a. Preparatory Phase.

(1) Check physician’s order.

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

(3) Place the patient in a supine position with legs extended.

(4) Place a sterile moisture proof drape across upper thighs.

(5) Place waste receptacle in accessible place.

(6) Direct light for visualization of genital area, if necessary.

(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 a retention catheter, you must also:

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

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

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

b. Performance Phase.

(1) Using your non-dominant hand, grasp penis, raising it almost straight up. (This maneuver straightens the urethra and facilitates catheterization.) Maintain grasp on penis until procedure is completed.

NOTE: This glove is no longer sterile.

(2) With dominant sterile hand, pick up cotton ball (with forceps) or one swab stick. Cleanse urethra meatus in a circular motion. Repeat as required, using a new swab or cotton ball each time. DO NOT RETRACE. Discard swabs/cotton balls.

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

(4) Gently insert the catheter into the urethra until urine begins to flow (6-9 inches). The catheter may be held with Kelly forceps rather than the gloved hand, if preferred.

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

**If inserting a retention catheter, skip steps (6) through (9) and go to step (10).

(6) 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.

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

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

(9) Wash hands. Skip steps (10) through (16). Go to follow-up phase (item c).

(10) 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.)

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

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

(13) Secure catheter in place with adhesive tape. Anchor the catheter to the skin of the abdomen, with the penis pointing toward the patient’s head.

(14) Dry the patient and leave him in a comfortable position.

(15) Wash hands.

(16) If collection of a sterile specimen is ordered, you may collect it from the 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 patient’s tolerance.