Skill 12-8

Catheterizing the Urinary Bladder of a Patient With Male Genitalia

Skill Variation: Intermittent Urethral Catheterization of a Patient With Male Genitalia

Urinary catheterization is the introduction of a catheter (tube) through the urethra into the bladder for the purpose of withdrawing urine. Catheter-associated urinary tract infections (CAUTIs) remain one of the most common causes of health care-associated infections in the United States (Knill et al., 2018). The best way to prevent a CAUTI is to use urinary catheters only when absolutely necessary (ANA, n.d.; Panchisin, 2016). The CDC provides parameters to guide the decision to insert an indwelling urinary catheter (Gould et al., 2019). When the use of a urinary catheter is deemed necessary, it should be performed using strict aseptic technique, left in place only as long as needed, and removed as soon as possible (ANA, 2014; Gould et al., 2019; Gyesi-Appiah et al., 2020; SUNA, 2015).

If a catheter is to remain in place for continuous drainage, an indwelling urethral catheter is used. Indwelling catheters are also called retention or Foley catheters. The indwelling urethral catheter is designed so that it does not slip out of the bladder. A balloon is inflated to ensure that the catheter remains in the bladder once it is inserted (see Figure 1A, Skill 12-7).

Intermittent urethral catheters, or straight catheters, are used to drain the bladder for shorter periods (see Figure 1B, Skill 12-7). Intermittent catheterization should be considered as an alternative to short- or long-term indwelling urethral catheterization to reduce CAUTIs (Gould et al., 2019). Intermittent catheterization is the preferred bladder management method for patients with urinary retention and bladder-emptying dysfunctions and following surgical interventions (Beauchemin et al., 2018; Gould et al., 2019). Certain advantages to intermittent catheterization, including the lower risks of CAUTI and complications, may make it a more desirable and safer option than indwelling catheterization (Panchisin, 2016; Wilson, 2015).

Some facilities have adopted a two-person urinary catheter insertion protocol, in which one nurse catheterizes the patient and one observes to ensure that the nurse inserting the catheter follows sterile technique and performs the procedure correctly (Belizario, 2015; Rhone et al., 2017). Implementation of the two-person urinary catheter insertion protocol has been shown to decrease CAUTI (Belizario, 2015; Fletcher-Gutowski & Cecil, 2019; Rhone et al., 2017).

The following procedure reviews insertion of an indwelling catheter into the urinary bladder of a patient with male genitalia. The procedure for intermittent catheterization of a urinary bladder of a patient with male genitalia follows as a Skill Variation. Guidelines for caring for a patient with an indwelling catheter are summarized in Box 12-1, located within Skill 12-7.

Delegation Considerations

The catheterization of the urinary bladder is not delegated to assistive personnel (AP). Depending on the state's nurse practice act and the organization's policies and procedures, catheterization of the urinary bladder may be delegated to licensed practical/vocational nurses (LPN/LVNs). The decision to delegate must be based on careful analysis of the patient's needs and circumstances as well as the qualifications of the person to whom the task is being delegated. Refer to the Delegation Guidelines in Appendix A.

Equipment

Sterile catheter kit that contains:
- Sterile gloves
- Sterile drapes (one of which is fenestrated)
- Sterile catheter (use the smallest appropriate-size catheter, usually a 14F catheter with a 5- to 10-mL balloon [ANA, 2014; SUNA, 2021d; Yates, 2017a])
- Antiseptic cleansing solution and cotton balls or gauze squares; antiseptic swabs
- Lubricant
- Forceps
- Prefilled syringe with sterile water (sufficient to inflate indwelling catheter balloon)
- Sterile basin (usually base of kit serves as this)
- Sterile specimen container (if specimen is required)
- Anesthetic gel, as prescribed or indicated (see Assessments below)
Flashlight or lamp
Waterproof, disposable pad
Sterile, disposable urine collection bag and drainage tubing (may be connected to catheter in catheter kit)
Catheter-securing device
Disposable gloves
Additional PPE, as indicated
Washcloth, skin cleanser, and warm water to perform perineal hygiene before and after catheterization

