1806-150x150.jpg\" alt=\"Secure catheter to patient's leg\" class=\"wp-image-5689 size-thumbnail\" height=\"150\" width=\"150\" \/><\/a> Secure catheter to patient's leg[\/caption]\r\n\r\nFor male patients, leaving the foreskin retracted can cause pain and edema.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"3\">24. Dispose of supplies following\u00a0agency policy.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">This reduces the transmission of microorganisms.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"3\">25. Remove gloves and perform hand hygiene.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">This reduces the transmission of microorganisms.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"3\">26. Document procedure according to\u00a0agency policy, including\u00a0patient tolerance of procedure, any unexpected outcomes, and urine output.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Timely and accurate documentation promotes patient safety.\r\n\r\nSample documentation: <em>date \/ time: Unable to void. Bladder scanned for 750 ml. Suprapubic abdomen firm and uncomfortable. #16 - 10cc Foley inserted without difficulty. Clear yellow returns. Attached to urine drainage bag. Tolerated without discomfort.<\/em>\u00a0 \u00a0-----IPee\u00a0 \u00a0RN.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"5\">Data source: BCCNP, 2019; BCIT, 2015c; Perry et al., 2018<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<div class=\"textbox shaded\" style=\"text-align: center\">Watch the videos <a href=\"https:\/\/barabus.tru.ca\/nursing\/urinary_catherization_male.html\"><em>Urinary Catheterization (Male)<\/em><\/a> AND <a href=\"https:\/\/barabus.tru.ca\/nursing\/urinary_catherization_female.html\"><em>Urinary Catheterization (Female)<\/em><\/a> developed by Ren\u00e9e Anderson and Wendy McKenzie of Thompson Rivers University, 2018.<\/div>\r\n<h2>Removing a Urinary Catheter<\/h2>\r\nRemoving an indwelling Foley catheter is within the RN's scope of practice. As such the RN can choose to remove an indwelling catheter within their independent scope of practice if agency policy is supportive and the RN is competent to do so (BCCNP, 2018). Even with an order to remove an indwelling catheter, it remains the responsibility of the healthcare provider to evaluate if the indwelling catheter is necessary for the patient's recovery.\r\n\r\nA urinary catheter should be removed as soon as possible when it is no longer needed.\u00a0For post-operative patients who\u00a0require an indwelling catheter, the catheter should be removed preferably within 24 hours. The following are appropriate uses of an indwelling catheter (Gould et al., 2009):\r\n<ul>\r\n \t<li>Improved comfort for end-of-life care<\/li>\r\n \t<li>Assisting in the healing process of an open sacral or perineal pressure ulcer<\/li>\r\n \t<li>Patients requiring prolonged immobilization (unstable thoracic or lumbar fractures, multiple traumatic injuries)<\/li>\r\n \t<li>Select surgical procedures (prolonged procedures, urological surgeries, etc.)<\/li>\r\n \t<li>Intra-operative monitoring of urinary output<\/li>\r\n \t<li>Patients receiving large-volume infusions or diuretic intra-operatively<\/li>\r\n<\/ul>\r\nWhen a urinary catheter is removed, the healthcare provider must assess if normal bladder function has returned. The healthcare provider should report any hematuria, inability or difficulty voiding, or any new incontinence after catheter removal. Prior to removing a urinary catheter, the patient requires education on the process of removal, and on expected and unexpected outcomes (e.g.,\u00a0a mild burning sensation with the first void)\u00a0(VCH Professional Practice, 2014). The healthcare provider should instruct patients to:\r\n<ul>\r\n \t<li>Increase or maintain fluid intake (unless contraindicated).<\/li>\r\n \t<li>Void when able and within six to\u00a0eight\u00a0hours after removal of the\u00a0catheter.<\/li>\r\n \t<li>Inform the healthcare provider when he or she has voided, and measure the amount, colour, and any abnormal findings; ensure first void (urine output) is measured as per agency policy.<\/li>\r\n \t<li>Report any burning, pain, discomfort, or small amount of urine volume.<\/li>\r\n \t<li>Report an inability to void, bladder tenderness, or distension.<\/li>\r\n \t<li>Report any signs of a CAUTI.<\/li>\r\n<\/ul>\r\nReview the steps in Checklist 83 on how to remove an indwelling catheter.\r\n<table style=\"border-color: #000000;height: 3633px\">\r\n<tbody>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;text-align: center;height: 204px;width: 977.4px\" colspan=\"4\">\r\n<h3 style=\"text-align: center\"><a id=\"checklist83\"><\/a>Checklist 83: Removing an Indwelling Catheter<\/h3>\r\n<h5 style=\"text-align: center\"><em><span style=\"color: #000000\">Disclaimer:\u00a0Always review and follow your agency policy regarding this specific skill.<\/span><\/em><\/h5>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;height: 472px;width: 977.4px\" colspan=\"4\">\r\n<h5><span style=\"color: #333333\">Safety considerations:<\/span><\/h5>\r\n<ul>\r\n \t<li>Some agencies allow nurses to remove catheters within their independent scope of practice (ie. without an order). Check your agency guidelines.<\/li>\r\n \t<li>Perform\u00a0<a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/1-3-hand-hygiene-and-non-sterile-gloves\/\">hand hygiene<\/a>.<\/li>\r\n \t<li><span style=\"color: #333333\">Check room for <a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/1-4-additional-precautions-and-personal-protective-equipment-ppe\/\">additional precautions.<\/a><\/span><\/li>\r\n \t<li><span style=\"color: #333333\">Introduce yourself to patient.<\/span><\/li>\r\n \t<li><span style=\"color: #333333\">Confirm patient ID using two patient identifiers (e.g., name and date of birth).<\/span><\/li>\r\n \t<li><span style=\"color: #333333\">Explain process to patient;\u00a0offer analgesia, bathroom, etc.<\/span><\/li>\r\n \t<li><span style=\"color: #333333\">Listen and attend to patient cues.<\/span><\/li>\r\n \t<li><span style=\"color: #333333\">Ensure patient's privacy and dignity.<\/span><\/li>\r\n \t<li>Complete <a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/2-13-quick-priority-assessment-qpa\/\">QPA<\/a> including safety.<\/li>\r\n \t<li><span style=\"color: #333333\">Complete\u00a0necessary\u00a0<a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/2-5-head-to-toe-systems-approach-to-assessment\/\">focused assessments<\/a>.<\/span><\/li>\r\n \t<li>Recognize the personal nature of this procedure and provide culturally sensitive care.<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 121px\" colspan=\"2\">\r\n<h4 style=\"text-align: center\">Steps<\/h4>\r\n<\/td>\r\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 121px\" colspan=\"2\">\r\n<h4 style=\"text-align: center\">\u00a0Additional Information<\/h4>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;height: 76px;width: 480.6px\" colspan=\"2\">1. Verify prescriber's orders, perform hand hygiene, and gather supplies.<\/td>\r\n<td style=\"border: 1px solid #000000;height: 76px;width: 479.8px\" colspan=\"2\">Supplies include non-sterile gloves, sterile syringe (verify size of balloon on Foley catheter), waterproof pad, garbage bag, cleaning supplies for perineal care, and urine collection device (hat or urinal).<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 38px\" colspan=\"2\">2. Identify patient using two identifiers. Create privacy, and explain procedure for catheter removal.<\/td>\r\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 38px\" colspan=\"2\">This ensures you have the correct patient and follows agency policy on proper patient identification.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 57px\" colspan=\"2\">3. Educate patient on catheter removal and care post catheter removal.