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Sterile Intermittent Straight Catheterization for Bladder Decompression (3.15AP)

Sterile Intermittent Straight Catheterization for Bladder Decompression (3.15AP) - Policies, Clinical, UWHC Clinical, Department Specific, Nursing Patient Care, Genitourinary

3.15AP

NURSING PATIENT CARE POLICY & PROCEDURE







Effective Date:
June 30, 2017
Administrative Manual
Nursing Manual (Red)
Other _
Policy #: 3.15AP
Original

Revision
Page
1
of 6
Title: Sterile Intermittent Urinary Straight
Catheterization for Bladders (Adult &
Pediatric)

I. PURPOSE

Provide guidance for use of sterile intermittent urinary catheterization for bladders.

II. POLICY

A. Sterile intermittent catheterization can be performed by:
1. Registered Nurse (RN)
2. Trained Caregivers
3. Surgical technician (only when necessary during a sterile OR procedure)
4. Medical assistant (ambulatory setting)
B. Straight catheterization can be performed according to provider order or if the
patient has the bladder management protocol ordered and meets all criteria.
1. Refer to Protocol 26, Bladder Management-Inpatient-Adult or the Bladder
Management Medical and Surgical Pediatric Inpatient Practice Protocol on
U-Connect.
C. Use of a new sterile catheter with each insertion while inpatient.

III. EQUIPMENT

A. Kits
1. Touchless system (Central Service [CS] Item Number 4002348)
2. Open System (CS Item Number 1203409) Selection of appropriate size
catheter for patient
3. For pediatrics, an appropriate size pediatric red rubber catheter, or
touchless catheter system (Bard Female Cath Kit CS # 2226004). See
Appendix A.
4. Alternative approved equipment for location if no kit available
B. Non-sterile gloves
C. Sterile gloves
D. Sheet to provide privacy
E. Blue pad/linen saver
F. Organization approved cleansing product (see Skin Care and Cleansing Product
Descriptions on the Wound, Skin, Ostomy, and Continence Care website on
UConnect)
G. Sterile water or sterile saline (ONLY if patient allergic to antiseptic cleanser in
urinary catheter kit)
H. Anesthetic lubricant, if needed (requires a provider order)
I. New Urinal
J. Bladder scanner


Page 2 of 6

IV. PROCEDURE

A. Perform hand hygiene according to UW Health Clinical Policy 4.1.13, Hand
Hygiene.
B. Explain procedure to patient/or caregiver as appropriate emphasizing the need to
maintain a sterile field.
C. Verify patient allergies.
D. Provide privacy.
E. Bladder scan patient
F. Raise bed/exam table to a comfortable working height. Lower side rails, if
present. Assist females into a dorsal recumbent or side lying position.
G. Place disposable blue pad/linen saver under patient’s buttocks.
H. Drape patient so only perineum is exposed.
I. Provide light to allow better visualization.
J. Don non-sterile gloves.
K. Cleanse perineal area with hospital approved cleansing product:
1. For female patients, open labia and cleanse entrance to urinary meatus
with approved cleanser and washcloth wiping from front to back on each
side with a downward stroke, using a new washcloth with each stroke. In
side lying position, pull upward on upper labia minora.
2. For male patients, cleanse suprapubic and pubic area with approved
cleanser and washcloth. Grasp the shaft of the penis firmly. Cleanse
urinary meatus and glans with approved cleanser and washcloth beginning
at the urethral opening. Retract foreskin on uncircumcised male patients.
Cleanse in a circular motion moving from the meatus outward towards the
shaft of the penis. For uncircumcised male patients, push foreskin back
into place after cleansing.
L. Remove gloves and perform hand hygiene, according to UW Health Clinical
Policy 4.1.13, Hand Hygiene.
M. Set up sterile field:
1. If using an open system:
a. Remove catheter kit from outer plastic package.
b. Place catheter kit between patient’s knees (preferred). If using side
lying position, place kit about one (1) foot from perineal area near
thighs.
c. Carefully open outer edges, opening the first flap away from
inserter.
d. Don non-sterile gloves.
e. Remove full drape from kit with fingertips and place plastic side
down just under buttocks by having the patient lift their hips. Keep
other side sterile as this will be the sterile work field.
f. Perform hand hygiene, according to UW Health Clinical Policy
4.1.13, Hand Hygiene.
g. Don sterile gloves.
h. Pour antiseptic solution over applicators (i.e., cotton balls/swabs)
i. Remove fenestrated drape from the kit and place on patient to
expose either the labia or the penis