Assessment

Assess the patient's usual elimination habits. Assess the patient's degree of limitations and ability to help with activity. Assess for health problems, such as hip surgery or spinal injury, which would contraindicate certain actions by the patient. Assess for the presence of any other conditions that may interfere with passage of the catheter or contraindicate insertion of the catheter, such as urethral strictures or bladder cancer. Check for the presence of drains, dressings, intravenous fluid infusion sites/equipment, traction, or any other devices that could interfere with the patient's ability to help with the procedure or that could become dislodged. Assess bladder fullness before performing the procedure, either by palpation or with a handheld bladder ultrasound device. Question the patient about any allergies, especially to latex or iodine. Ask the patient if they have ever been catheterized. If they had an indwelling catheter previously, ask why and for how long it was used. The patient may have urethral strictures, which may make catheter insertion more difficult. If the patient is age 50 years or older, ask if they have had any prostate problems. Prostate enlargement typically is noted to begin around age 50 years. Assess for the need to use anesthetic gel; the use of anesthetic gel inserted in the urethra prior to catheterization is an option in for patients with male anatomy and should be considered if it is the patient's first catheterization or if a difficulty catheterization is suspected (SUNA, 2021d). Assess the characteristics of the urine and the patient's skin.

Actual or Potential Health Problems and Needs

Many actual or potential health problems or issues may require the use of this skill as part of related interventions. An appropriate health problem or issue may include:

Urinary retention
Infection risk
Total urinary incontinence

Outcome Identification and Planning

The expected outcomes to achieve when catheterizing the urinary bladder is that the catheter is successfully inserted without adverse effect, the patient's urinary elimination is maintained, and the patient's bladder is not distended. Other appropriate outcomes may include that the patient's skin remains clean, dry, intact, and without evidence of irritation or breakdown, and the patient verbalizes an understanding of the purpose for and care of the catheter, as appropriate.