<\/td>\r\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 57px\" colspan=\"2\">Patient must be informed of what to expect after catheter is removed, and how to measure urine output, etc. Expect to void approximately 150 ml with each void initially.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 335px\" colspan=\"2\">4.\u00a0Perform hand hygiene\u00a0and set up supplies.<\/td>\r\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 335px\" colspan=\"2\">\r\n\r\n[caption id=\"attachment_6220\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1093.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_1093-150x150.jpg\" alt=\"Perform hand hygiene\" class=\"wp-image-6220 size-thumbnail\" height=\"150\" width=\"150\" \/><\/a> Perform hand hygiene[\/caption]\r\n\r\nRaise bed to working height.\r\n\r\nOrganize supplies.\r\n\r\nPosition patient supine for easy access.\r\n\r\nPlace waterproof pad under buttocks and garbage bag close to perineum.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 234px\" colspan=\"2\">5. Apply non-sterile gloves.<\/td>\r\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 234px\" colspan=\"2\">This reduces the transfer of microorganisms.\r\n\r\n[caption id=\"attachment_62202\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1511.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/05\/DSC_1511-150x150.jpg\" alt=\" Apply non-sterile gloves\" class=\"wp-image-5559 size-thumbnail\" height=\"150\" width=\"150\" \/><\/a> Apply non-sterile gloves[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 331px\" colspan=\"2\">6.\u00a0Remove catheter securement\/anchor device (often requires alcohol). Perform catheter care with warm water and soap, or according to\u00a0agency protocol.<\/td>\r\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 331px\" colspan=\"2\">Removing catheter securement device provides easy access to catheter for cleaning and removing.\r\n\r\n[caption id=\"attachment_6310\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1770.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_1770-150x150.jpg\" alt=\"Remove catheter securement device\" class=\"wp-image-6310 size-thumbnail\" height=\"150\" width=\"150\" \/><\/a> Remove catheter securement device[\/caption]\r\n\r\nPericare reduces microorganisms and\u00a0 risk of UTI.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 279px\" colspan=\"2\">7.\u00a0Insert syringe in balloon port and drain fluid from balloon. Verify balloon size on catheter to ensure all fluid is removed from balloon.\r\n\r\nNote: some catheter manufacturers advise to attach a syringe and the balloon will automatically deflate.<\/td>\r\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 279px\" colspan=\"2\">A partially deflated balloon will cause trauma to the urethra wall and pain during removal.\r\n\r\n[caption id=\"attachment_6312\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1773.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_1773-150x150.jpg\" alt=\"Insert syringe in balloon port and drain fluid from balloon\" class=\"wp-image-6312 size-thumbnail\" height=\"150\" width=\"150\" \/><\/a> Insert syringe in balloon port and drain fluid from balloon[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 339px\" colspan=\"2\">8.\u00a0Ask the patient to take a deep breath, and pull catheter out slowly and smoothly. Catheter should slide out easily.<\/td>\r\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 339px\" colspan=\"2\">\r\n\r\n[caption id=\"attachment_6313\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1774.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_1774-150x150.jpg\" alt=\"Pull catheter out slowly and smoothly\" class=\"wp-image-6313 size-thumbnail\" height=\"150\" width=\"150\" \/><\/a> Pull catheter out slowly and smoothly[\/caption]\r\n\r\nTaking a deep breath is a distraction to help facilitate the process of removal. If resistance is felt, stop removal and reattempt to remove the fluid from the balloon. Attempt removal again. If unable to remove the catheter, stop and notify prescriber.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 306px\" colspan=\"2\">9.\u00a0Wrap used catheter in waterproof pad or gloves or place in garbage bag. Unhook catheter tube from urinary bag. Measure, empty, and record contents of catheter bag. Remove gloves, perform hand hygiene, and apply new non-sterile gloves.<\/td>\r\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 306px\" colspan=\"2\">\r\n\r\n[caption id=\"attachment_6319\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1779.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_1779-150x150.jpg\" alt=\"Wrap used catheter in waterproof pad or gloves\" class=\"wp-image-6319 size-thumbnail\" height=\"150\" width=\"150\" \/><\/a> Wrap used catheter in waterproof pad or gloves[\/caption]\r\n\r\nThis prevents accidental spilling of urine from the catheter. Record drainage amount, colour, and consistency according to\u00a0agency policy.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 38px\" colspan=\"2\">10.\u00a0Discard equipment and supplies according to\u00a0agency policy.<\/td>\r\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 38px\" colspan=\"2\"><\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 95px\" colspan=\"2\">11. Review post-catheter care, fluid intake, and expected and unexpected outcomes with patient.<\/td>\r\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 95px\" colspan=\"2\">Ensure patient has access to toilet, commode, bedpan, or urinal. Place call bell within reach. Ensure first void (urine output) is measured as per agency policy.\r\nEncourage patient to maintain or increase fluid intake to maintain normal urine output (unless contraindicated).<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 287px\" colspan=\"2\">12. Lower bed to safe position, remove gloves, and perform hand hygiene.<\/td>\r\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 287px\" colspan=\"2\">Lowering the bed helps prevent falls. Hand hygiene prevents the transmission of microorganisms from patient to healthcare provider.\r\n\r\n[caption id=\"attachment_5972\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-247.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/05\/Book-pictures-2015-247-150x150.jpg\" alt=\"Hand hygiene with ABHR\" class=\"wp-image-5972 size-thumbnail\" height=\"150\" width=\"150\" \/><\/a> Hand hygiene with ABHR[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 402px\" colspan=\"2\">13. Document procedure according to\u00a0agency policy.<\/td>\r\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 402px\" colspan=\"2\">Document time of catheter removal, condition of urethra, and any teaching related to post-catheter care and fluid intake.\r\n\r\nSample documentation: <em>date \/ time: #16 - 7 cc Foley removed as ordered. Tolerated procedure. Aware to increase fluid intake to 2 litres \/ day. Aware to anticipate mild discomfort with first void. Aware of need for measurement of initial void. ----------IMGlad\u00a0 \u00a0RN<\/em>\r\n\r\nDocument time, amount, and characteristics of first void after catheter removal.\r\n\r\nSample documentation: <em>Date \/ time: Initial void post Foley removal 350 ml. Denies discomfort. Reports clear urine and feels she has emptied her bladder completely. ------GInhome\u00a0 RN<\/em><\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 977.4px;height: 19px\" colspan=\"4\">Data sources: BCCNP, 2019; BCIT, 2015b; Perry et al., 2018; VCH Professional Practice, 2014<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<div class=\"textbox shaded\" style=\"text-align: center\">Watch the video <a href=\"https:\/\/barabus.tru.ca\/nursing\/foley_catheter_removal.html\"><em>Foley Catheter Removal<\/em> <\/a>developed by Ren\u00e9e Anderson and Wendy McKenzie of Thompson Rivers University, 2018.