Steps

Rationale/Points of Emphasis

1 Perform hand hygiene and gather the necessary supplies.

Reduces the transmission of microorganisms. Promotes efficient time management and provides an organized approach to the procedure.

2 Close the door to the child’s room or draw the curtains around the child’s bed.

Provides privacy during the procedure.

3 Raise the bed to a comfortable working height or stand on a step stool at crib side.

Reduces the strain placed on your back.

4 Don nonsterile gloves.

Standard precaution to reduce the transmission of microorganisms.

5 Place a waterproof pad under the child’s/infant’s buttocks while positioning the child/infant. Females should be placed in the supine position with their legs spread apart. Males should be placed in the supine position with their legs straight.

Allows for ease of access. This position facilitates visualization of the inner labia or the urethral opening.

6 Place a drape over the child/infant. For a female, place the drape in a diamond configuration with one corner at the child’s sternum, one corner over each knee, and one corner over the perineum. For a male, cover the child’s chest and lower extremities with a sheet, leaving only the genital area exposed. A flashlight or examination light may be helpful in locating the urethral opening.

Allows exposure of the child’s perineum while covering the rest of the body, allowing for privacy.

7 Wash the child’s genital area with warm water and soap. Cleanse around the urinary meatus and around the catheter itself, being careful not to manipulate the catheter back and forth. Gently retract the foreskin of the uncircumcised boy and cleanse the area. Return the foreskin to its normal position.

Removes secretions, smegma, and fecal matter. Movement of the catheter can introduce organisms into the urinary tract. Failure to return the foreskin can lead to swelling of the penis and impair circulation. Use of antiseptics to clean around the periurethral area to prevent catheter-related infections is not recommended.

8 Observe for any signs of irritation, trauma, secretions, or incrustations on the catheter. Assess for any foul smells emanating from the urethra.

These signs can indicate a urinary tract infection.

9 Rinse and dry the child’s perineum.

Reduces creating a conductive environment for microorganism growth.

10 Assess the drainage tubing for urine flow. Observe that there are no kinks or obstructions in the tubing or occlusions in bag valve and make sure that all connections are tightly secured. If you tug on the catheter gently and its does not appear to be secure in the bladder, ensure the inflation balloon is fully inflated. Use sterile syringe filled with sterile water to assess balloon inflation.

Provides for a closed-system collection of urine output, with free flow of urine, and prevents microorganism introduction into the catheter. Drainage bags should not be allowed to overfill and need to be emptied frequently enough to maintain urine flow and therefore prevent reflux.

Routine irrigation of the bladder (with or without antimicrobials) is not recommended.

Routine instillations of antiseptic or antimicrobial agents into the urinary drainage bag is not recommended.

11 Ensure the collection or drainage bag is attached to the frame of the bed or crib below the level of the bladder and that it is not touching the floor.

Positioning the bag below the level of the bladder prevents reflux of urine through the tubing and back into the bladder.

12 Ensure that the catheter is taped to the thigh of the older child. For small male infants not using a balloon catheter, tape the catheter to the lower abdomen or upper perineum, allowing the penis to point upward toward the umbilicus. For small female infants not using a balloon catheter, tape the catheter at its closest point outside on the left or right labia.

Taping is done to prevent any tension from being placed on the catheter from inside the bladder and to avoid dislodgment from accidental pulling or tugging. Movement of the catheter in and out can lead to contamination from microorganisms.

caREminder

Ensure that there are no pressure points or areas of skin breakdown before taping to the thigh, leg, abdomen, or perineum.

13 Remove the waterproof underpad and re-cover the child as appropriate.

Maintains dry linens for the child and promotes sense of well-being.

14 Return the child’s bed to the lowest position or to a level that is age appropriate; raise the bed rails. Place the child in a position of comfort.

Reduces potential injury from falls.

15 Dispose of used equipment and waste in appropriate waste containers.

Standard precautions.

16 Remove gloves and perform hand hygiene.

Reduces transmission of microorganisms.