Implementation

Action	Rationale
1. Review the patient's health record for any limitations in physical activity. Confirm the prescribed intervention for indwelling catheter insertion.	Physical limitations may require adaptations in performing the skill. Verifying the prescribed intervention ensures that the correct intervention is administered to the right patient.
2. Gather equipment. Obtain assistance from another staff member, if necessary.	Assembling equipment provides for an organized approach to the task. Assistance from another person may be required to perform the intervention safely.
3. Perform hand hygiene and put on PPE, if indicated.	Hand hygiene and PPE prevent the spread of microorganisms. PPE is required based on transmission precautions.
4. Identify the patient.	Identifying the patient ensures the right patient receives the intervention and helps prevent errors.
5. Close the curtains around the bed and close the door to the room, if possible. Discuss the procedure with the patient and assess the patient's ability to assist with the procedure. Ask the patient if they have any allergies, especially to latex or iodine.	This ensures the patient's privacy. Discussion promotes reassurance and provides knowledge about the procedure. Dialogue encourages patient participation and allows for individualized nursing care. Some catheters and gloves in kits are made of latex. Some antiseptic solutions contain iodine.
6. Provide good lighting. Artificial light is recommended (use of a flashlight requires an assistant to hold and position it). Place a trash receptacle within easy reach.	Good lighting is necessary to see the meatus clearly. A readily available trash receptacle allows for prompt disposal of used supplies and reduces the risk of contaminating the sterile field.
7. Assemble equipment on the overbed table or other surface within reach.	Arranging items nearby is convenient, saves time, and prevents unnecessary stretching and twisting of muscles on the part of the nurse.
8. Adjust the bed to a comfortable working height (VHACEOSH, 2016). Stand on the patient's right side if you are right-handed, or the patient's left side if you are left-handed.	Having the bed at the proper height prevents back and muscle strain. Positioning allows for ease of use of your dominant hand for catheter insertion.
9. Position the patient on their back with their thighs slightly apart. Drape the patient so that only the area around the penis is exposed. Slide a waterproof pad under the patient.	Proper positioning allows adequate visualization of the urinary meatus. This prevents unnecessary exposure and promotes warmth. The waterproof pad will protect bed linens from moisture.
10. Put on gloves. Clean the genital area with a washcloth, skin cleanser, and warm water. Clean the tip of the penis first, moving the washcloth in a circular motion from the meatus outward. Wash the shaft of the penis using downward strokes toward the pubic area. Rinse and dry. Remove gloves. Perform hand hygiene.	Gloves reduce the risk of exposure to blood and body fluids. Cleaning the penis reduces microorganisms near the urethral meatus. Hand hygiene reduces the spread of microorganisms.
11. Prepare the urine drainage setup if a separate urine collection system is to be used. Secure it to the bed frame according to the manufacturer's directions.	This facilitates connection of the catheter to the drainage system and provides for easy access.
12. Open the sterile catheterization tray on a clean overbed table or other flat surface, using sterile technique.	Placement of equipment near the worksite increases efficiency. Sterile technique protects the patient and prevents the spread of microorganisms.
13. Put on sterile gloves. Open the sterile drape and place it on the patient's thighs. Place the fenestrated drape with the opening over the penis (Figure 1).	The drape provides a sterile field close to the meatus.
14. Place the catheter setup on or next to the patient's legs on the sterile drape.	The sterile setup should be arranged so that the nurse's back is not turned to it, nor should it be out of the nurse's range of vision. This provides easy access to supplies.
15. Open all the supplies. Remove the cap from the prefilled sterile saline syringe and attach it to the balloon inflation port on the catheter. Open the package of antiseptic swabs. Alternatively, fluff cotton balls in a tray before pouring antiseptic solution over them. Open the specimen container if a specimen is to be obtained. If using anesthetic gel, remove the cap from the prefilled syringe. Open and squirt lubricant in the tray.	It is necessary to open all supplies and prepare for the procedure while both hands are sterile. The use of anesthetic gel inserted in the urethra prior to catheterization is an option in for patients with male anatomy and should be considered if it is the patient's first catheterization or if a difficulty catheterization is suspected (SUNA, 2021d).
16. Remove the cover from the catheter and lubricate 5 to 7 inches of the catheter tip (SUNA, 2021d).	Lubrication facilitates catheter insertion, reduces urethral trauma, and reduces discomfort during insertion (SUNA, 2021d).
17. Lift the penis with your nondominant hand. Retract the foreskin in an uncircumcised patient. Be prepared to keep your hand in this position until the catheter is inserted and urine is flowing well and continuously. Use your dominant hand to pick up an antiseptic swab, or use forceps to pick up a cotton ball. Using a circular motion, clean the penis, moving from the meatus down the glans of the penis (Figure 2). Repeat this cleansing motion two more times, using a new swab/cotton ball each time. Discard each swab/cotton ball after one use.	The hand touching the penis becomes contaminated. Cleansing the area around the meatus and under the foreskin in the uncircumcised patient helps prevent infection. Moving from the meatus toward the base of the penis prevents bringing microorganisms to the meatus.