<\/div>\r\nIf a patient is unable to void after six to eight\u00a0hours of removing a urinary catheter, or has the sensation of not emptying the bladder, or is experiencing small voiding amounts with increased frequency, a bladder scan may be performed. A bladder scan can assess if excessive urine is being retained. Notify the healthcare provider if patient is unable to void within six to eight\u00a0hours of removal of a urinary catheter. If a patient is found to have retained urine in the bladder and is unable to void, an intermittent\/straight catheterization should be performed\u00a0(Perry et al., 2018).\r\n<div class=\"textbox shaded\" style=\"text-align: center\">Read the <a href=\"http:\/\/journals.lww.com\/nursingmadeincrediblyeasy\/Fulltext\/2012\/07000\/To_scan_or_not_to_scan__Detecting_urinary.13.aspx\"><em>To Scan or Not To Scan<\/em><\/a><em>\u00a0<\/em>journal article by\u00a0Davis, Chrisman, and Walden (2012) for more information on bladder scanning.<\/div>\r\n<div class=\"bcc-box bcc-info\">\r\n<h3 style=\"text-align: center\">Critical Thinking Exercises<\/h3>\r\n<ol>\r\n \t<li>Describe the cleaning techniques for cleansing both a female and a male patient prior to catheterization.<\/li>\r\n \t<li>Your male patient complains of pain while you are inserting a urinary catheter. Describe your next steps.<\/li>\r\n<\/ol>\r\n<\/div>","rendered":"<p>Urinary elimination is a basic human function that can be compromised by illness, surgery, and other conditions. Urinary catheterization may be used to support urinary elimination in patients who are unable to void naturally. Urinary catheterization may be required:<\/p>\n<ul>\n<li>In cases of acute urinary retention<\/li>\n<li>When intake and output are being monitored<\/li>\n<li>For postoperative management<\/li>\n<li>To enhance healing in incontinent patients with open sacral and perineal wounds<\/li>\n<li>For comfort measures during end-of-life care<\/li>\n<\/ul>\n<h2>Catheter-Associated Urinary Tract Infections<\/h2>\n<p>Catheter-associated urinary tract infections (CAUTI) are a common complication of indwelling urinary catheters\u00a0and have been associated with increased morbidity, mortality, hospital cost, and length of stay (Gould et al., 2009). Urinary drainage systems are often reservoirs for multidrug-resistant organisms (MDROs) and a source of the transmission of microorganisms to other patients (Gould et al., 2009). The most important risk factor for developing a CAUTI, a healthcare-associated infection (HAI), is the prolonged use of a urinary catheter (Centers for Disease Control and Prevention [CDC], 2015). Urinary tract infections (UTIs) are the most commonly reported HAIs in acute care hospitals and account for more than 30% of all reported infections (Gould et al., 2009). Catheters in place for more than a few days place the patient at risk for a CAUTI. A healthcare provider must assess patients for signs and symptoms of CAUTIs and report immediately to the primary healthcare provider. Signs and symptoms of a CAUTI include:<\/p>\n<ul>\n<li>Fever, chills<\/li>\n<li>Lethargy<\/li>\n<li>Lower abdominal pain<\/li>\n<li>Back or flank pain<\/li>\n<li>Urgency, frequency of urination<\/li>\n<li>Painful urination<\/li>\n<li>Hematuria<\/li>\n<li>Change in mental status (confusion, delirium, or agitation), most commonly seen in older adults<\/li>\n<\/ul>\n<p>The following are practices for preventing CAUTIs (Perry et al., 2018):<\/p>\n<ul>\n<li>Insert urinary catheters using sterile technique.<\/li>\n<li>Only insert indwelling catheters when essential, and remove as soon as possible.<\/li>\n<li>Use the smallest tube size (gauge) possible.<\/li>\n<li>Provide daily cleansing of the urethral meatus with soap and water or perineal cleanser, following agency policy.<\/li>\n<li>Ensure a closed drainage system.<\/li>\n<li>Ensure that no kinks or blockages occur in the tubing.<\/li>\n<li>Secure the catheter tube to prevent urethral damage.<\/li>\n<li>Avoid routine use of antiseptic solutions on the urethral meatus and\/or in the urinary bag.<\/li>\n<li>Ensure urine bags are positioned to allow gravity to drain urine.<\/li>\n<\/ul>\n<h2>Urinary Catheterization<\/h2>\n<p>Urinary catheterization refers to the insertion of a catheter tube through the urethra and into the bladder\u00a0to drain urine. Although not a particularly complex skill, urethral catheterization can be difficult to master. Both male and female catheterizations present unique challenges.<\/p>\n<p>Having\u00a0adequate lighting and visualization is helpful, but does not ensure entrance of the catheter into the female urethra. It is not uncommon for the catheter to enter the vagina. Leaving the catheter in the vagina can assist in the correct insertion of a new catheter into the urethra, but you must remember\u00a0to remove the one in the vagina.<\/p>\n<p>For some women, the supine lithotomy position can be very uncomfortable or even dangerous. For example, patients\u00a0in the last trimester of pregnancy\u00a0may\u00a0faint with decreased blood supply to the fetus in this position. Patients with arthritis of the knees and hips may also find this position extremely uncomfortable. Catheterization may also be accomplished with the patient in the lateral to Sims position (three-quarters\u00a0prone).<\/p>\n<p>The male urinary sphincter may create resistance when passing a urinary catheter, particularly for older men with prostatic hypertrophy.<\/p>\n<p>Urethral\u00a0catheterization might be intermittent indwelling.<\/p>\n<p>Intermittent catheterization (single-lumen catheter) is used for:<\/p>\n<ul>\n<li>Immediate relief of urinary retention<\/li>\n<li>Long-term management of incompetent\u00a0bladder<\/li>\n<li>Obtaining\u00a0a sterile urine specimen<\/li>\n<li>Assessing\u00a0residual urine in the bladder after voiding (if a bladder scanner is not available)<\/li>\n<\/ul>\n<p>Indwelling catheterization (double- or triple-lumen catheter) is used for:<\/p>\n<ul>\n<li>Promoting urinary\u00a0elimination for persons requiring prolonged bed rest due to certain other health conditions (i.e., spinal cord injury)<\/li>\n<li>Measuring accurate\u00a0urine output<\/li>\n<li>Preventing skin\u00a0breakdown caused by urinary incontinence<\/li>\n<li>Facilitating wound\u00a0management for wounds in perineum, coccyx<\/li>\n<li>Allowing surgical repair of\u00a0urethra, bladder, or\u00a0surrounding structures<\/li>\n<li>Instilling irrigation\u00a0fluids or medications<\/li>\n<li>Assessing abdominal or pelvic pain<\/li>\n<li><span style=\"line-height: 1.5\">Investigating conditions of the genitourinary system<\/span><\/li>\n<\/ul>\n<p>The steps for inserting an intermittent or an indwelling catheter are the same, except that the indwelling catheter requires a closed drainage system and inflation of a balloon to keep the catheter in place. Indwelling catheters may have two\u00a0or three lumens (double or triple lumens). Double-lumen catheters comprise one lumen for draining the urine and a second lumen for inflating a balloon that keeps the catheter in place. Triple-lumen catheters are used for continuous bladder irrigation and for instilling medications into the bladder; the additional lumen delivers the irrigation fluid into the bladder.<\/p>\n<p>Indwelling urinary catheters are made of latex or silicone. Intermittent catheters may be made of rubber or polyvinyl chloride (PVC), making them softer and more flexible than indwelling catheters (Perry et al., 2018). The size of a urinary catheter is based on the French (Fr) scale, which reflects the internal diameter of the tube. Recommended catheter size is 12 to 16 Fr for females, and 14 to 16 Fr for males. Smaller sizes are used for infants and children. The balloon size also varies with catheters:\u00a0smaller for children (3 ml) and larger for continuous bladder irrigation (30 to 60 ml). The size of the catheter is usually printed on the side of the catheter port.<\/p>\n<p>Insertion of a Foley catheter is within the RN scope of practice, and as such an RN can insert a catheter within their independent scope of practice if the agency policy is supportive and the RN is competent to do so (BCCNP, 2018).