Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [178], C).
2. 2.Show
   Collect all equipment necessary for the procedure.
   To ensure all the equipment required is easily available. E
3. 3.Show
   Take the equipment to the toilet, a bathroom or a screened bed area. Ensure there is a good light and a full‐length mirror.
   To ensure the patient's privacy. To ensure the patient can see the stoma clearly. E
4. 4.Show
   The equipment should be arranged on a clean surface and within easy reach. The nurse remains in the room with the patient.
   To reduce the risk of contamination by surface bacteria. So that the equipment is easily available. E
5. 5.Show
   The patient needs to remove any inhibiting clothing.
   To ensure the patient can examine the stoma. E
6. 6.Show
   The patient should wash their hands with soap and water and dry them.
   To ensure the hands are clean (NHS England and NHSI [161], C).

Procedure

1. 7.Show
   The patient should look at the stoma, if necessary with the aid of a mirror.
   To look for mucus and swelling around the stoma (Leaver [126], E).
2. 8.Show
   The patient should wipe away any mucus with a tissue soaked in warm water and gently pat dry.
   To ensure the opening of the stoma is clear and mucus does not block the catheter during insertion into the stoma. E
3. 9.Show
   A lubricated catheter should be used; there are many types available. Selection should be based on patient choice or specialist advice.
   To allow the catheter to enter the urinary reservoir without causing internal trauma. E
4. 10.Show
   The patient should ensure the drainage end of the catheter is in a receiver, such as a jug, bowl or toilet.
   To ensure the urine goes into the receiver and not onto the patient. E
5. 11.Show
   The patient can either use a mirror to guide the tube into the opening of the stoma or feel the opening with two fingers slightly apart with the stoma between.
   To act as a guide to pass the catheter into the continent urinary stoma. E
6. 12.Show
   The patient should insert the catheter gently into the stoma, following the pathway inside (usually towards the middle of the abdomen) until urine starts to flow, then insert the tube a further 4–6 cm to reduce the risk of contamination.
   The direction of insertion and the diameter of the catheter inserted will depend on the type, size and shape of the continent urinary stoma. E

   To negotiate the continence device. E
7. 13.Show
   When all the urine has stopped flowing, the patient should advance the catheter to ensure the bladder is completely empty. If urine starts flowing again, they should wait until it stops before removing the catheter any further.
   To ensure complete emptying of the urinary reservoir. Moving the tube may dislodge any debris or mucus blocking the tube and allow the urine to flow (Leaver [126], E).
8. 14.Show
   The patient should remove the tube, cover the end of the catheter with a finger just before it is removed from the tunnel, and then hold the catheter over the receptacle before removing the finger.
   To trap urine in the catheter and stop it leaking onto the patient (Leaver [126], E).

   To allow complete drainage of the tube. E

Post‐procedure

1. 15.Show
   The patient should dispose of the catheter in a clinical waste bag.
   To ensure correct and safe disposal of contaminated waste (DEFRA [63], C).
2. 16.Show
   If required (usually not), the patient should cover the stoma with a non‐adherent dressing and secure with skin‐protective tape.
   To prevent mucus staining the patient's clothing. E
3. 17.Show
   The patient should wash their hands with soap and water, and then dry them.
   To remove any urine on the hands. E
4. 18.Show
   The patient can then dress, collect the equipment and dispose of any soiled dressings.
   To prevent cross‐infection (Fraise and Bradley [81], E).