18. Hold the penis with slight upward tension and perpendicular to the patient's body at a 90-degree angle to the patient's thighs (SUNA, 2021d). If using anesthetic gel, use your noncontaminated dominant hand to pick up the anesthetic syringe. Gently insert the tip of the syringe with anesthetic into the meatus and inject approximately 5 to 10 mL into the urethra (SUNA, 2021d) (Figure 3). Allow the gel to dwell for approximately 3 to 5 minutes before starting the catheter insertion (SUNA, 2021d).	This position extends the urethra and straightens the curvature of the penis (SUNA, 2021d). The use of anesthetic gel inserted in the urethra prior to catheterization is an option in for patients with male anatomy and should be considered if it is the patient's first catheterization or if a difficulty catheterization is suspected (SUNA, 2021d).
19. With your noncontaminated, dominant hand, place the drainage end of the catheter in a receptacle. If the catheter is pre-attached to the sterile tubing and drainage container (closed drainage system), position the catheter and setup within easy reach on the sterile field. Ensure that the clamp on the drainage bag is closed.	This facilitates drainage of urine and minimizes risk of contaminating sterile equipment.
20. Use your noncontaminated, dominant hand to pick up the catheter and hold it 3 to 4 inches from the tip. Ask the patient to bear down as if voiding. Insert the catheter tip into the meatus (Figure 4). Ask the patient to take deep breaths. Advance the catheter about 7 to 10 inches into the urethra; urine should begin to flow through the tubing. Once urine flow is established, insert the catheter 2 more inches further, to the bifurcation or “Y” juncture of the ports (SUNA, 2021d). Do not use force to introduce the catheter. If the catheter resists entry, ask the patient to breathe deeply and rotate the catheter slightly.	Bearing down eases the passage of the catheter through the urethra. The male urethra is about 20 cm long. Having the patient take deep breaths or twisting the catheter slightly may ease the catheter past resistance at the sphincters. Insert indwelling catheters in patients with male genitalia to the catheter bifurcation (the “Y” level created by the balloon filling and urinary drainage ports) to assure the balloon is within the bladder and to avoid inadvertent inflation of the balloon in the urethra (ANA, 2014; SUNA, 2021d).
21. Hold the catheter securely at the meatus with your nondominant hand. Use your dominant hand to inflate the catheter balloon. Inject the entire volume of sterile water supplied in the prefilled syringe. Once the balloon is inflated, the catheter may be gently pulled back into place. Replace the foreskin, if present, over the catheter. Lower the penis.	Bladder or sphincter contraction could push the catheter out. The balloon anchors the catheter in place in the bladder. The manufacturer provides the appropriate amount of solution for the size of the catheter in the kit; as a result, use the entire syringe provided in the kit.
22. Pull gently on the catheter after the balloon is inflated to feel resistance.	Improper inflation can cause patient discomfort and malpositioning of the catheter.
23. Attach the catheter to the drainage system, if necessary.	The closed drainage system minimizes the risk for microorganisms being introduced into the bladder (Gould et al., 2019).
24. Remove equipment and dispose of it according to facility policy. Discard the syringe in a sharps container. Wash and dry the perineal area, as needed.	Proper disposal prevents the spread of microorganisms. Placing the syringe in a sharps container prevents reuse. Cleaning promotes comfort and appropriate personal hygiene.
25. Remove gloves. Perform hand hygiene. Secure the catheter tubing to the patient's inner thigh or lower abdomen (with the penis directed toward the patient's chest) with a catheter-securing device. Leave some slack in the catheter for leg movement.	Proper securement prevents tension on the catheter; reduces risk for catheter displacement, expulsion, migration, and trauma; and increases patient comfort (Holroyd, 2019). Hand hygiene prevents the spread of microorganisms. Whether to take the drainage tubing over or under the leg depends on gravity flow, the patient's mobility, and the comfort of the patient.
26. Assist the patient to a comfortable position. Cover the patient with bed linens. Place the bed in the lowest position.	Positioning and covering provides warmth and promotes comfort.
27. Secure the drainage bag below the level of the bladder. Check that the drainage tubing is not kinked and that movement of the side rails does not interfere with the catheter or drainage bag.	This facilitates drainage of urine and prevents the backflow of urine (ANA, 2014; Gould et al., 2019).
28. Put on gloves. Obtain a urine specimen immediately, if needed, from the drainage bag. Label the specimen. Send the urine specimen to the laboratory promptly or refrigerate it.	The catheter system is sterile. Obtaining a specimen immediately allows access to the sterile system. Keeping the urine at room temperature may cause microorganisms, if present, to grow and distort laboratory findings.
29. Remove gloves and additional PPE, if used. Perform hand hygiene.	Proper removal of PPE reduces the risk for infection transmission and contamination of other items. Hand hygiene prevents the spread of microorganisms.