<\/p>\n<p>An indwelling catheter is attached to a drainage bag to allow for unrestricted flow of urine. Make sure that the urinary bag hangs below the level of the patient&#8217;s bladder so that urine flows out of the bladder. The bag should not touch the floor, and the patient should carry the bag below the level of the bladder when ambulating. To review how to insert an indwelling catheter, see Checklist 82.<\/p>\n<table style=\"border-color: #000000\">\n<tbody>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;text-align: center\" colspan=\"5\">\n<h3 style=\"text-align: center\"><a id=\"checklist82\"><\/a>Checklist 82: Insertion of an Intermittent or Indwelling Urinary Catheter<\/h3>\n<h5 style=\"text-align: center\"><em><span style=\"color: #000000\">Disclaimer:\u00a0Always review and follow your agency policy regarding this specific skill.<\/span><\/em><\/h5>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"5\">\n<h5><span style=\"color: #333333\">Safety considerations:\u00a0<\/span><\/h5>\n<ul>\n<li>Some agencies allow nurses to insert catheters within their independent scope of practice (ie. without an order). Check your agency guidelines.<\/li>\n<li>Perform\u00a0<a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/1-3-hand-hygiene-and-non-sterile-gloves\/\">hand hygiene<\/a>.<\/li>\n<li><span style=\"color: #333333\">Check room for <a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/1-4-additional-precautions-and-personal-protective-equipment-ppe\/\">additional precautions.<\/a><\/span><\/li>\n<li><span style=\"color: #333333\">Introduce yourself to patient.<\/span><\/li>\n<li><span style=\"color: #333333\">Confirm patient ID using two patient identifiers (e.g., name and date of birth).<\/span><\/li>\n<li><span style=\"color: #333333\">Explain process to patient;\u00a0offer analgesia, bathroom, etc.<\/span><\/li>\n<li><span style=\"color: #333333\">Listen and attend to patient cues.<\/span><\/li>\n<li><span style=\"color: #333333\">Ensure patient&#8217;s privacy and dignity.<\/span><\/li>\n<li>Complete <a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/2-13-quick-priority-assessment-qpa\/\">QPA<\/a> including safety.<\/li>\n<li><span style=\"color: #333333\">Apply <a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/1-5-principles-of-surgical-asepsis\/\">principles of\u00a0asepsis<\/a>.<\/span><\/li>\n<li><span style=\"color: #333333\">Complete\u00a0necessary\u00a0<a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/2-5-head-to-toe-systems-approach-to-assessment\/\">focused assessments<\/a>.<\/span><\/li>\n<li>Recognize the personal nature of this procedure and provide culturally sensitive care.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 50%;text-align: center\" colspan=\"3\">\n<h4 style=\"text-align: center\">Steps<\/h4>\n<\/td>\n<td style=\"border: 1px solid #000000;width: 50%;text-align: center\" colspan=\"2\">\n<h4 style=\"text-align: center\">\u00a0Additional Information<\/h4>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"3\">1. Verify physician order for catheter insertion. Assess for bladder fullness and pain by palpation or by using a bladder scanner.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Palpation of a full bladder will cause an urge to void and\/or pain.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"3\">2. Position patient prone to semi-upright with knees raised; apply gloves; and inspect perineal region for erythema, drainage, and odor. Also assess perineal\u00a0anatomy.<\/p>\n<p>Apply non-sterile gloves. Wash perineal area with warm water and soap or perineal cleanser according to\u00a0agency policy.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Assessment of perineal area allows for determination of perineal condition and position of anatomical landmarks to assist with insertion.<\/p>\n<figure id=\"attachment_5559\" aria-describedby=\"caption-attachment-5559\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1511.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/05\/DSC_1511-150x150.jpg\" alt=\"Apply non-sterile gloves\" class=\"wp-image-5559 size-thumbnail\" height=\"150\" width=\"150\" \/><\/a><figcaption id=\"caption-attachment-5559\" class=\"wp-caption-text\">Apply non-sterile gloves<\/figcaption><\/figure>\n<p>Washing the perineum reduces microorganisms and reduces risk of urinary tract infection.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"3\">3. Remove gloves and perform hand hygiene.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">This prevents transmission of microorganisms.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"3\">4. Gather supplies:<\/p>\n<p><strong>Note: <\/strong>A catheterization kit may include most of these items.<\/p>\n<ul>\n<li>Sterile gloves<\/li>\n<li>Cleaning solution (usually povidone iodine swabs \u00d7 3)<\/li>\n<li>Lubricant<\/li>\n<li>Prefilled syringe for balloon inflation as per catheter size<\/li>\n<li>Sterile drape<\/li>\n<li>Urinary bag<\/li>\n<li>Foley catheter (usually 14 to 16)<\/li>\n<li>Catheter securement device<\/li>\n<li>Flashlight (helpful to visualize meatus on some women)<\/li>\n<\/ul>\n<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">When selecting catheter size, consider the patient&#8217;s history. If hematuria is present, select a larger catheter that will allow clots to pass. If bladder irrigation is necessary select a 3-way Foley.<\/p>\n<p>Larger catheter size increases the risk of urethral trauma.<\/p>\n<p>Preparation ahead of time enhances patient comfort and safety.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"3\">5.\u00a0 Ensure adequate lighting.<\/p>\n<p>&nbsp;<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Adequate lighting helps with accuracy and speed of catheter insertion. If using flashlight, position it to illuminate perineum.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"3\">6. Place waterproof pad under patient.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">This step prevents soiling of bed linens.<\/p>\n<figure id=\"attachment_5675\" aria-describedby=\"caption-attachment-5675\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1785.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_1785-150x150.jpg\" alt=\"Place waterproof pad under patient\" class=\"wp-image-5675 size-thumbnail\" height=\"150\" width=\"150\" \/><\/a><figcaption id=\"caption-attachment-5675\" class=\"wp-caption-text\">Place waterproof pad under patient<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"3\">7. Positioning of patient depends on gender.<\/p>\n<p><em>Female patient:<\/em> On back with knees flexed and thighs relaxed so that hips rotate to expose perineal area. Alternatively, if patient cannot abduct leg at the hip, patient can be side-lying with upper leg flexed at knee and hip, supported by pillows.<\/p>\n<p><em>Male patient:<\/em> Supine with legs extended and slightly apart.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Patient should be comfortable as possible, with perineum or penis exposed, for ease and safety in completing procedure.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"3\">8. Place\u00a0a blanket or sheet to cover patient\u00a0and expose only required anatomical areas.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">This step helps protect patient dignity.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"3\">9. Perform hand hygiene.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">This reduces the transmission of microorganisms.<\/p>\n<figure id=\"attachment_56751\" aria-describedby=\"caption-attachment-56751\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1492.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_1492-150x150.jpg\" alt=\"Perform hand hygiene\" class=\"wp-image-5550 size-thumbnail aligncenter\" height=\"150\" width=\"150\" \/><\/a><figcaption id=\"caption-attachment-56751\" class=\"wp-caption-text\">Perform hand hygiene<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"3\">10. If using indwelling catheter and closed drainage system, attach urinary bag to the bed and ensure that the clamp is closed.