Skill 78

Urinary Catheter Insertion

Urinary catheterization is the placement of a tube through the urethra into the bladder to drain urine. This is an invasive procedure that requires a medical order and aseptic technique in institutional settings (Gould et al., 2009; Lo et al., 2008). Urinary catheterization may be short term (2 weeks or less) or long term (more than 1 month) (Parker et al., 2009). The steps for inserting an indwelling and a single-use straight/intermittent catheter are the same. The difference lies in the inflation of a balloon to keep the indwelling catheter in place and the presence of a closed drainage system.

For patients with urinary retention or critical illness and who require long-term catheterization, catheter changes should be individualized, not routine (Gould et al., 2009; Green et al., 2008; Willson et al., 2009). They should be changed for leaking, for blockage, and before obtaining a sterile specimen for urine culture (Smith et al., 2008). Long-term catheterization should be avoided because of its association with urinary tract infection (UTI) (Green et al., 2008). Make every attempt to remove catheters as soon as a patient can void.

An indwelling catheter is attached to a urinary drainage bag to collect the continuous flow of urine. Always hang the bag below the level of the bladder on the bed frame or a chair so that urine drains down, out of the bladder. The bag should never touch the floor.

Delegation Considerations

The skill of inserting a straight or indwelling urinary catheter cannot be delegated to nursing assistive personnel (NAP). The nurse directs the NAP to:

▪ Help with patient positioning, focus lighting for the procedure, maintain privacy, empty urine from collection bag, and help with perineal care.

▪ Report postprocedure patient discomfort or fever to the nurse.

▪ Report abnormal color, odor, or amount of urine in drainage bag and if the catheter is leaking or causes pain.