Evaluation

The expected outcomes have been met when the catheter has been inserted without adverse effect, the patient's urinary elimination has been maintained, and the patient's bladder has not distended. Other outcomes have been met when the patient's skin has remained clean, dry, intact, and without evidence of irritation or breakdown, and the patient has verbalized an understanding of the purpose for and care of the catheter, as appropriate.

Documentation

Guidelines

Document the type and size of catheter and balloon inserted as well as the amount of fluid used to inflate the balloon. Document the patient's tolerance of the activity. Record the amount of urine obtained through the catheter and any specimen obtained. Document any other assessments, such as unusual urine characteristics or alterations in the patient's skin. Record the urine amount on the intake and output record, if appropriate.

Sample Documentation

Practice documenting catheterization of the male urinary bladder in Lippincott DocuCare.

Developing Clinical Reasoning and Clinical Judgment

Unexpected Situations and Associated Interventions

You cannot insert the catheter past 3 to 4 inches; rotating the catheter and having the patient breathe deeply are of no help: If still unable to place the catheter, notify the health care team. Repeated catheter placement attempts can traumatize the urethra. Anticipate the possible insertion of a coudé catheter by a urologist or advanced practice professional.
Patient is obese or has a retracted penis: Have an assistant available to place their fingers on either side of the pubic area and press backward to bring the penis out of the pubic cavity. Hold the patient's penis up and forward. The catheter still needs to be inserted to the bifurcation; the length of the urethra has not changed.
Urine leaks out of meatus around the catheter: Do not increase the size of the indwelling catheter. Make sure the smallest-sized catheter with a 10-mL balloon is used. Large catheters cause bladder and urethral irritation and trauma. Large balloon-fill volumes occupy more space inside the bladder and put added weight on the base of the bladder. Irritation of the bladder wall and detrusor muscle can cause leakage. If leakage persists, consider an evaluation for urinary tract infection. Ensure that the correct amount of solution was used to inflate the balloon. Underfilling the balloon can cause the catheter to dislodge into the urethra, causing urethral spasm, pain, and discomfort. If you suspect underfill, do not attempt to push the catheter farther into the bladder. Remove the catheter and replace with a new catheter. Assess the patient for constipation. A bowel full of stool can cause pressure on the catheter lumen and prevent the drainage of urine. Implement interventions to prevent/treat constipation.
Urine flow is initially well established, and urine is clear, but after several hours urine flow dwindles: Check the tubing for kinking. If the patient has changed position, the tubing and drainage bag may need to be moved to facilitate drainage of urine.

Special Considerations

General Considerations

Some facilities have adopted a two-person urinary catheter insertion protocol, in which one nurse catheterizes the patient and one observes to ensure that the nurse inserting the catheter follows sterile technique and performs the procedure correctly (Belizario, 2015; Rhone et al., 2017). Implementation of the two-person urinary catheter insertion protocol has been shown to decrease CAUTI (Belizario, 2015; Fletcher-Gutowski & Cecil, 2019; Rhone et al., 2017).
Assess for the need to use anesthetic gel; the use of anesthetic gel inserted in the urethra prior to catheterization is an option in for patients with male anatomy and should be considered if it is the patient's first catheterization or if a difficulty catheterization is suspected (SUNA, 2021d).
Check for patient allergy before use of anesthetic gel. Anesthetic gel instilled into the patient's urethra should be administered at least 5 minutes before catheterization to ensure sufficient anesthetic effect (Yates, 2017b).
Be familiar with facility policy and/or primary health care provider guidelines for the maximum amount of urine to remove from the bladder at the time of insertion.
Supplies can be opened and prepared on the overbed table, moving the tray onto the bed just before cleansing the patient.
If there is not an immediate flow of urine after the catheter has been inserted, several measures may prove helpful:
- Have the patient take a deep breath, which helps to relax the perineal and abdominal muscles.
- Rotate the catheter slightly because a drainage hole may be resting against the bladder wall.
- Raise the head of the patient's bed to increase pressure in the bladder area.
- Assess the patient's intake to ensure adequate fluid intake for urine production.
- Assess the catheter and drainage tubing for kinks and occlusion.
- Urethral strictures, false passages, prostatic enlargement, and postsurgical bladder-neck contractures can make urethral catheterization difficult and may require the services of a urologist. If there is any question as to the location of the catheter, do not inflate the balloon. Remove the catheter and notify the health care team (SUNA, 2021c).
If the catheter cannot be advanced, having the patient take several deep breaths may be helpful. Rotate the catheter half a turn, and try to advance it. If you are still unable to advance it, remove the catheter. Notify the health care team.
Some catheter kits do not contain the catheter. This allows you to select a catheter and balloon size separately.
Maintain a constant downward flow of urine. Check tubing frequently to ensure kinks and dependent loops (low points) are not present in the tubing (ANA, 2014; Gould et al., 2019; Wuthier et al., 2016). Check to see that the patient is not lying on the drainage tubing and compressing it.
Keep the catheter drainage bag below the level of the bladder at all times (ANA, 2014; Gould et al., 2019).
Keep the drainage bag off the floor at all times to reduce the risk of infection (ANA, 2014; Gould et al., 2019). The floor is grossly contaminated.