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Urinary bag should be closed to prevent urine drainage leaving\u00a0bag. A closed system also reduces risk of urinary tract infection<\/p>\n<figure id=\"attachment_6386\" aria-describedby=\"caption-attachment-6386\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_2104.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_2104-150x150.jpg\" alt=\"Urinary bag\" class=\"wp-image-6386 size-thumbnail\" height=\"150\" width=\"150\" \/><\/a><figcaption id=\"caption-attachment-6386\" class=\"wp-caption-text\">Urine drainage bag<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"3\">11. Prepare sterile field following <a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/1-5-principles-of-surgical-asepsis\/\">principles of asepsis<\/a>.<\/p>\n<p>Add supplies to\u00a0sterile field.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">This step ensures preparation and organization for procedure.<\/p>\n<figure id=\"attachment_5678\" aria-describedby=\"caption-attachment-5678\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1788.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_1788-150x150.jpg\" alt=\"Choose smallest catheter size possible\" class=\"wp-image-5678 size-thumbnail\" height=\"150\" width=\"150\" \/><\/a><figcaption id=\"caption-attachment-5678\" class=\"wp-caption-text\">Add catheter to the sterile field.<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"3\">12. Apply <a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/1-7-surgical-hand-scrub-applying-sterile-gloves-and-preparing-a-sterile-field\/\">sterile\u00a0gloves<\/a> following principles of asepsis.<\/p>\n<p>Arrange items in the urine collection tray. Attach the water filled syringe to the pigtail of the catheter.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Sterile gloves reduce the transmission of microorganisms.<\/p>\n<figure id=\"attachment_5680\" aria-describedby=\"caption-attachment-5680\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1791.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_1791-150x150.jpg\" alt=\"Apply sterile gloves\" class=\"wp-image-5680 size-thumbnail\" height=\"150\" width=\"150\" \/><\/a><figcaption id=\"caption-attachment-5680\" class=\"wp-caption-text\">Apply sterile gloves<\/figcaption><\/figure>\n<p>Organizing items facilitates a smooth process.<\/p>\n<figure id=\"attachment_5684\" aria-describedby=\"caption-attachment-5684\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1799.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_1799-150x150.jpg\" alt=\"Open sterile catheterization kit and add supplies as necessary\" class=\"wp-image-5684 size-thumbnail\" height=\"150\" width=\"150\" \/><\/a><figcaption id=\"caption-attachment-5684\" class=\"wp-caption-text\">Place supplies into the urine collection tray<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"3\">13.Lubricate tip of catheter. For males lubricate approximately 20 cm; for females lubricate approximately 5 to 10 cm.<\/p>\n<p>&nbsp;<\/p>\n<p>Note: manufacturers no longer recommend to test the catheter balloon before insertion. In fact doing so may stretch the catheter and cause urethral trauma.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\u00a0Lubrication minimizes urethral trauma and discomfort during procedure.<\/p>\n<figure id=\"attachment_5683\" aria-describedby=\"caption-attachment-5683\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1795.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_1795-150x150.jpg\" alt=\"Lubricate tip of catheter\" class=\"wp-image-5683 size-thumbnail\" height=\"150\" width=\"150\" \/><\/a><figcaption id=\"caption-attachment-5683\" class=\"wp-caption-text\">Lubricate the tip of the catheter<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"3\">14.\u00a0Drape patient with drape found in catheterization kit one under the buttocks and one on top of and exposing the perineum or penis.<\/p>\n<p>&nbsp;<\/p>\n<p>Ensure that any sterile supplies only touch the middle of the sterile drape (not the edges), and that sterile gloves do not touch non-sterile surfaces.<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">The outer\u00a02.5 cm is considered non-sterile on a sterile\u00a0drape.<\/p>\n<figure id=\"attachment_5676\" aria-describedby=\"caption-attachment-5676\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1786.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_1786-150x150.jpg\" alt=\"Cover patient with sterile drape\" class=\"wp-image-5676 size-thumbnail\" height=\"150\" width=\"150\" \/><\/a><figcaption id=\"caption-attachment-5676\" class=\"wp-caption-text\">Cover patient with sterile drape<\/figcaption><\/figure>\n<p>**note &#8211; some nurses drape before applying sterile gloves, others drape after applying sterile gloves. the principle to remember is sterile to sterile.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"3\">15. Place sterile tray with catheter between patient&#8217;s legs.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Sterile tray will collect urine once catheter tip is inserted into bladder.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"3\">16. Clean perineal area as follows.<\/p>\n<p><em>Female patient<\/em>: Separate labia with fingers of non-dominant hand (now contaminated and no longer sterile). Using sterile technique and dominant hand, clean labia and urethral meatus from clitoris to anus, and from outside labia to inner labial folds and urethral meatus is the last swipe of the swab. If using prepackaged swabs, use a new swab for each cleansing stroke. If using cotton swabs and sterile forceps it is still one wipe one way discard<\/p>\n<p><em>Male patient<\/em>: Gently grasp penis at shaft and hold it at right angle to the body throughout procedure with non-dominant hand\u00a0(now contaminated and no longer sterile).\u00a0Using sterile technique and dominant hand, clean urethral meatus in a circular motion working outward from meatus. If using prepackaged swabs, use a new swab for each cleansing stroke. If using cotton swabs and sterile forcepts it is till one wipe one way discard.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">This reduces the transmission of microorganisms.<\/p>\n<figure id=\"attachment_5685\" aria-describedby=\"caption-attachment-5685\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1800.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_1800-150x150.jpg\" alt=\"Cleanse perineal area\" class=\"wp-image-5685 size-thumbnail\" height=\"150\" width=\"150\" \/><\/a><figcaption id=\"caption-attachment-5685\" class=\"wp-caption-text\">Cleanse perineal area<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"3\">17. Pick up catheter with sterile dominant hand 7.5 to 10 cm below the tip of the catheter.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Holding catheter closer to the tip will help to control and manipulate catheter during insertion.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"3\">18. Insert catheter as follows.<\/p>\n<p><em>Female patient<\/em>:<\/p>\n<ul>\n<li>Ask patient to bear down gently (as if to void or cough) to help expose urethral meatus.<\/li>\n<li>Advance catheter 5 to 7.5 cm until urine flows from catheter, then advance an additional 5 cm.<\/li>\n<\/ul>\n<p><em>Male patient<\/em>:<\/p>\n<ul>\n<li>Hold penis perpendicular to body and pull up slightly\u00a0on shaft.<\/li>\n<li>Ask patient to take a deep breath and slowly insert catheter through urethral meatus.<\/li>\n<li>Advance catheter 17 to 22.5 cm or until urine flows from catheter then advance it to the bifurcation.<\/li>\n<\/ul>\n<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">This process helps visualize urethral meatus and relax external urinary sphincter.<\/p>\n<figure id=\"attachment_5686\" aria-describedby=\"caption-attachment-5686\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1801.