Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed. Offer a chaperone.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [178], C; RCN [208], C).
2. 2.Show
   Screen the bed.
   To ensure the patient's privacy. To allow dust and airborne organisms to settle before the sterile field is exposed (Fraise and Bradley [81], E).
3. 3.Show
   Prepare the trolley, placing all equipment required on the bottom shelf. (See also ‘Catheter selection’ under ‘Equipment’ above.)
   The top shelf acts as a clean working surface. E
4. 4.Show
   Take the trolley to the patient's bedside, disturbing the screens as little as possible.
   To minimize airborne contamination (Fraise and Bradley [81], E).
5. 5.Show
   Assist the patient to get into the supine position with the legs extended on the bed.
   To ensure the necessary area is easily accessible. E
6. 6.Show
   Remove the underpants or trousers and use a towel to cover the patient's thighs and genital area.
   To maintain the patient's dignity and comfort (NMC [178], C).
7. 7.Show
   Wash hands using bactericidal soap and water or alcohol‐based handrub and apply personal protective equipment.
   To reduce the risk of infection (NHS England and NHSI [161], C). To reduce the risk of cross‐infection from micro‐organisms on the uniform (Fraise and Bradley [81], E).

Procedure

1. 8.Show
   Open the outer cover of the catheterization pack and slide the pack onto the top shelf of the trolley.
   To prepare the equipment. E
2. 9.Show
   Using an aseptic technique, open the sterile catheter pack. Pour 0.9% sodium chloride or 0.1% chlorhexidine solution into a gallipot. Open the outer packaging of an appropriately selected catheter onto the sterile field.
   To reduce the risk of introducing infection into the bladder (NICE [174], C; RCN [208], C).
3. 10.Show
   Remove the cover from the patient's genital area, maintaining the patient's privacy, and position a disposable pad under the patient's buttocks and thighs.
   To ensure urine does not leak onto the bedclothes. E
4. 11.Show
   Clean hands with an alcohol‐based handrub.
   Hands may have become contaminated by handling the outer packs (NHS England and NHSI [161], C).
5. 12.Show
   Put on sterile gloves.
   To reduce the risk of cross‐infection (NICE [174], C).
6. 13.Show
   On the sterile field, place the catheter into the sterile receiver with drainage bag attached.
   To ensure a closed system, minimizing the infection risk (EAUN [71], C).
7. 14.Show
   Place a sterile towel across the patient's thighs.
   To create a sterile field. E
8. 15.Show
   With your non‐dominant hand, wrap a sterile gauze swab around the penis. Use this to retract the foreskin, if necessary, and clean around the glans penis with swabs soaked with 0.9% sodium chloride or 0.1% chlorhexidine solution held between forceps, being careful not to touch the penis or gauze with your hand.
   To reduce the risk of introducing infection to the urinary tract during catheterization (Loveday et al. [135], R).
9. 16.Show
   Confirm patient's allergy status first. If no allergies to products exist, then insert the nozzle of the local anaesthetic or lubricating gel into the urethra. Squeeze the gel into the urethra and withdraw the nozzle, being sure not to touch the penis with your dominant hand. Wait 2 to 5 minutes (as per manufacturer's instructions).
   Adequate lubrication helps to prevent urethral trauma. Use of a local anaesthetic minimizes the discomfort experienced by the patient (Ghaffary et al. [87], E). To allow the anaesthetic gel to take effect (Ahluwalia et al. [8], E).
10. 17.Show
    With your non‐dominant hand, hold the penis firmly behind the glans, raising it until it is almost totally extended (maintain this hold until the catheter is inserted and urine flows).
    This manoeuvre straightens the penile urethra and prevents damage to the penoscrotal junction. Maintaining a grasp of the penis prevents contamination and retraction (EAUN [71], C).
11. 18.Show
    With your free hand, place the receiver containing the catheter between the patient's legs. Take the catheter with your dominant hand and advance the catheter into the urethra.
     
12. 19.Show
    If resistance is felt at the external sphincter, increase the traction on the penis slightly and apply steady, gentle pressure on the catheter. Ask the patient to cough gently or wiggle his toes (to distract the patient).
    Some resistance may be due to spasm of the external sphincter. Gentle coughing helps to relax the external sphincter (Yates [259], E).
13. 20.Show
    When the urine begins to flow, advance the catheter up to the bifurcation (hilt). If urine is not flowing, gently compress the lower abdomen with your hand to place pressure on bladder.
    Advancing the catheter ensures that it is correctly positioned in the bladder. This helps to ensure the balloon is in the bladder and not in the urethra (EAUN [71], C).
14. 21.Show
    Gently inflate the balloon according to the manufacturer's instructions, having ensured that the catheter is draining properly beforehand.
    Inadvertent inflation of the balloon in the urethra causes pain and urethral trauma (Davis et al. [61], R).
15. 22.Show
    Withdraw the catheter slightly so that the balloon is sitting at the bladder neck.
    To ensure that the balloon is inflated and the catheter is secure. E
16. 23.Show
    Secure the catheter using a specially designed support, for example the Simpla G‐Strap or the Bard StatLock™ Foley stabilization device (see Figure 6.12). Ensure that the catheter does not become taut when the patient is mobilizing or when the penis becomes erect. Ensure that the catheter lumen is not occluded by the fixation device.
    To maintain patient comfort and to reduce the risk of urethral and bladder neck trauma. Care must be taken when applying securing devices to ensure these do not interfere with drainage of the catheter by being applied too tightly. Leg straps must not impair circulation (Yates [260], E).
17. 24.Show
    Ensure that the glans penis is clean and dry and then extend the foreskin (if patient is not circumcised).
    Retraction and constriction of the foreskin behind the glans penis (paraphimosis) may occur if this is not done (EAUN [71], C).

Post‐procedure

1. 25.Show
   Assist the patient to replace his underwear and clothing, feeding the catheter down the leg. Ensure that the area is dry.
   To ensure clothing does not occlude drainage. E

   If the area is left wet or moist, secondary infection and skin irritation may occur (Voegeli [238], E).
2. 26.Show
   Measure the amount of urine.
   To be aware of the bladder capacity of patients who have presented with urinary retention. To monitor renal function and fluid balance if clinically indicated. It is not necessary to measure the amount of urine if the patient is having the urinary catheter changed routinely (EAUN [71], C).
3. 27.Show
   If required, take a urine specimen for urinalysis or laboratory examination.
   For further information, see Procedure guideline 14.7: Urinalysis: reagent strip and Chapter c13: Diagnostic tests.
4. 28.Show
   Dispose of equipment (including apron and gloves) in a clinical waste bag as per local policy.
   To reduce the risk of infection (NHS England and NHSI [161], C).
5. 29.Show
   Draw back the screen.
    
6. 30.Show
   Wash hands thoroughly with soap and water.
   To reduce the risk of infection (NHS England and NHSI [161], C).
7. 31.Show
   Record information in relevant documents; this should include:

   • reasons for catheterization
   • date and time of catheterization
   • catheter type, length and size
   • amount of water instilled into the balloon
   • batch number
   • manufacturer
   • any problems negotiated during the procedure
   • review date to assess the need for continued catheterization or date of change of catheter.
   To ensure accurate documentation and to provide a point of reference or comparison in the event of later queries (NMC [178], C).