Urinary Catheterization Procedural Guide

The nursing staff in the Internal Patients Unit strives to elevate the nursing profession and provide effective, safe, and quality nursing care to the unit’s patients according to Egyptian, national, and international standards.

Nursing Care Mission in the Internal Patients Unit

The nursing staff in the Internal Patients Unit is committed to improving the health status of patients and providing them with the best nursing care in alignment with the hospital's goals and procedures, as well as the nursing management. It also works on enhancing the scientific and practical level of all nursing staff in the unit and directs their focus toward modern approaches in nursing and medical sciences.

Indications for Urinary Catheterization:

Therapeutic Indications:

1. Urine drainage during labor, especially if the patient has received an epidural.
2. Urine drainage before, during, and after certain surgical procedures.
3. Delivery of specific medications directly into the bladder, such as chemotherapy for bladder cancer.
4. Urine drainage in cases of urethral obstruction, such as in males due to prostate enlargement.
5. Assisting patients with weakened bladder muscles or nerves that hinder their ability to urinate.
6. Birth defects in the urinary system.
7. Gallstones, bladder stones, or kidney stones.
8. Tumors in the urinary system.
9. Use in chronic urinary incontinence patients who have not responded to other treatments.

Diagnostic Indications:

1. Monitoring and calculating urine output.
2. Collecting a urine sample for laboratory analysis.

Steps for Inserting the Urinary Catheter:

1. Ensure patient privacy.
2. Explain the procedure to the patient and the medical reasons for catheter insertion.
3. Gather all necessary tools for catheterization.
4. Wash hands thoroughly.
5. Wear sterile gloves and use aseptic technique.
6. Attach the urine collection bag to the catheter, ensuring it is closed and suspended.
7. Apply 3 ml of gel or any other lubricant to reduce friction.
8. Introduce the sterile catheter into the urinary tract.
9. Inflate the catheter balloon with the recommended sterile water.

After the Catheterization:

• Secure the catheter to the patient's thigh using medical adhesive.
• Place the urine collection bag below the level of the patient's bed and ensure it is on a stand to prevent backflow.
• Provide the patient with a special urinal to empty the collection bag.
• Dispose of waste in the designated red bag.
• Wash hands after removing gloves and dry thoroughly.
• Record the type of catheter, the time of insertion, and the physician who performed the procedure in the nursing notes.
• Observe and document the amount of urine and any abnormal changes such as blood or pus, and inform the doctor.

Infection Control Precautions for Urinary Catheterization:

• Hand hygiene: Wash hands with antiseptics such as povidone-iodine (7.5%) for at least 2 minutes or wash with soap and water, followed by rubbing hands with alcohol-based solution.
• Personal protective equipment: Use sterile gloves and a disposable plastic apron.
• Sterilized instruments and equipment: All tools must be sterilized.
• Cleaning the catheter insertion site: Clean the pubic area with water and soap or a foaming antiseptic (such as Betadine foam 7.5%) and dry it well, using a clean glove and a disposable plastic apron.
• Disinfect the insertion site using an appropriate antiseptic.
• Cover the insertion site with a sterile drape.

Steps for Collecting a Urine Sample: A sample is collected from the designated port on the catheter. If no such port exists, follow these steps:

1. Perform routine hand hygiene and wear clean gloves.
2. Disinfect the catheter collection port with alcohol solution.
3. Use a new sterile syringe to collect the sample.
4. Ensure the syringe is inserted at a higher point in the catheter where the urine exits.

Emptying the Urine Collection Bag:

• Empty the urine from the designated opening at the bottom of the collection bag into a designated container for single patient use.
• Reprocess and sterilize the container before reuse.

Types of Urinary Catheters: The two most common types of urinary catheters are:

1. Foley catheter
2. Silicone catheter

Sometimes, the duration for which a urinary catheter remains in place depends on the manufacturer's instructions.

Sizes of the Urinary Catheter: Catheters are measured in French (Fr) and millimeters (mm).

• For children: 6, 8, or 10 French
• For males: 16–18 French
• For females: 12–14 French
• For clot retention: 20–22 French

 Important Notes:

1. A sterile lubricating gel (preferably single-use) is used during catheter insertion.
2. After cleaning the insertion area, it is prohibited to touch the catheter or insertion site unless wearing sterile gloves.
3. It is prohibited to disconnect the urine collection bag from the catheter for any reason (such as emptying or obtaining a urine sample).
4. The collection bag should not be placed above the patient's level or in contact with the floor.
5. The use of prophylactic antibiotics (either topical or systemic) to prevent catheter-associated urinary tract infections (CAUTI) is not recommended.

Preventive Measures to Prevent Catheter-Associated Urinary Tract Infections (CAUTI):

1. Urinary catheter insertion should only be performed for a medical necessity.
2. The procedure should be performed by a trained healthcare provider following the hospital's catheter insertion protocol.
3. The closed urinary system should be maintained.
4. Infection prevention techniques must be followed during catheter insertion:
• Hand hygiene.
• Use of sterile gloves.
• Cleaning and disinfecting the pubic area.
• Using a sterile drape for the pubic area.
• Using sterile lubricant (preferably single-use).

Post-Procedure Preventive Measures for Urinary Catheter Care:

1. Evaluate the necessity of keeping the catheter in place daily.
2. Empty the urine collection bag when it is 2/3 full and use a clean container for each patient.
3. Secure the catheter properly to the patient's thigh.
4. Collect urine samples only from the designated port.
5. Practice hand hygiene and use personal protective equipment before and after catheter care.

Daily Care for Urinary Catheters:

1. Secure the catheter firmly.
2. Ensure there is no obstruction in the flow of urine through the catheter.
3. Avoid placing the urine collection bag higher than the patient's level or in contact with the floor.
4. Use a dedicated container for each patient to empty the collection bag.
5. Review and evaluate daily whether the catheter can be removed once it is no longer needed.
6. Keep the urinary collection system closed at all times.

Important Precautions:

• Ensure the urine collection bag is emptied completely to prevent microbial growth in the remaining urine.
• Bladder irrigation with antiseptics is not recommended.
• Prophylactic antibiotic use is not recommended when inserting the catheter.
• Routine cleaning of the urethral opening after catheter insertion is not necessary for preventing catheter-associated urinary tract infections.
• Always keep the urinary collection system closed (maintain a closed system).