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_1801-150x150.jpg\" alt=\"Insert catheter gently\" class=\"wp-image-5686 size-thumbnail\" height=\"150\" width=\"150\" \/><\/a><figcaption id=\"caption-attachment-5686\" class=\"wp-caption-text\">Insert catheter gently<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"5\"><strong>Note:<\/strong>\u00a0If urine does not appear in a female patient, the catheter may be in the patient&#8217;s vagina. Leave catheter in vagina as a landmark, and insert another sterile catheter.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"5\"><strong>Note:<\/strong> If catheter does not advance in a male patient, do not use force. Ask patient to take deep breaths while holding steady pressure with the tip of the catheter. Sometimes the catheter will pass via the prostate. If catheter still does not advance, reposition the penis toward the abdomen while holding steady pressure with the tip of the catheter. If the catheter still does not advance, stop procedure and inform physician. Patient may have an enlarged prostate or urethral obstruction and may require a coud\u00e9 tip catheter or the expertise of someone else.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"3\">19. Place catheter in sterile tray and collect urine specimen if required.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Urine specimen may be required for analysis. Collect as per agency policy.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"3\">20. While holding the catheter in place, slowly inflate balloon for indwelling catheters according to\u00a0catheter size, using\u00a0prefilled syringe. Observe the patient&#8217;s facial expression during inflating noting any evidence of discomfort. If discomfort, STOP and deflate the balloon. The catheter balloon may be in the urethra.<\/p>\n<p>Likewise, if every indication suggests the balloon is in the bladder, keep gentle pressure on the syringe plunger with thumb, gently pull back on the catheter to confirm the balloon is inflated and the catheter will remain insitu.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">The size of balloon is marked on the catheter port.<\/p>\n<figure id=\"attachment_5687\" aria-describedby=\"caption-attachment-5687\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1803.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_1803-150x150.jpg\" alt=\"Slowly inflate balloon\" class=\"wp-image-5687 size-thumbnail\" height=\"150\" width=\"150\" \/><\/a><figcaption id=\"caption-attachment-5687\" class=\"wp-caption-text\">Slowly inflate balloon<\/figcaption><\/figure>\n<p>Inflating a balloon in a urethra can cause severe trauma.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"5\"><strong>Note:<\/strong> If patient experiences pain on balloon inflation, deflate balloon, allow urine to drain, advance catheter, and reinflate balloon.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"3\">21. After balloon is inflated, pull gently on catheter until resistance is felt, and then advance the catheter again.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Moving catheter back into bladder will avoid placing pressure on bladder neck.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"3\">22. Connect urinary bag to catheter using principles of asepsis.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Keep urinary bag below level of patient&#8217;s bladder.<\/p>\n<figure id=\"attachment_5688\" aria-describedby=\"caption-attachment-5688\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1805.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_1805-150x150.jpg\" alt=\"Connect urinary bag to catheter using sterile technique\" class=\"wp-image-5688 size-thumbnail\" height=\"150\" width=\"150\" \/><\/a><figcaption id=\"caption-attachment-5688\" class=\"wp-caption-text\">Connect urinary bag to catheter using sterile technique<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"3\">23. Secure catheter to patient&#8217;s leg using securement device at tubing just above catheter bifurcation.<\/p>\n<p>&nbsp;<\/p>\n<p><em>Female patient<\/em>: Secure catheter to inner thigh, allowing enough slack to prevent tension.<\/p>\n<p>&nbsp;<\/p>\n<p><em>Male patient<\/em>: Secure catheter to upper thigh (with penis directed downward). Some patients require catheters to be secured to the abdomen (with penis directed toward chest). Always allow enough slack to prevent tension on the urinary meatus. Ensure foreskin is not left retracted.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Securing catheter reduces risk of CAUTI (catheter acquired urinary tract infection), urethral erosion, and accidental catheter removal.<\/p>\n<figure id=\"attachment_5689\" aria-describedby=\"caption-attachment-5689\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1806.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_1806-150x150.jpg\" alt=\"Secure catheter to patient's leg\" class=\"wp-image-5689 size-thumbnail\" height=\"150\" width=\"150\" \/><\/a><figcaption id=\"caption-attachment-5689\" class=\"wp-caption-text\">Secure catheter to patient&#8217;s leg<\/figcaption><\/figure>\n<p>For male patients, leaving the foreskin retracted can cause pain and edema.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"3\">24. Dispose of supplies following\u00a0agency policy.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">This reduces the transmission of microorganisms.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"3\">25. Remove gloves and perform hand hygiene.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">This reduces the transmission of microorganisms.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"3\">26. Document procedure according to\u00a0agency policy, including\u00a0patient tolerance of procedure, any unexpected outcomes, and urine output.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Timely and accurate documentation promotes patient safety.<\/p>\n<p>Sample documentation: <em>date \/ time: Unable to void. Bladder scanned for 750 ml. Suprapubic abdomen firm and uncomfortable. #16 &#8211; 10cc Foley inserted without difficulty. Clear yellow returns. Attached to urine drainage bag. Tolerated without discomfort.<\/em>\u00a0 \u00a0&#8212;&#8211;IPee\u00a0 \u00a0RN.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"5\">Data source: BCCNP, 2019; BCIT, 2015c; Perry et al., 2018<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<div class=\"textbox shaded\" style=\"text-align: center\">Watch the videos <a href=\"https:\/\/barabus.tru.ca\/nursing\/urinary_catherization_male.html\"><em>Urinary Catheterization (Male)<\/em><\/a> AND <a href=\"https:\/\/barabus.tru.ca\/nursing\/urinary_catherization_female.html\"><em>Urinary Catheterization (Female)<\/em><\/a> developed by Ren\u00e9e Anderson and Wendy McKenzie of Thompson Rivers University, 2018.<\/div>\n<h2>Removing a Urinary Catheter<\/h2>\n<p>Removing an indwelling Foley catheter is within the RN&#8217;s scope of practice. As such the RN can choose to remove an indwelling catheter within their independent scope of practice if agency policy is supportive and the RN is competent to do so (BCCNP, 2018). Even with an order to remove an indwelling catheter, it remains the responsibility of the healthcare provider to evaluate if the indwelling catheter is necessary for the patient&#8217;s recovery.<\/p>\n<p>A urinary catheter should be removed as soon as possible when it is no longer needed.\u00a0For post-operative patients who\u00a0require an indwelling catheter, the catheter should be removed preferably within 24 hours. The following are appropriate uses of an indwelling catheter (Gould et al., 2009):<\/p>\n<ul>\n<li>Improved comfort for end-of-life care<\/li>\n<li>Assisting in the healing process of an open sacral or perineal pressure ulcer<\/li>\n<li>Patients requiring prolonged immobilization (unstable thoracic or lumbar fractures, multiple traumatic injuries)<\/li>\n<li>Select surgical procedures (prolonged procedures, urological surgeries, etc.)