 Catheterization is accomplished by inserting a catheter

(a hollow tube, often with and inflatable balloon tip)

into the urinary bladder

 Aninvasive procedure that should only be carried out

by a qualified competent health care professional using
aseptic technique.
 Used for diagnostic purposes (to help determine the
etiology of various genitourinary conditions) For
investigations
 Therapeutically (to relieve urinary retention, instill
medication, or provide irrigation).
 To accurately measure the urine output
 Todrain the bladder prior to, during, or after
surgery(following surgical procedures to the urethra, in
unconscious patients (due to surgical anesthesia,
coma, or other reasons

 To relieve urinary incontinence when no other means

is practical
 To drain the bladder prior to, during, or
after surgery
 For investigations
 To relieve retention of urine
 To accurately measure the urine
output
 To relieve urinary incontinence when no
other means is practical
 The balloon holds the catheter in place for a duration
of time. Catheterization in males is slightly more
difficult and uncomfortable than in females because of
the longer urethra.
 Catheterization of the urinary tract should only be
done when there is a specific and adequate clinical
indication, as it carries a high risk of infection.
 Routine medical procedure that facilitates direct
drainage of the urinary bladder.
 Catheters
may be inserted as an in-and-out procedure
for immediate drainage.

 Left
in with a self-retaining device for short-term
drainage (as during surgery), or left indwelling for long-
term drainage in patients with chronic urinary
retention.
 Patients
of all ages may require urethral
catheterization, but those who are elderly or
chronically ill are more likely to require indwelling
catheters, which carry their own independent risks
The developed female urethra is a 4-cm tubular structure
that begins at the bladder neck and terminates at the
vaginal vestibule.
It is a richly vascular spongy cylinder and is designed to
provide continence.
 Toensure the insertion and care of the urinary
catheter is carried out in a manner that minimizes
trauma and infection risks.
1. Explained procedure to the child and the parents and
obtain consent.
2. The bed is screened to ensure privacy
3. Keep the child warm at all times
4. Ensure adequate light source
• Dressing trolley
• Catheterization pack and drapes
• Sterile gloves
• Appropriate size catheter (see catheter size guideline
below)
• Xylocaine jelly syringe (plain sterile lubricant for infants)
• Sterile water for balloon
• 10 ml Syringe
• Specimen jar
• Antiseptic solution.
• Tape to secure catheter to leg
• Drainage bag
• Urine bag holder
 Use the smallest bore that will allow good drainage
to minimize bladder and urethral trauma