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j. Lubricate catheter tip with gel (3 to 4 inches for adult females; 7 to 8
inches for adult males, pediatric: lubricate appropriate for age of
patient)
2. If using touchless system:
a. Perform hand hygiene, according to UW Health Clinical Policy
4.1.13, Hand Hygiene.
b. Open package and carefully remove drape and place under
patient’s buttocks
c. Don sterile gloves
d. Open applicators.
N. Cleanse meatus with applicators.
1. For female patients:
a. Separate labia minora with non-dominant hand.
b. With the dominant hand, cleanse meatus with the appropriate
applicators.
i. For patients with sensitivity or allergy to the antiseptic
solution provided in the urinary catheter kit, sterile saline or
sterile water can be applied to applicator for meatal
cleansing.
c. Wipe downward once with each applicator and discard.
d. Begin at labium on side farther from you and move towards labium
closer to you.
e. Wipe once down the center of the meatus.
2. For male patients:
a. Pull penis up to a 90-degree angle to the patient’s body.
b. With the non-dominant hand, gently grasp the glans (tip) of the
penis and retract foreskin, if necessary.
c. With the dominant hand, cleanse the meatus and glans with
antiseptic solution, beginning at urethral opening and moving
toward the shaft of the penis. Make one complete circle around the
penis with each applicator, discarding after each wipe.
i. For patients with sensitivity or allergy to the antiseptic
solution provided in the urinary catheter kit, sterile saline or
sterile water can be applied to applicator for meatal
cleansing.
O. Using the sterile hand, pick up the catheter about 1.5 to 2 inches from the tip
with the thumb and first finger.
P. Ask patient to bear down and take slow, deep breaths. Encourage slow
deep breathing until catheter is placed.
Q. Insert tip of catheter slowly through the urethral opening until you see urine
flow. Allow remaining urine to drain until it stops. Use a second container,
bedpan or urinal if necessary.
R. If accidental dislodgement or contamination occurs, start procedure over
from beginning with new equipment.
S. If resistance is met, verify position. DO NOT FORCE the catheter. If unable
to advance catheter, remove catheter and notify provider.
T. Remove catheter

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1. For patients with radioactive prostatic seed implants, catheter removal
and disposal of urine is performed according to UW Health Clinical
Policy 2.3.8, Radioactive Prostatic Seed Implant
U. For uncircumcised males, replace foreskin.
V. Clear bed of all equipment and supplies.
W. Position patient for comfort. Replace linens for privacy.
X. Raise side rails. Put bed in lowest position.
Y. Remove and discard gloves.
Z. Perform hand hygiene, according to UW Health Clinical Policy 4.1.13, Hand
Hygiene. Patients with neurogenic bladders may require use of Credés maneuver.
Begin the Credé maneuver when urine flow stops after catheter insertion. Palpate
for the fundus of the bladder. Place a fist at the fundus and apply pressure down
toward the symphysis pubis. Release pressure, palpate again and repeat until all
urine is expelled.