<\/li>\n<li>Intra-operative monitoring of urinary output<\/li>\n<li>Patients receiving large-volume infusions or diuretic intra-operatively<\/li>\n<\/ul>\n<p>When a urinary catheter is removed, the healthcare provider must assess if normal bladder function has returned. The healthcare provider should report any hematuria, inability or difficulty voiding, or any new incontinence after catheter removal. Prior to removing a urinary catheter, the patient requires education on the process of removal, and on expected and unexpected outcomes (e.g.,\u00a0a mild burning sensation with the first void)\u00a0(VCH Professional Practice, 2014). The healthcare provider should instruct patients to:<\/p>\n<ul>\n<li>Increase or maintain fluid intake (unless contraindicated).<\/li>\n<li>Void when able and within six to\u00a0eight\u00a0hours after removal of the\u00a0catheter.<\/li>\n<li>Inform the healthcare provider when he or she has voided, and measure the amount, colour, and any abnormal findings; ensure first void (urine output) is measured as per agency policy.<\/li>\n<li>Report any burning, pain, discomfort, or small amount of urine volume.<\/li>\n<li>Report an inability to void, bladder tenderness, or distension.<\/li>\n<li>Report any signs of a CAUTI.<\/li>\n<\/ul>\n<p>Review the steps in Checklist 83 on how to remove an indwelling catheter.<\/p>\n<table style=\"border-color: #000000;height: 3633px\">\n<tbody>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;text-align: center;height: 204px;width: 977.4px\" colspan=\"4\">\n<h3 style=\"text-align: center\"><a id=\"checklist83\"><\/a>Checklist 83: Removing an Indwelling Catheter<\/h3>\n<h5 style=\"text-align: center\"><em><span style=\"color: #000000\">Disclaimer:\u00a0Always review and follow your agency policy regarding this specific skill.<\/span><\/em><\/h5>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;height: 472px;width: 977.4px\" colspan=\"4\">\n<h5><span style=\"color: #333333\">Safety considerations:<\/span><\/h5>\n<ul>\n<li>Some agencies allow nurses to remove catheters within their independent scope of practice (ie. without an order). Check your agency guidelines.<\/li>\n<li>Perform\u00a0<a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/1-3-hand-hygiene-and-non-sterile-gloves\/\">hand hygiene<\/a>.<\/li>\n<li><span style=\"color: #333333\">Check room for <a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/1-4-additional-precautions-and-personal-protective-equipment-ppe\/\">additional precautions.<\/a><\/span><\/li>\n<li><span style=\"color: #333333\">Introduce yourself to patient.<\/span><\/li>\n<li><span style=\"color: #333333\">Confirm patient ID using two patient identifiers (e.g., name and date of birth).<\/span><\/li>\n<li><span style=\"color: #333333\">Explain process to patient;\u00a0offer analgesia, bathroom, etc.<\/span><\/li>\n<li><span style=\"color: #333333\">Listen and attend to patient cues.<\/span><\/li>\n<li><span style=\"color: #333333\">Ensure patient&#8217;s privacy and dignity.<\/span><\/li>\n<li>Complete <a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/2-13-quick-priority-assessment-qpa\/\">QPA<\/a> including safety.<\/li>\n<li><span style=\"color: #333333\">Complete\u00a0necessary\u00a0<a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/2-5-head-to-toe-systems-approach-to-assessment\/\">focused assessments<\/a>.<\/span><\/li>\n<li>Recognize the personal nature of this procedure and provide culturally sensitive care.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 121px\" colspan=\"2\">\n<h4 style=\"text-align: center\">Steps<\/h4>\n<\/td>\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 121px\" colspan=\"2\">\n<h4 style=\"text-align: center\">\u00a0Additional Information<\/h4>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;height: 76px;width: 480.6px\" colspan=\"2\">1. Verify prescriber&#8217;s orders, perform hand hygiene, and gather supplies.<\/td>\n<td style=\"border: 1px solid #000000;height: 76px;width: 479.8px\" colspan=\"2\">Supplies include non-sterile gloves, sterile syringe (verify size of balloon on Foley catheter), waterproof pad, garbage bag, cleaning supplies for perineal care, and urine collection device (hat or urinal).<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 38px\" colspan=\"2\">2. Identify patient using two identifiers. Create privacy, and explain procedure for catheter removal.<\/td>\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 38px\" colspan=\"2\">This ensures you have the correct patient and follows agency policy on proper patient identification.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 57px\" colspan=\"2\">3. Educate patient on catheter removal and care post catheter removal.<\/td>\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 57px\" colspan=\"2\">Patient must be informed of what to expect after catheter is removed, and how to measure urine output, etc. Expect to void approximately 150 ml with each void initially.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 335px\" colspan=\"2\">4.\u00a0Perform hand hygiene\u00a0and set up supplies.<\/td>\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 335px\" colspan=\"2\">\n<figure id=\"attachment_6220\" aria-describedby=\"caption-attachment-6220\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1093.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_1093-150x150.jpg\" alt=\"Perform hand hygiene\" class=\"wp-image-6220 size-thumbnail\" height=\"150\" width=\"150\" \/><\/a><figcaption id=\"caption-attachment-6220\" class=\"wp-caption-text\">Perform hand hygiene<\/figcaption><\/figure>\n<p>Raise bed to working height.<\/p>\n<p>Organize supplies.<\/p>\n<p>Position patient supine for easy access.<\/p>\n<p>Place waterproof pad under buttocks and garbage bag close to perineum.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 234px\" colspan=\"2\">5. Apply non-sterile gloves.<\/td>\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 234px\" colspan=\"2\">This reduces the transfer of microorganisms.<\/p>\n<figure id=\"attachment_62202\" aria-describedby=\"caption-attachment-62202\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1511.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/05\/DSC_1511-150x150.jpg\" alt=\"Apply non-sterile gloves\" class=\"wp-image-5559 size-thumbnail\" height=\"150\" width=\"150\" \/><\/a><figcaption id=\"caption-attachment-62202\" class=\"wp-caption-text\">Apply non-sterile gloves<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 331px\" colspan=\"2\">6.\u00a0Remove catheter securement\/anchor device (often requires alcohol). Perform catheter care with warm water and soap, or according to\u00a0agency protocol.<\/td>\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 331px\" colspan=\"2\">Removing catheter securement device provides easy access to catheter for cleaning and removing.<\/p>\n<figure id=\"attachment_6310\" aria-describedby=\"caption-attachment-6310\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1770.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_1770-150x150.jpg\" alt=\"Remove catheter securement device\" class=\"wp-image-6310 size-thumbnail\" height=\"150\" width=\"150\" \/><\/a><figcaption id=\"caption-attachment-6310\" class=\"wp-caption-text\">Remove catheter securement device<\/figcaption><\/figure>\n<p>Pericare reduces microorganisms and\u00a0 risk of UTI.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 279px\" colspan=\"2\">7.\u00a0Insert syringe in balloon port and drain fluid from balloon. Verify balloon size on catheter to ensure all fluid is removed from balloon.<\/p>\n<p>Note: some catheter manufacturers advise to attach a syringe and the balloon will automatically deflate.<\/td>\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 279px\" colspan=\"2\">A partially deflated balloon will cause trauma to the urethra wall and pain during removal.