1. Urinary Bladder Catheterization

2. Definition
Invasive aseptic or sterile procedure where a flexible draining tube (catheter) is placed through the urethra into the bladder to empty the patient’s bladder of urine
Considerations
Patient may be asked to urinate prior to procedure
Patient may arrive to the OR with a catheter in place
Catheter may be left in or changed
Will be placed pre-operatively and remain in place post-operatively

3. Types of Catheters Robinson or Rob-nel (Red Rubber)
used for one time emptying prior to procedure
is a straight less flexible catheter
Indwelling Foley used if surgeon wants bladder to be drained continuously during surgery
Carson-Coude tip of catheter slightly bent to aid in passing through an obstructed urethra (BPH or prostate surgery history)
Supra-pubic/Mushroom catheter

4. Cath Kit

5. Standard Latex Foley

6. Red Rubber

7. Coude Tip

8. Supra-pubic/Mushroom catheter

9. Catheter Materials Consider types of materials catheters are made of:
Latex rubber
Polyvinyl chloride (PVC)
Silicone

10. Types of Drainage Systems
Gravity bag
Urimeter
Sterile container

11. Purpose To empty or decompress the bladder during a surgical procedure
Drain urine from the bladder
Obtain a sterile urine specimen for lab analysis

12. Reasons for Catheterization
Pelvic surgery
Genitourinary system surgery
Spinal or epidural anesthesia
Surgery expected to last more than 2 hours
Patient having difficulty urinating
Patient unconscious

13. Procedure Basic handwash Gather supplies:
catheter kit (catheter & drainage system)
sterile water in a 5 or 10cc syringe (know balloon capacity)
PPE (sterile gloves)
Cleaning solution (betadine solution, other, & cotton balls
gauze sponges) OR
Water soluble sterile lubricant
Positioning aides if needed (tape, blanket, assistant)
Trash
Clean surface available that allows use of dominant hand for inserter
Good Lighting

14. Procedure Identify self if patient alert/awake Identify patient
Explain procedure if patient awake/alert
KNOW allergy status (betadine, latex)
Know where alternatives are (gloves, catheters, solutions)

15. Procedure Expose external genitalia
Maintain privacy as much as possible
Male: Supine
Female: “frog-legged”
Catheter set opened aseptically creating a sterile field
Open glove technique

16. Procedure
Prepare set
Pour sterile betadine solution or have other poured over gauze or cotton balls
Prepare lubricant
Test catheter balloon with sterile water leaving connected
Attach urinary drainage system to catheter)

17. Procedure For Males
Place sterile drape or towel over thighs under penis (extends sterile field)
Place towel above penis
Two towels should meet OR
Place fenestrated towel over penis
Move catheter system closer to target area
Use nondominant hand to grasp and pull the penis up
*Note: this hand is contaminated and will remain where it is until the catheter is inserted and the balloon is inflated

18. Procedure For Males
Antiseptic solution soaked sponge is grasped with forceps from set or dominant hand
Urethral meatus is cleansed from urethra out times two in a circular motion, removing sponge away from sterile field, after each cleansing
Grasp catheter about three inches from the tip with your sterile dominant hand and put into the urethral meatus until the end of the catheter is buried or until urine drains
May need to press on the bladder to get urine to drain
Securing catheter with nondominant hand, inflate the balloon with sterile water of the appropriate amount
Gently pull catheter until resistance is felt
Secure to patient’s thigh
Place drainage bag below the level of the OR bed

20. Procedure For Males Clean patient prn Clean up supplies
Remove soiled gloves using proper technique
Reposition and cover patient prn
Wash your hands
Record or note abnormalities to circulator
Note color and clarity of urine

21. Procedure For Females Sterile drape is placed between the thighs
Fenestrated drape placed over pubis exposing urethral meatus
Move catheter system closer to target area
Spread labia with nondominant hand
*Note: this hand is contaminated and will remain where it is until the catheter is inserted and the balloon is inflated

22. Procedure For Females
Antiseptic solution soaked sponge is grasped with forceps from set or dominant hand
Urethral meatus is cleansed anterior to posterior times two, removing sponge from sterile field, after each cleansing
Grasp catheter about three inches from the tip with your sterile dominant hand and put into the urethral meatus until urine drains
May need to press on the bladder to get urine to drain
Securing catheter with nondominant hand, inflate the balloon with sterile water of the appropriate amount
Gently pull catheter until resistance is felt
Secure to patient’s thigh
Place drainage bag below the level of the OR bed

24. Procedure For Females Clean patient prn Clean up supplies
Remove soiled gloves using proper technique
Reposition and cover patient prn
Wash your hands
Record or note abnormalities to circulator
Note color and clarity of urine

25. Summary
Catheterization
Purpose
Considerations
Male
Female