V. TEACHING FOR PATIENTS REQUIRING INTERMITTENT
CATHERIZATION AT HOME

A. The patient and/or caregiver will receive education on sterile intermittent
catheterization procedure by the RN and will demonstrate competency performing
the procedure prior to discharge, if the patient will be on an intermittent
catheterization program at home. It is acceptable for patients and caregivers to
perform intermittent catheterization at home as a clean procedure but will
demonstrate sterile technique for hospitalization.
1. If the patient requires assistance with intermittent catheterization, the
patient and caregiver(s) may be taught the program. This should be initiated
early in the program with the goal of having the patient and/or caregiver
having a thorough understanding of the intermittent catheterization
program and being competent to perform sterile and clean intermittent
catheterization prior to discharge.
2. Patient teaching is initiated at onset of the sterile intermittent
catheterization program. The RN will review and provide the appropriate
copy of Health Facts for You (HFFY) 4358, Catheterization-Clean
Intermittent-Males (Spanish version is 5515) or HFFY 4355,
Catheterization-Clean Intermittent-Females (Spanish version is 5516).
3. Only sterile intermittent catheterization should be performed while the
patient is an inpatient.
4. The RN provides education on the following: complications of urinary
retention, potential for urinary tract infections, other potential effects on the
genitourinary tract system, complications of urinary incontinence and the
potential for skin breakdown, and intermittent catheterization procedure
using sterile technique.
5. The RN assesses the patient's knowledge and provides the necessary
education on anatomy, function of the normal urinary tract and the
pathophysiology of disease, illness or trauma and its impact on the urinary
system.

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6. The RN evaluates the patient/caregiver’s understanding of educational
materials, evaluates the patient/family’s knowledge about and ability to
perform intermittent catheterization procedure using sterile and clean
technique.

VI. DOCUMENTATION

A. Document the following in the patient’s clinical record:
1. Date and time of catheterization
2. Bladder scan results
3. Reason for catheterization, amount, color, consistency and/or odor of urine
4. Difficulties encountered during insertion of urinary catheter
5. Urine specimen collection (U/A), urine culture, etc.)
6. Any teaching done and patient and/or caregiver understanding of the
procedure for patients who will need to self catheterize upon discharge.

VII. UWHC CROSS REFERENCES

A. CAUTI Toolbox on U-Connect
B. Nursing Patient Care Policy 3.31AP, Insertion, Removal, and Maintenance of
an Indwelling Urinary Catheter (IUC) (Adult & Pediatric)
C. Nursing Patient Care Policy 13.12A, Basic Care Standards (Inpatient Adult)
D. Nursing Patient Care Policy 13.16P, Basic Care – Inpatient Pediatrics (Birth –
18 years of age) (Pediatric)
E. UW Health Clinical Policy 2.3.8, Radioactive Prostatic Seed Implants
F. UW Health Clinical Policy 2.5.2, Collecting a Urine Specimen
G. UW Health Clinica Policy 4.1.13 Hand Hygiene
H. Nursing Practice Guideline At A Glance: Prevention of Catheter-
Associated Urinary Tract Infection (CAUTI)
I. Protocol 25, Indwelling Urinary Catheter Removal - Adult - Inpatient
J. Protocol 26, Bladder Management – Medical/Surgical-Inpatient-Adult
K. Protocol 8, Bladder Management- Pediatric- Inpatient

VIII. REFERENCES

A. Center for Disease Control and Prevention (2009). Guideline for Prevention of
Catheter-Associated Urinary Tract Infections. Retrieved from
http://www.cdc.gov/hicpac/pdf/CAUTI/CAUTIguideline2009final.pdf
B. Dolan, V. J., & Cornish, N. E. (2013). Urine specimen collection: How a
multidisciplinary team improved patient outcomes using best practices.
Urologic Nursing, 33(5), 249-256.
C. Newman, D. K., & Willson, M. M. (2011). Review of intermittent catheterization
and current best practices. Urologic Nursing, 31(1).
D. Smith-Temple, J., & Young-Johnson, J. (2009). Nurses’ guide to
clinical procedures (6th Ed.). Philadelphia, PA: Lippincott Williams &
Wilkins.


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IX. REVIEWED BY

Clinical Nurse Specialist, Nursing Quality and Safety
Clinical Nurse Specialist, Transplant Surgery
Clinical Nurse Specialist, Geriatrics
Clinical Nurse Specialist, Universal Care Unit & Float Team
UW Health Ambulatory Nursing Program Specialist
UW Home Health
CAUTI Workgroup
Nursing Patient Care Policy and Procedure Committee, June 30, 2017

SIGNED BY
Beth Houlahan, DNP, RN, CENP
Senior Vice President, Chief Nurse Executive