Step-by-Step Master’s Guide to Urinary Catheterization

Learn the procedures, risks, and requirements of catheterization.

While patients may not be fond of having a catheter placed into their bladder, it’s a necessary procedure for emptying the bladder.

For a nurse, becoming proficient with urinary catheterization is an essential skill that goes beyond keeping patients comfortable. Testing urine taken through catheterization can be vital to gauging kidney function and diagnosing other problems. Catheterization also can bypass blockages in the bladder outlet, which keeps urinary pressure from building.

Catheterization is a standard procedure but is only performed when a specific clinical need exists.

This article provides everything you’ll need to know about catheterization, a fundamental nursing skill. (Read more about what a nurse does.)

Let’s get into the details of urinary catheterization.

What is Urinary Catheterization?

Not to be confused with cardiac catheterization, urinary catheterization involves the insertion of a catheter into the patient’s bladder through their urethra. The purpose is to drain and collect urine from the bladder.

What is a Catheter?

Catheters are hollow, partially flexible tubes. They come in many sizes and types. They may be rubber, plastic (PVC), or silicone.

There are three types of catheters:

1. Indwelling catheters: These catheters sit in the bladder. A registered nurse inserts the indwelling catheter into the bladder through the urethra. In some cases, the catheter is inserted into the bladder through a small hole in the abdomen. Once in place, a tiny balloon at the end of the catheter is inflated with water to prevent the tube from sliding out of the body.
2. External catheters: This is also known as a condom catheter. It goes outside the body. External catheters are typically used with men who don’t have urinary retention problems but have functional or mental disabilities.
3. Short-term catheters: Short-term catheters empty the bladder for a limited period, such as immediately before or after surgery.

Why is Catheterization Done?

The purpose of catheterization is to remove urine directly from the patient’s bladder, bypassing the normal exit through the urethra. These are the common reasons catheterization may be necessary:

• To empty a patient’s bladder before, during, or after surgery
• To relieve urinary retention to alleviate pressure in the kidneys
• To measure the residual amount of urine in the patient’s bladder
• To gain a sterile urine sample from a female patient
• To address problems with urinary incontinence

Less common reasons for catheterization could involve:

• Medical conditions such as multiple sclerosis
• Spinal cord injury
• Erratic bladder drainage
• Continuous bladder drainage
• To slowly drain a distended bladder

How Long Does It Take to Perform a Catheterization?

Urinary catheterization is a standard procedure for nurses. Inserting the catheter typically only takes a few minutes. How long the catheter stays in varies with the patient and the reasons for catheterization. Removing the catheter takes just a minute or so.

Who Performs Catheterization?

Catheterization is typically the nurse’s job. However, there isn’t any restriction on who performs the task as doctors and other professional caregivers also perform catheterization.

Still, this is a fundamental procedure for any nurse.

What Are the Training Requirements to Perform Catheterization?

Catheterization is a fundamental skill for all nurses. Training in inserting, removing, and caring for catheters is a part of all programs necessary for becoming a licensed registered nurse or licensed practical nurse.

At Brookline, we offer three excellent nursing programs depending on your goals: a Practical Nursing program, a Bachelor of Science in Nursing program, and an Accelerated Bachelor of Science in Nursing Program Track

The NCLEX (National Council Licensure Examination) also covers catheterization on the nursing licensure exam,

What Equipment is Necessary for Catheterization?

There are three main types of catheters: indwelling, condom, and intermittent self-catheters.

• Indwelling catheters are inserted and remain in the bladder. An indwelling catheter (also known as a Foley catheter) may be used for either short- or long-term use. The tubing is attached to a balloon at the tip inflated with sterile water.
• Condom catheters are not inserted into the urethra, functioning like a condom attached to a urine collection bag strapped to the upper thigh.
• Intermittent catheters, also known as Robinson catheters, don’t have a balloon on the tip and cannot stay in place without assistance. Intermittent catheters are removed after each use.

The size of the catheter used depends on the patient’s needs. Catheter diameters are listed on the French catheter scale. The most common sizes are 3.3mm to 9.3mm. The nurse selects a size large enough to allow the free flow of urine and control leakage around the catheter. Larger diameters can damage the urethra. But they may be necessary if the urine is thick, bloody, or contains large amounts of sediment.

How is Catheterization Done?

A Step-by-Step Guide

With urinary catheterization, the primary goal is to place the catheter into the urethra and to advance it into the bladder where it will, in effect, override the natural process of urination and drain the bladder. This is an essential skill for every nurse. It can seem daunting, but practice will make you more comfortable and adept at the process.

