21.14 Checklist for Straight Catheterization – Female/Male (with Urine Specimen Collection)
Please follow the checklist below to review the steps for completion of “Straight Catheterization for Female/Male.”
Steps
Disclaimer: Always review and follow agency policy regarding this specific skill.
- Gather supplies: peri-care supplies, nonsterile gloves, straight catheter kit, extra pair of sterile gloves, and preprinted patient label.
- Perform safety steps:
- Perform hand hygiene.
- Check the room for transmission-based precautions.
- Introduce yourself, your role, the purpose of your visit, and an estimate of the time it will take.
- Confirm patient ID using two patient identifiers (e.g., name and date of birth).
- Explain the process to the patient.
- Be organized and systematic.
- Use appropriate listening and questioning skills.
- Listen and attend to patient cues.
- Ensure the patient’s privacy and dignity.
- Assess ABCs.
- Assess for latex/iodine allergies, joint limitations for positioning, and history of previous difficulties with catheterization:
- Female: Ask about previous gynecological surgeries.
- Male: Ask about previous diagnosis of enlarged prostate.
- Place the hand sanitizer and other supplies for use during/after procedure on the table near the bed.
- Place the catheter kit and peri-care supplies on the over-the-bed table.
- Ensure adequate lighting. Enlist assistance for positioning if needed.
- Raise the opposite side rail. Set the bed to a comfortable height.
- Position the patient supine and uncover the patient, exposing the patient’s groin, legs, and feet for positioning and sterile field (male = supine, legs extended; female = dorsal recumbent; may need assistance to position patient and help support legs).
- Wash your hands, apply clean gloves, and clean the perineal area.
- Remove your gloves and perform hand hygiene.
- Open the package. Take out the sterile package and place it on the table. Place the plastic package wrapping at end of the bed or on the side of the bed near you.
- Open the kit extending the outer wrapping to create a sterile field; position the sterile field on the table to create space for opening gloves at the end of the table.
- Place the sterile pad/sheet under the patient without contaminating the center of the drape by only holding onto the edges of the drape.
- Perform hand hygiene and apply sterile gloves.
- (Optional use of fenestrated drape). Place the fenestrated drape over the patient’s perineal area, keeping your gloves sterile by folding the corners of the sterile drape over the sterile gloves before approaching the patient.
- If a urine specimen is ordered, remove the sterile specimen container and remove the lid, if attached. Set the container on the sterile drape and invert the lid to maintain sterility. Position the container on the sterile drape to be within reach during the procedure.
- Place the plastic tray with cotton balls and forceps on the sterile drape. Simulate opening the iodine solution and simulate pouring on the cotton balls; set the iodine package on the drape. Iodine cannot be used on mannequins.
- Locate the catheter in the bottom of the tray; leave it in the tray. Open the water-soluble sterile lubricant and empty it into the bottom of the tray.
- Put the plastic tray with saturated cotton balls horizontally on top of the tray to fit above the catheter and lubricant, which are located in the bottom of the tray.
- Make sure that the sterile specimen container is within reach of your dominant hand. Then, carefully move the tray as a unit with supplies inside to the sterile drape between the patient’s legs.
- Tell the patient that you are now going to start the cleaning process and that there will be a cold sensation:
- Once the nondominant/nonsterile hand touches the patient, the position is held throughout the procedure until the catheter is inserted.
- Inspect for the urinary meatus:
- Female: Gently spread the labia minora with your thumb and index finger of your nondominant hand and visualize the urinary meatus.
- Male: Gently grasp the penis with the nondominant hand and retract the foreskin if present.
- Cleanse the urinary meatus:
- Female: With your dominant hand, use an antiseptic swab or pick up a sterile antiseptic soaked cotton ball with plastic forceps to clean the labia minora farthest from you using a downward stroke, then discard the swab or cotton ball. Repeat for the labia minora closest to you. Use another antiseptic swab or antiseptic soaked cotton ball to clean the area between the labia minora. With the dominant sterile gloved hand, pick up the lubricated catheter about 4 inches from the end for stability. Place the distal end in the receptacle.
- Male: With your sterile dominant hand, use the forceps to pick up a cotton ball. Cleanse the glans penis with the antimicrobial cleanser using a circular motion from the center of the meatus outward to the base of the glans. Discard each cotton ball after use without crossing the sterile field. Continue to hold the penis perpendicular to the body with your nondominant hand. With the dominant sterile gloved hand, pick up the lubricated catheter about 4 inches from the end for stability. Place the distal end in the receptacle.
- Steadily insert the catheter, maintaining sterility into the meatus until a return of urine occurs.
- Continue inserting another 1-2 inches and hold the catheter in place.
- When urine begins to drain out of the catheter, pinch the catheter with your thumb and index finger of your nondominant/nonsterile hand while continuing to hold the labia apart or penis perpendicular to the body.
- With your dominant/sterile hand, obtain the sterile specimen container from the table and put it under the catheter.
- Release clamping/pinching of the catheter, allowing urine to drain into the sterile specimen container.
- When the container is almost full, use your dominant hand to remove the container from under the stream of urine and set it on the table, maintaining sterility.
- Allow urine to continue to flow into the receptacle provided until the flow of urine stops.
- Tell the patient that the catheter will be removed. Instruct the patient to take a deep breath and exhale, and then remove the catheter and place it on the sterile drape on the bed.
- Carefully remove the urine container full of urine from the bed and place it on the kit wrapper on the table. Do not put the urine container directly on the table.
- Put the cap on the sterile specimen container, maintaining sterility.
- Remove the catheter and other supplies from the patient’s bed; provide peri-care. For males, replace foreskin if it was retracted for the procedure.
- Remove your gloves; wash hands and apply new gloves.
- Write the date, time collected, and your initials on the two preprinted patient labels.
- With an antibacterial wipe, clean the outer surface of the specimen container.
- Apply one patient label to the specimen container and one patient label to the outside of the clear biohazard bag for transport to the lab.
- Place the specimen container in the biohazard bag.
- Measure and dispose of the urine in the bathroom.
- Remove your gloves and perform hand hygiene.
- Assist the patient to a comfortable position, ask if they have any questions, and thank them for their time.
- Ensure safety measures when leaving the room:
- CALL LIGHT: Within reach
- BED: Low and locked (in lowest position and brakes on)
- SIDE RAILS: Secured
- TABLE: Within reach
- ROOM: Risk-free for falls (scan room and clear any obstacles)
- Send the specimen to the lab for processing.
- Document the procedure and related assessment findings. Report any concerns according to agency policy.