10.4 Urinary Catheters

Critical Thinking Exercises: Questions, Answers, and Sources / References

1. Describe the cleaning techniques for cleansing both a female and a male patient just prior to catheterization.

Answer: Clean perineal area as follows.

Female patient: 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

Male patient: Gently grasp penis at shaft and hold it at right angle to the body throughout procedure with non-dominant hand (now contaminated and no longer sterile). Using 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.

Source: Perry, A. G., Potter, P. A., & Ostendorf, W. R. (2017). Clinical nursing skills and techniques (9th ed.). St. Louis, MO: Elsevier-Mosby.

2. A male patient complains of pain while you are inserting a urinary catheter. Describe your next steps.

Answer: Stop. Consider if you’ve used enough lubricant. Reassess for history of urethral trauma. Consider if your agency protocols allow you to use xylocaine urethral jelly for local anesthetic effect. 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 pain is associated with the catheter passing 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 coudé tip catheter or the expertise of someone else.

If pain does not subside, consult the prescriber.

Sources: Perry, A. G., Potter, P. A., & Ostendorf, W. R. (2017). Clinical nursing skills and techniques (9th ed.). St. Louis, MO: Elsevier-Mosby.

• What signs and symptoms suggest a person with an indwelling foley catheter has a urinary tract infection? Select all that apply

a. Pain in flank

b. Suprapubic discomfort

c. Cloudy urine

d. Foul smelling urine

e. Blood in urine

f. Sediment in urine

g. Confusion

h. Fever

Answer: all of the above.

Source: Perry, A. G., Potter, P. A., & Ostendorf, W. R. (2017). Clinical nursing skills and techniques (9th ed.). St. Louis, MO: Elsevier-Mosby.