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).
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.
   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 appropriate area is easily accessible. E
6. 6.Show
   Remove any necessary clothing 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 soap and water or alcohol‐based handrub.
   To reduce the risk of infection (NHS England and NHSI [161] R).
8. 8.Show
   Put on a disposable plastic apron.
   To reduce the risk of cross‐infection from micro‐organisms on the uniform (Fraise and Bradley [81], E).

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 catheter pack. Pour 0.9% sodium chloride 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).
3. 11.Show
   Remove the bedclothes from the patient's abdomen, exposing the catheter exit site.
   To ensure urine does not leak onto the bedclothes. E
4. 12.Show
   Clean hands with an alcohol‐based handrub.
   Hands may have become contaminated by handling the 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 with the drainage bag attached.
   To ensure a closed system, minimizing the infection risk (EAUN [71], C).
7. 15.Show
   Place a sterile towel across the patient's thighs.
   To create a sterile field. E
8. 16.Show
   Observe the current suprapubic site for the lie of the catheter, angle of insertion and length of catheter exposed outside the body as this will aid insertion of the new catheter.
   To assist with reinsertion of the suprapubic catheter (EAUN [71], C).
9. 17.Show
   Clean around the insertion site with 0.9% sodium chloride or 0.1% chlorhexidine solution, holding the indwelling catheter using a gauze swab.
   To reduce the risk of introducing infection (Mangnall [141], E).
10. 18.Show
    Put on new sterile gloves and place a new sterile drape over the change site.
    To minimize infection risk with sterile gloves during insertion of the new catheter and maintain a sterile field (EAUN [71], C).
11. 19.Show
    Deflate the balloon and remove the existing catheter. Cover the change site with sterile gauze.
    A two‐person approach can be adopted at this stage with one person remaining ‘aseptic’ to insert the new catheter (EAUN [71], C).
12. 20.Show
    Instill 5–10 mL of water‐soluble lubricant or anaesthetic gel into the suprapubic tract.
    Adequate lubricant reduces trauma to the tissues, helping to glide the catheter along the existing tract (EAUN [71], C).
13. 21.Show
    Advance the catheter into the tract 3 cm deeper than it was prior to removal. If no urine drains, press gently on the patient's lower abdomen to elicit urine drainage.
    Further advancement can inadvertently pass the catheter into the proximal urethra, leading to tissue damage on balloon inflation. E
14. 22.Show
    Inflate the catheter balloon, after ensuring that urine is draining, then gently withdraw the catheter.
    To ensure the balloon is inflated and maintains adequate urine drainage. E
15. 23.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 drainage of the catheter by being applied to tightly. Leg straps must not impair circulation (Yates [260], E).

Post‐procedure

1. 24.Show
   Assist the patient into a comfortable position and feed the catheter bag along the patient's leg. Ensure that drainage is aided by gravity. Replace the bedcovers and make sure the area is dry.
   If the area is left wet or moist, secondary infection and skin irritation may occur (Voegeli, [238], E).
2. 25.Show
   Measure the amount of urine drained.
   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 suprapubic catheter change (EAUN [71], C).
3. 26.Show
   If required, take a urine specimen for laboratory examination.
   For further information, see Chapter c13: Diagnostic tests.
4. 27.Show
   Dispose of equipment (including apron and gloves) in a clinical waste bag as per local policy.
   To ensure correct and safe disposal of clinical waste (DEFRA [63], C).
5. 28.Show
   Draw back the screen.
    
6. 29.Show
   Wash hands thoroughly with soap and water.
   To reduce the risk of infection (Fraise and Bradley [81], E).
7. 30.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 provide a point of reference or comparison in the event of later queries (NMC [178], C).