a. Preparatory Phase.

(1) Check physician’s order.

(2) Approach and identify the patient and explain the procedure.

(3) Place patient in supine position with knees bent and feet resting flat on the bed about two feet apart. Drape the patient.

(4) Position moisture-proof pad under patient’s buttocks.

(5) Place waste receptacle in accessible place.

(6) Direct light for visualization of genital area.

(7) Wash hands.

(8) Open catheter kit using aseptic technique.

(9) Squeeze lubricant into plastic tray.

(10) Pour cleansing solution over cotton balls or open swab packet.

(11) Wash hands and put on sterile gloves.

**If inserting retention catheter, you must also:

(12) Inspect catheter for defects. Test the balloon by injecting 10 cc of sterile water into the balloon. Allow water to drain back into syringe.

NOTE: If there is a leak in the balloon, the catheter must be discarded and replaced.

(13) Connect the catheter to the connecting tubing on the drainage bag. Maintain sterility of catheter and drainage bag.

b. Performance Phase.

(1) Using your non-dominant hand, separate the labia, so that the urethra meatus is visualized. This hand maintains separation of the labia until catheterization is finished. This helps prevent labial contamination of the catheter.

NOTE: This glove is no longer sterile.

(2) With dominant sterile hand, pick up cotton ball (with forceps) or one swab stick. With downward stroke, from anterior to posterior, cleanse the labia farthest from you. DO NOT RETRACE.

(3) Repeat the procedure to cleanse the labia closest to you.

(4) Repeat the procedure a third time to cleanse the area between the two labia. Stroke from top to bottom, cleansing the urinary meatus. Discard cotton balls or swabs.

(5) Grasp the catheter about 3 inches from the tip and lubricate it, keeping the remainder coiled in the palm of the hand.

(6) Gently insert the catheter about 2 inches into the urethra or until urine begins to flow. Aim the catheter downward and to the back.

NOTE: If the catheter is accidentally introduced into the vagina, remove the catheter and discard it. Obtain another sterile catheter and begin the procedure again.

(7) Allow the urine to flow into the catheter tray (drainage bag, if retention catheter).

**If inserting a retention catheter, skip steps (8) through (11) and go to step (12).

(8) Collect a sterile specimen (if ordered) in the sterile specimen cup contained in the kit.

NOTE: Never allow more than 1000 cc of urine to drain from the bladder at one time. Clamp the catheter and wait about 15 minutes before allowing the remainder of the urine to drain.

(9) When the urine has stopped flowing, pinch off the catheter and gently remove it.

(10) Dry the patient and leave her in a comfortable position. Replace any soiled linen.

(11) Wash hands. Skip steps (12) through (18) and go to follow-up phase (item c).

(12) When urine is observed moving through the collecting tubing, advance the catheter another 1/2 inch. (This will ensure that the catheter tip is fully within the bladder.)

(13) Inflate the balloon with 10 cc of sterile water.

(14) GENTLY pull on the catheter to ensure that it is properly placed, and then gently push back into the bladder about 1/4 inch.

(15) Secure catheter in place with adhesive tape. Anchor the catheter to the skin of the inner thigh.

(16) Dry the patient and leave her in a comfortable position.

(17) Wash hands.

(18) If collection of a sterile specimen is ordered, you may collect it from the urinary drainage bag at this time. (Closed system is sterile until opened.)

NOTE: This is the ONLY time it is acceptable to collect urine from the drainage bag for testing purposes.

c. Follow-Up Phase.

(1) Remove all equipment from the patient’s bedside. Discard disposable items and return other equipment to the appropriate storage areas.

(2) Measure the urine. Send the sterile specimen to the laboratory with the appropriate request slips.

(3) Record the procedure in the Nursing Notes: include the date, time, amount and appearance of urine obtained, whether specimen was sent to the lab, and the patient’s tolerance.