Urology – Catheter Insertion and Management, Bladder Irrigation, Nephrectomy and Trans Urethral Prostatectomy (turp)

Back to Table of Contents

Section 2 – Insertion of Female Indwelling Catheter (IDC)

Equipment:

• 
  Disposable catheter pack (includes extra gloves)
  
• 
  0.9% Sodium Chloride 60ml
  
• 
  Lubricant sachet Latex (short-term) or Silicone (long-term) catheters x two, usually 14 or 16F
  
• 
  Sterile urinary drainage bag to meet patients needs
  
• 
  One x 10ml syringe
  
• 
  One x 10ml Sterile Water for Injection
  
• 
  Securement device
  

Inpatient specific: Foleys Statlock device pack including skin prep

Community specific: Urinary Retaining Strap

• 
  Measuring jug if required
  
• 
  Procedural under pad
  
• 
  Clean gown
  
• 
  Sterile gloves
  
• 
  Community specific: Sterile gloves x two
  
• 
  Community specific: non sterile gloves
  
• 
  Safety glasses or goggles
  
• 
  Sterile specimen jar, if required
  

Procedure:

1. 
   The medical officer must document the order for catheter insertion and removal in clinical record
   
2. 
   Community Specific: Medical Officers Catheter Management
   
3. 
   Explain procedure to patient and ensure privacy
   
4. 
   Patient identification and allergy band are checked against clinical notes and stickers.
   
5. 
   Prepare equipment
   
6. 
   Don safety goggles
   
7. 
   Inpatient specific: Raise bed to the appropriate height
   
8. 
   Position the patient supine with knees flexed drawn up soles of feet together, or knees wide apart
   
9. 
   Place procedural under pad beneath the buttocks
   
10. 
    Don clean gown
    
11. 
    Don sterile gloves (separate) then gloves from catheter pack
    
12. 
    Remove the protective cover from the tip of the catheter ONLY. Lubricate, leaving the catheter cover in place
    
13. 
    Place the catheter in the dish
    
14. 
    Using a clean swab each time, cleanse the labia majora with 0.9% Sodium Chloride using downward strokes
    
15. 
    Separate the labia with free hand, using gloved hand
    
16. 
    Cleanse the labia minora and urethral meatus
    
17. 
    Discard forceps and first pair of gloves. Drape patient with fenestrated sheet to establish sterile area
    
18. 
    Separate the labia with free hand
    
19. 
    Maintain the separation until the catheterisation is complete
    
20. 
    Place the dish containing the catheter between the patient's thighs
    
21. 
    Identify the urethra
    
22. 
    Ask the patient to take a deep breath to relax the sphincter
    
23. 
    Gently insert the catheter until urine flows, then advance 2.5cm further into the orifice using the sterile catheter sleeve.
    

Note: Do not use force

24. 
    Remove the sterile catheter sleeve and drain urine into the dish
    
25. 
    Collect sterile urine specimen if required
    
26. 
    Inflate the balloon with the required amount of sterile water (see balloon hub)
    
27. 
    Remove the protective cap from the urinary drainage bag, seal outlet tube and attach to the catheter
    
28. 
    Inpatient specific: Attach statlock (dated) to the leg to anchor urinary catheter bag (Attachment A)
    

Community specific: Catheter Retention Strap

29. 
    Drain 600ml only then clamp for one (1) hour
    
30. 
    Leave the patient comfortable
    
31. 
    Lower the patient’s bed
    
32. 
    Discard equipment
    
33. 
    Inpatient specific: Record the procedure in the patient's clinical record (Attachment B):
    
    1. 
       Date and time of procedure
       
    2. 
       Type and catheter size
       
    3. 
       Amount of water in the balloon
       
    4. 
       Indication and scheduled date for removal or change
       
34. 
    Community specific: Record the procedure using the ‘Urinary Catheter Management Chart’ clinical record form (form no.60535)
    
35. 
    Record output, clarity, colour and odour on the patient's FBC and clinical record
    
36. 
    Perform urinalysis and document on General Observation Chart and clinical record
    
37. 
    Record if a specimen is sent to pathology
    
38. 
    Watch for haematuria and diuresis in patients with chronic urinary retention
    
39. 
    Adjust the Patient Accountability and Care Plan to indicate IDC insitu and associated perineal toilets required for hygiene needs
    

Alert: Companies who manufacture latex catheters recommend that the catheter be changed every seven days. Silicone catheters as per manufacturers’ recommendations to be changed 6 to 12 weekly.
Stabilisation of Urinary Catheters:

• 
  Prepare skin with protectant and allow to dry
  
• 
  Align anchor pad over securement site (arrow towards body)
  
• 
  Press catheter into anchor and close lid
  
• 
  Position on anterior thigh or abdomen
  
• 
  Peel away paper backing and place on skin (See Attachment A)
  

Back to Table of Contents

Section 3 – Insertion of Male Indwelling Catheter (IDC)