 Consider silicone catheter if for long term use

Age Weight Foley

Neonate < 1200g 3.5Fr umbilical catheter

Neonate 1200-1500g 5Fr umbilical catheter

Neonate 1500-2500g 5Fr umbilical catheter or size 6 Foley

0-6 months 3.5-7kg 6

1Y 10kg 6-8

2Y 12kg 8

3Y 14kg 8-10
5Y 18kg 10

6Y 21kg 10

8Y 27kg 10-12

12Y Varies 12-14

 ASSESSMENT
 1. Assess the client and check the order.
 2. Determine if the procedure is to be straight or
indwelling catheterization.
 3. Assess need for collection of specimen.
 PLANNING
 4. Wash hands.
 5. Select specific type and size of catheter.
 6. Assemble all the equipment including
catheterization set, light source, bath blanket, sheet for
draping and extra equipment as individually
determined.
Procedure
1.Gather the equipments needed.
2. Identify the client and explain the
procedure.
3. Wash hands.
4. Assists the client to an appropriate
position and drape all areas except the
perineum.
a. Female-dorsal recumbent
b. Male- supine with legs slightly
abducted.
5. Established adequate lighting.
6.Open the catheterization set and arranges
the sterile field.
Rationale
 To promote efficiency in the procedure.
 To alley fear and anxiety of the patient
regarding his condition and the
procedure.
 For infection control.
 To relax muscles and allow visualization
of the area to facilitate the insertion of
the catheter.
Good lighting is necessary to see the
perineum clearly.
Placement of equipment in order of use
increases the speed of performance and
decrease the risk of contamination.
Procedure
7. Set up receptacle for soiled cleaning
swabs.
8. If drainage bag is in separate bag, open
and attach to the bed.
9.Put on sterile gloves.
10. For an Indwelling catheter, attach
syringe and test balloon by instilling
sterile water and deflating balloon by
withdrawing the water.
11. If drainage bag is in set, connect distal
end of catheter to drainage tubing.
Rationale
 To facilitates systematic action.
 To reduce the risks of infection by
keeping the bag off the flow because
the flow is grossly contaminated.
 To prevent contamination.
 To check for the balloon patency and
for a defect in catheter.
 To prevent urine spilling from a
collecting container while performing
the procedure.
Procedure
12. Clean urinary meatus with antiseptic
solution using downward stroke.
13. Lubricate the distal portion of the
catheter and place it on a nearby sterile
field.
14. Insert the catheter gently, in rotating
motion. Instruct the client to take a slow
deep breath upon insertion. For male
patient , hold the penis at 45 degree angle
until urine flows.
a. Length of catheter insertion
male: 6-9 inches
15. Inflate the retention balloon with sterile
water.
16.Tape the catheter to the thigh of a female  To prevent pull on the neck of the
patient and to the lower abdomen for a
male patient.
Rationale
 To remove dirt and minimize the risk of
urinary tract infection by removing
surface pathogens.
 To reduce friction and possible irritation
as catheter inserted.
 To relax the sphincter , in order to
facilitate the insertion of catheter.
 To straighten the urethra and facilitate
the insertion.
 To prevent the catheter from slipping out
of position.
bladder as the patient moves.
Procedure Rationale
17. Secure the drainage tubing and To allow the bladder to drain freely by
place drainage bag below the level of gravity.
the bladder.

18. Assist the client to a comfortable To provide comfort and safety.

position.

19. Gather and discard disposable To prevent contamination.

equipment.

20. Wash hands. To prevent the transmission of

microorganisms.

21. Document the procedure. Provides accurate data in the care of

the client.
◦ Rapid drainage of large volumes of urine from the
bladder may result in hypotension and/or
haemorrhage
 Clamp catheter if the volume seems excessive.
Release clamp after 20 minutes to allow more
urine to drain
◦ For post obstructive diuresis IV replacement of
electrolytes may be required
◦ Indication for catheterization
◦ Time and date of procedure
◦ Type of catheter.
◦ Size of catheter
◦ Expiry date of catheter
◦ Amount of water in balloon
◦ Any problems with insertion
◦ Description of urine, colour and volume
◦ Specimen collected
◦ Review date
1. Measure urine output hourly and
document
 Normal urine output is 0.5-1ml/kg/hr.
Report any variation from this
 If oliguric ensure catheter is not blocked
(see trouble shooting below)
2. No routine change of urinary catheter
or drainage bag is necessary. Change for
clinical indicators if infection,
obstruction or if system disconnects or
leaks. Replace system and/or catheter
using aseptic technique and sterile
equipment
3. Maintain unobstructed urine flow.
Gravity is important for drainage and
prevention of urine backflow. Ensure the
drainage bag is below the level of the
bladder, is not kinked and is secured
 4. Urine for urinalysis or culture should be
collected fresh from sampling port of
catheter tubing (not drainage bag). Clean
port with disinfectant first
5. Drainage system
 Adherence to a sterile continuously closed method of urinary
drainage has been shown to markedly reduce the risk of acquiring
a catheter associated infection
6.Hygiene
 Daily warm soapy water is sufficient meatal care
or PRN if build up of secretions is evident
 Uncircumcised boys should have the foreskin
gently eased down over the catheter after
cleaning
 Consider daily the need for the IDC to remain
insitu. Remove as soon as no longer required to
reduce risk of UTI
 Cloudy, offensive smelling or unexplained blood
stained urine is not normal and needs further
investigation
 Full Ward Test (dipstick) should be done each day.
This test can detect urinary protein, blood, nitrates
(produced by bacterial reduction of urinary nitrate)
and leucocyte esterase (an enzyme present in White
Blood Cells)
 Specimen collection
 § Large volumes e.g. 24hr collection, can be
collected from drainage bag
◦ Record fluid balance. A fluid balance which keeps
the urine dilute will lessen the risk of infection. This
may not be possible due to the clinical condition of
the child
◦ Catheter not draining/ patient oliguric
 Check catheter/tubing not kinked
 Check catheter is still secured to patient leg and hasn't migrated
out of bladder
 Checking patency by irrigating catheter with 2-3ml of sterile 0.9%
normal saline. Do not use force to instil fluid. This is an aseptic
procedure
◦ Catheter leaking
 Remove catheter. If indication for IDC remains follow insertion
procedure with new catheter
Purpose:
To discontinue the use of an indwelling catheter upon
physicians order.