Infant and Child Considerations

Size 6F to 8F is used for infants and young children (Kyle & Carman, 2021). Size 8F to 12F catheters are commonly used for older children (Kyle & Carman, 2021).
Distraction, such as blowing bubbles, deep breathing, or singing a song, can help the child relax.
Consider the use of lidocaine jelly to anesthetize and lubricate the area before insertion of the catheter, decreasing the child's discomfort and anxiety. Refer to facility policy regarding prescribing requirements and use.

Older Adult Considerations

If resistance is met while inserting a catheter, and rotating does not help, it is important to never force the catheter. The resistance may be caused by enlargement of the prostate gland, which is commonly seen in men over age 50 years. A special crook-tipped catheter called a coudé catheter, inserted by the urologist or advanced practice professional, may be required to maneuver past the prostate gland.

Community-Based Care Considerations

Intermittent catheterization, performed by the patient or a caregiver in the home, may be necessary for patients with spinal cord injuries or other neurologic conditions. Although the risk for UTI is always present, and practice guidelines support the use of clean, rather than sterile, technique in the home environment (Bardsley, 2015a; Beauchemin et al., 2018; Gould et al., 2019; Wilson, 2015a). The procedure for self-intermittent catheterization is essentially the same as that used by the nurse to catheterize a patient, using clean, nonsterile technique (Collins, 2019; Leach, 2018). Box 12-2 (page 748) outlines important information related to patient intermittent self-catheterization (ISC).
Single-use catheters and no-touch catheters are options for use for ISC in the home setting (Beauchemin et al., 2018). The past practice of catheter reuse in community settings, instructing patients to wash and reuse the same catheter for multiple catheterizations, is not recommended; no evidence-based guidelines on cleaning or disposing of a reused catheter are available (Beauchemin et al., 2018; Newman, 2019b).