<\/p>\n<figure id=\"attachment_6312\" aria-describedby=\"caption-attachment-6312\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1773.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_1773-150x150.jpg\" alt=\"Insert syringe in balloon port and drain fluid from balloon\" class=\"wp-image-6312 size-thumbnail\" height=\"150\" width=\"150\" \/><\/a><figcaption id=\"caption-attachment-6312\" class=\"wp-caption-text\">Insert syringe in balloon port and drain fluid from balloon<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 339px\" colspan=\"2\">8.\u00a0Ask the patient to take a deep breath, and pull catheter out slowly and smoothly. Catheter should slide out easily.<\/td>\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 339px\" colspan=\"2\">\n<figure id=\"attachment_6313\" aria-describedby=\"caption-attachment-6313\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1774.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_1774-150x150.jpg\" alt=\"Pull catheter out slowly and smoothly\" class=\"wp-image-6313 size-thumbnail\" height=\"150\" width=\"150\" \/><\/a><figcaption id=\"caption-attachment-6313\" class=\"wp-caption-text\">Pull catheter out slowly and smoothly<\/figcaption><\/figure>\n<p>Taking a deep breath is a distraction to help facilitate the process of removal. If resistance is felt, stop removal and reattempt to remove the fluid from the balloon. Attempt removal again. If unable to remove the catheter, stop and notify prescriber.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 306px\" colspan=\"2\">9.\u00a0Wrap used catheter in waterproof pad or gloves or place in garbage bag. Unhook catheter tube from urinary bag. Measure, empty, and record contents of catheter bag. Remove gloves, perform hand hygiene, and apply new non-sterile gloves.<\/td>\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 306px\" colspan=\"2\">\n<figure id=\"attachment_6319\" aria-describedby=\"caption-attachment-6319\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1779.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_1779-150x150.jpg\" alt=\"Wrap used catheter in waterproof pad or gloves\" class=\"wp-image-6319 size-thumbnail\" height=\"150\" width=\"150\" \/><\/a><figcaption id=\"caption-attachment-6319\" class=\"wp-caption-text\">Wrap used catheter in waterproof pad or gloves<\/figcaption><\/figure>\n<p>This prevents accidental spilling of urine from the catheter. Record drainage amount, colour, and consistency according to\u00a0agency policy.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 38px\" colspan=\"2\">10.\u00a0Discard equipment and supplies according to\u00a0agency policy.<\/td>\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 38px\" colspan=\"2\"><\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 95px\" colspan=\"2\">11. Review post-catheter care, fluid intake, and expected and unexpected outcomes with patient.<\/td>\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 95px\" colspan=\"2\">Ensure patient has access to toilet, commode, bedpan, or urinal. Place call bell within reach. Ensure first void (urine output) is measured as per agency policy.<br \/>\nEncourage patient to maintain or increase fluid intake to maintain normal urine output (unless contraindicated).<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 287px\" colspan=\"2\">12. Lower bed to safe position, remove gloves, and perform hand hygiene.<\/td>\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 287px\" colspan=\"2\">Lowering the bed helps prevent falls. Hand hygiene prevents the transmission of microorganisms from patient to healthcare provider.<\/p>\n<figure id=\"attachment_5972\" aria-describedby=\"caption-attachment-5972\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-247.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/05\/Book-pictures-2015-247-150x150.jpg\" alt=\"Hand hygiene with ABHR\" class=\"wp-image-5972 size-thumbnail\" height=\"150\" width=\"150\" \/><\/a><figcaption id=\"caption-attachment-5972\" class=\"wp-caption-text\">Hand hygiene with ABHR<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 402px\" colspan=\"2\">13. Document procedure according to\u00a0agency policy.<\/td>\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 402px\" colspan=\"2\">Document time of catheter removal, condition of urethra, and any teaching related to post-catheter care and fluid intake.<\/p>\n<p>Sample documentation: <em>date \/ time: #16 &#8211; 7 cc Foley removed as ordered. Tolerated procedure. Aware to increase fluid intake to 2 litres \/ day. Aware to anticipate mild discomfort with first void. Aware of need for measurement of initial void. &#8212;&#8212;&#8212;-IMGlad\u00a0 \u00a0RN<\/em><\/p>\n<p>Document time, amount, and characteristics of first void after catheter removal.<\/p>\n<p>Sample documentation: <em>Date \/ time: Initial void post Foley removal 350 ml. Denies discomfort. Reports clear urine and feels she has emptied her bladder completely. &#8212;&#8212;GInhome\u00a0 RN<\/em><\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 977.4px;height: 19px\" colspan=\"4\">Data sources: BCCNP, 2019; BCIT, 2015b; Perry et al., 2018; VCH Professional Practice, 2014<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<div class=\"textbox shaded\" style=\"text-align: center\">Watch the video <a href=\"https:\/\/barabus.tru.ca\/nursing\/foley_catheter_removal.html\"><em>Foley Catheter Removal<\/em> <\/a>developed by Ren\u00e9e Anderson and Wendy McKenzie of Thompson Rivers University, 2018.<\/div>\n<p>If a patient is unable to void after six to eight\u00a0hours of removing a urinary catheter, or has the sensation of not emptying the bladder, or is experiencing small voiding amounts with increased frequency, a bladder scan may be performed. A bladder scan can assess if excessive urine is being retained. Notify the healthcare provider if patient is unable to void within six to eight\u00a0hours of removal of a urinary catheter. If a patient is found to have retained urine in the bladder and is unable to void, an intermittent\/straight catheterization should be performed\u00a0(Perry et al., 2018).<\/p>\n<div class=\"textbox shaded\" style=\"text-align: center\">Read the <a href=\"http:\/\/journals.lww.com\/nursingmadeincrediblyeasy\/Fulltext\/2012\/07000\/To_scan_or_not_to_scan__Detecting_urinary.13.aspx\"><em>To Scan or Not To Scan<\/em><\/a><em>\u00a0<\/em>journal article by\u00a0Davis, Chrisman, and Walden (2012) for more information on bladder scanning.<\/div>\n<div class=\"bcc-box bcc-info\">\n<h3 style=\"text-align: center\">Critical Thinking Exercises<\/h3>\n<ol>\n<li>Describe the cleaning techniques for cleansing both a female and a male patient prior to catheterization.<\/li>\n<li>Your male patient complains of pain while you are inserting a urinary catheter. Describe your next steps.<\/li>\n<\/ol>\n<\/div>\n","protected":false},"author":397,"menu_order":4,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":"cc-by"},"chapter-type":[],"contributor":[],"license":[50],"class_list":["post-1066","chapter","type-chapter","status-publish","hentry","license-cc-by"],"part":1017,"_links":{"self":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/1066","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/users\/397"}],"version-history":[{"count":25,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/1066\/revisions"}],"predecessor-version":[{"id":5090,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/1066\/revisions\/5090"}],"part":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/parts\/1017"}],"metadata":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/1066\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/media?parent=1066"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapter-type?post=1066"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/contributor?post=1066"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/license?post=1066"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}