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 (Action figure 3) 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], C).
5. 5.Show
   Remove the patient's underwear. Assist the patient to get into the supine position with knees bent, hips flexed and feet resting about 60 cm apart (Action figure 5).
   To enable the genital area to be seen. E
6. 6.Show
   Place a towel over the patient's thighs and genital area.
   To maintain the patient's dignity and comfort (NMC [178], C).
7. 7.Show
   Ensure that a good light source is available.
   To enable the genital area to be seen clearly. E
8. 8.Show
   Wash hands using bactericidal soap and water or alcohol‐based handrub. Apply personal protective equipment.
   To reduce the risk of cross‐infection (NHS England and NHSI [161], C).

Procedure

1. 9.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. 10.Show
   Using an aseptic technique, open the sterile pack. Open the selected catheter and place it on the sterile field.
   To reduce the risk of introducing infection into the urinary tract. E
3. 11.Show
   Remove the towel, maintaining the patient's privacy, and position a disposable pad under the patient's buttocks.
   To ensure urine does not leak onto the bedclothes. E
4. 12.Show
   Clean hands with alcohol‐based handrub.
   Hands may have become contaminated by handling of outer packs (Fraise and Bradley [81], C).
5. 13.Show
   Put on sterile gloves.
   To reduce the risk of cross‐infection (NICE [174], C).
6. 14.Show
   On the sterile field, place the catheter into the sterile receiver.
   To ensure a closed system, minimizing infection risk (EAUN [71], C).
7. 15.Show
   Place sterile towels under the patient's buttocks.
   To create a sterile field. E
8. 16.Show
   Using gauze swabs, separate the labia minora so that the urethral meatus is seen. Your non‐dominant hand should be used to maintain labial separation until the catheter is inserted and urine is flowing (Action figure 16).
   This manoeuvre provides better access to the urethral orifice and helps to prevent labial contamination of the catheter. E
9. 17.Show
   Clean around the urethral orifice with swabs soaked with 0.9% sodium chloride or 0.1% chlorhexidine solution held between forceps using single downward strokes, being careful not to touch the surrounding skin (Action figure 16).
   To clean the urethra orifice and thereby reduce the risk of CAUTI (Loveday et al. [135], R).
10. 18.Show
    Apply anaesthetic lubrication to the meatus and then insert the nozzle of the syringe into the urethra and instil gel into the urethra, being careful not to touch the surrounding skin (Action figure 18).
    Adequate lubrication helps to prevent urethral trauma. Use of a local anaesthetic minimizes the patient's discomfort (Ghaffary et al. [87], E).
11. 19.Show
    Place the catheter, in the sterile receiver, between the patient's legs and attach the drainage bag.
    To ensure a closed system, minimizing infection risk (EAUN [71], C).
12. 20.Show
    Using your dominant hand, introduce the tip of the catheter into the urethral orifice in an upward and backward direction. If the meatus is difficult to identify, this may be due to vaginal atrophy (see Problem‐solving table 6.4). Advance the catheter until urine is draining and up to the bifurcation (hilt) (Action figure 20).
    The direction of insertion and the length of the catheter inserted should relate to the anatomical structure of the area. E
13. 21.Show
    If there is no urine present, check that the catheter has not accidentally been inserted into the vagina. If the urethral meatus is clearly visible, consider removing the catheter and re‐attempting the procedure with a second sterile catheter. If the meatus is not clearly visible, see Problem‐solving table 6.4.
    This prevents repeated misplacement of the catheter. E
14. 22.Show
    Inflate the balloon according to the manufacturer's instructions, having ensured that the catheter is draining adequately (Action figure 22).
    Inadvertent inflation of the balloon within the urethra is painful and causes urethral trauma (Ghaffary et al. [87], E).
15. 23.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. 24.Show
    Support the catheter using a specially designed support, for example the Simpla G‐Strap or the Bard StatLock™ Foley stabilization device. Ensure that the catheter does not become taut when the patient is mobilizing. 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 the drainage of the catheter by being applied too tightly. Leg straps must not impair circulation (Yates [260], E).

Post‐procedure

1. 25.Show
   Assist the patient to replace her underwear and clothing, feeding the catheter down the leg. Replace the bedcovers and ensure that the area is dry.
   So that the catheter it is not occluded by clothing or tight underwear and is aided to drain by gravity. 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 bladder capacity for 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 a routine catheter change (EAUN [71], C).
3. 27.Show
   If required, take a urine specimen for 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 and manufacturer
   • any problems negotiated during the procedure
   • a review date to assess the need for continued catheterization or date of change of catheter.
   To ensure accurate documentation and provide a point of reference or comparison in the event of later queries (NMC [178], C).