Intermittent Urethral Catheterization of a Patient With Male Genitalia

Check the health record for the prescribed intervention of intermittent urethral catheterization. Review the patient's health record for any limitations in physical activity. Gather supplies. Obtain assistance from another staff member, if necessary.
Perform hand hygiene. Put on PPE, as indicated.
Identify the patient. Discuss the procedure with the patient and assess the patient's ability to assist with the procedure. Ask the patient if they have any allergies, especially to latex or iodine.
Close the curtains around the bed and close the door to the room, if possible.
Provide good lighting. Artificial light is recommended (use of a flashlight requires an assistant to hold and position it). Place a trash receptacle within easy reach.
Assemble equipment on the overbed table or other surface within reach.
Raise the bed to a comfortable working height. Stand on the patient's right side if you are right-handed, or the patient's left side if you are left-handed.
Position the patient on their back with their thighs slightly apart. Drape the patient so that only the area around the penis is exposed. Slide a waterproof pad under the patient.
Put on gloves. Clean the genital area with a washcloth, skin cleanser, and warm water. Clean the tip of the penis first, moving the washcloth in a circular motion from the meatus outward. Wash the shaft of the penis using downward strokes toward the pubic area. Rinse and dry. Remove gloves. Perform hand hygiene.
Open the sterile catheterization tray on a clean overbed table using sterile technique.
Put on sterile gloves. Open the sterile drape and place it on the patient's thighs. Place the fenestrated drape with the opening over the penis.
Place the catheter setup on or next to the patient's legs on the sterile drape.
Open all the supplies. Open the package of antiseptic swabs. Alternatively, fluff cotton balls in a tray before pouring antiseptic solution over them. Open the specimen container if a specimen is to be obtained. If using anesthetic gel, remove the cap from the prefilled syringe. Open and squirt lubricant in the tray.
Remove the cover from the catheter and lubricate 5 to 7 inches of the catheter tip.
Lift the penis with your nondominant hand. Retract the foreskin in an uncircumcised patient.Be prepared to keep your hand in this position until the catheter is inserted and urine is flowing well and continuously.
Use your dominant hand to pick up an antiseptic swab/cotton ball.Using a circular motion, clean the penis, moving from the meatus down the glans of the penis. Repeat this cleansing motion two more times, using a swab/cotton ball each time. Discard each swab/cotton ball after one use.
Hold the penis with slight upward tension and perpendicular to the patient's body at a 90-degree angle to the patient's thighs (SUNA, 2021d). If using anesthetic gel, use your noncontaminated dominant hand to pick up the anesthetic syringe. Gently insert the tip of the syringe with anesthetic into the meatus and inject approximately 5 to 10 mL into the urethra (SUNA, 2021d). Allow the gel to dwell for approximately 3 to 5 minutes before starting the catheter insertion (SUNA, 2021d).
With your noncontaminated, dominant hand, place the drainage end of the catheter in a receptacle. If a specimen is required, place the end into the specimen container in the receptacle.
Use your dominant hand to pick up the catheter and hold it 3 or 4 inches from the tip. Ask the patient to bear down as if voiding. Insert the catheter tip into the meatus. Ask the patient to take deep breaths as you advance the catheter 7 to 10 inches or until urine flows. Do not force the catheter through the urethra into the bladder.Ask the patient to breathe deeply, and rotate the catheter gently if slight resistance is met as the catheter reaches the external sphincter.
Hold the catheter securely at the meatus with your nondominant hand while the bladder empties. If a specimen is being collected, remove the drainage end of the tubing from the specimen container after the required amount is obtained and allow urine to flow into the receptacle. Set the specimen container aside and place the lid on the container.
Allow the bladder to empty. Withdraw the catheter slowly and smoothly after urine has stopped flowing. Remove equipment and dispose of it according to facility policy. Discard the syringe in a sharps container to prevent reuse. Wash and dry the genital area, as needed. Replace the foreskin in the forward position, if necessary.
Remove gloves. Perform hand hygiene. Assist the patient to a comfortable position. Cover the patient with bed linens. Place the bed in the lowest position.
Put on clean gloves. Secure the container lid and label the specimen. Send the urine specimen to the laboratory promptly or refrigerate it.
Remove gloves and additional PPE, if used. Perform hand hygiene.

Note: Intermittent catheterization in the home is performed using clean technique (Collins, 2019; Leach, 2018). Single-use catheters and no-touch catheters are options for use for intermittent self-catheterization (ISC) in the home setting (Beauchemin et al., 2018). The past practice of catheter reuse in community settings, instructing patients to wash and reuse the same catheter for multiple catheterizations, is not recommended; no evidence-based guidelines on cleaning or disposing of a reused catheter are available (Beauchemin et al., 2018; Newman, 2019b).

Box 12-2 (page 748) outlines information related to patient ISC.

EVIDENCE FOR PRACTICE

Prevention of Catheter-Associated Infections

Gould, C. V., Umscheid, C. A., Agarwal, R. K., Kuntz, G., Pegues, D. A., & the Healthcare Infection Control Practices Advisory Committee (HICPAC). (2019 [update]). Guideline for prevention of catheter-associated urinary tract infections 2009. Centers for Disease Control and Prevention, 31(4). https://www.cdc.gov/infectioncontrol/guidelines/cauti/index.html

These guidelines provide evidence-based recommendations to guide care for patients requiring catheterization of the urinary bladder to prevent CAUTI.

Refer to Skill 12-7 for additional evidence related to urinary catheterization.

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Skill 12-8

EVIDENCE FOR PRACTICE