To change the indwelling catheter.

Equipment:
Syringe without needle
Clean gloves
Protective pad
Bedpan/ urinal
◦ Inspect catheter for intactness. Report if not intact
◦ Dispose of catheter and drainage system in
appropriate waste
◦ Remove gloves & perform social hand wash
◦ Document catheter removal in patient notes
◦ Observe for urine output post catheter removal
◦ Inability to catheterize
◦ Urethral injury from trauma sustained during insertion or
balloon inflation in incorrect position
 Haemorrhage
 False passage
 Urethral strictures following damage to urethra. This may be a
long term problem
◦ Infection
◦ Psychological trauma
◦ Paraphimosis due to failure to return foreskin to normal
position following catheter insertion
 Definition
It is the aspiration of secretion through the use of bulb syringe.

 Purpose
To clear air passages of infant.
To maintain patent airway.

 Equipment
Sterile bulb syringe
Clean diaper or towel
Small Container
Clean gloves
 PROCEDURE
1.) Assess the rate and depth of the infant’s
respiration as well as the breathing sounds and chest
movement. Note also the pulse rate and the skin
color. Check the mouth and nose for the presence of
secretions.
2.) Wash hands
3.) Assemble the equipment.
RATIONALE
o Provides assessment data; determines
the need of suctioning. Usually doctor’s
order is not needed.
o To limit the transfer of microorganisms.
o To promote efficiency.

4.) Identify the client. Explain the
procedure to the mother or the family.
5.) Put on clean gloves.
6.) Position the infant. Wrap the infant
with a small sheet if necessary. The
infant’s head should be flat on the surface
of the crib. A newborn can be held in a
“football” fashion, with the held slightly
downward.
7.) Compress the bulb before inserting the o Any compression with the syringe tip in
syringe tip into the infant’s mouth.
o To gain cooperation of each member of
the family.
o To protect against secretions.
o Gravity will help move secretions from
the back of the throat to the mouth,
where they can be suctioned more
readily.
the mouth may force secretions deeper
into the respiratory tract.
 PROCEDURE
8.) Insert the syringe tip into the mouth
and release the bulb.
9.) Remove the syringe and compress the
bulb, expressing the contents into the
basin.
10.) Repeat steps 7 to 9 until the infant’s
checks and mouth are clear.
11.) Carefully suction the nostril, placing
the syringe tip just at each opening.
12.) Remove gloves and discard them
appropriately.
13.) Place the infant on the side after
suctioning.
14.) Wash your hands.
15.) Record the procedure.
RATIONALE
o To aspirate or suck secretions from the
mouth.
o Clear bulb from secretions
o To ensure thorough draining of secretions.
o To prevent irritation on the nausea
passages.
o To prevent contact with the secretions.
o To drain remaining secretions.
o To limit the transfer of microorganisms.
o To provide accurate data in the care of
client.