Catheterization Steps

Here are the general steps a nurse (or other providers) would use for catheterization:

1. Wash and sterilize your hands and put on sterile gloves.
2. For a female patient, use low-linting swabs and separate the labia to expose the urethral opening. Next, use sterile sodium chloride solution and clean the area in downward movements towards the anus. Each stroke should be a single downward movement. This helps prevent contamination from the anus.
3. Take the lubricating/anesthetic gel and insert the nozzle into the urethra. Squeeze the anesthetic gel into the urethra. It will numb the urethra in about five minutes. Wipe away any excess. Dispose of the gloves used, wash and dry your hands again, and put on new sterile gloves.
4. You’ll first want to test the balloon. Using the pre-filled syringe inflate the balloon. Once it functions properly, deflate the balloon by aspirating the fluid back into the syringe.
5. Now you’re ready to insert the catheter. For a female, introduce the tip into the urethral opening at a slightly upward and backward angle. The patient should not feel pain. Advance the catheter 5 to 6cm. If the patient is in any pain, stop and restart the process.
6. Once urine starts to drain through the catheter, insert it a little farther to ensure the balloon end is not still in the urethra, as inflation within the urethra is painful.
7. Inflate the balloon with 10ml of sterile solution or the pre-filled amount (depending upon which catheter you are using). Watch the patient to ensure she is comfortable, as there shouldn’t be any pain.
8. Once the balloon inflates, withdraw the catheter slightly to ensure the catheter is low in the bladder and secure.
9. If not already attached, attach the drainage bag to the catheter. Then attach the bag to the woman’s thigh. Make sure there isn’t any tension on the catheter when taping it to the patient’s leg.
10. The steps for male patients are the same, but the initial insertion involves lubricating the end of the penis and entering the urethra. Unlike women, the drainage bag with men will then hang on the bed frame. Ensure the level is below the patient’s bladder.

Here are the steps involved in removing a catheter:

1. The first step is to deflate the balloon, as the catheter cannot be removed when the balloon is inflated. Look for the colored valve on the end. This is where the catheter holds the water in the balloon.
2. Cut the valve off the balloon port. Do this by cutting the neck of the tube just behind the valve. The valve will come off, and water will trickle out of the tube.
3. When the water has stopped trickling out, the balloon is deflated. Use steady pulling pressure to remove the catheter. Don’t make jerking or yanking motions, as this can cause patient discomfort.
4. Discard the catheter and the drainage bag.
5. Clean the urethra opening with antiseptic swabs.

Potential Risks and Complications of Catheterization

Urinary catheterization is a simple procedure. When you’re first learning how to perform catheterization, you’ll have some anxiety, but you’ll soon master the necessary technique.

Still, as with any medical procedure, there are risks involved. The two main problems occur when the urethra is damaged or when infection occurs. Careful, attentive technique will make the chance of these complications low.

These are the potential risks and complications of urinary catheterization:

• Urethral injury
• Urinary tract or kidney infections
• Allergic reaction or sensitivity to latex
• Leakage, which is a sign the catheter is blocked by clotted blood or debris
• Bladder spasms, which are a sign the bladder is trying to push out the catheter
• Bladder stones
• Blood infections
• Blood in the urine
• Kidney damage (usually only with long-term indwelling catheters)
• Scarring from urethral damage that later restricts urine flow

Pro Tips for Catheter Care

While not an issue with short-term or external catheters, indwelling catheters require some attention. This is especially important for patients returning home or placing the catheter at home.

As a nurse performing these tasks or instructing patients on how to do them, there are best practices to follow when caring for an indwelling catheter.

• Keep the area where the catheter exits the body clean, washing the area with soap and water daily.
• Clean the area after every bowel movement to prevent infection.
• Check to ensure the drainage bag is secure.
• Wash your hands before disconnecting the drainage bag from the catheter.
• Disconnect the drainage bag only as needed, minimizing chances for potential contamination.
• Be sure to tell patients that sexual activity with a catheter inserted is not an option.
• Tell patients to never apply any lotion to the area around the catheter.
• Patients should drink enough water to produce at least two liters of urine daily.
• Check urine color, as it should be only slightly yellow or clear. This amount of water intake helps prevent infection.

Are You Ready to Make the Move Into a Nursing Career?

Now you understand what’s involved in catheterization. It’s an essential procedure and one of the regular tasks performed by a nurse.

Do you want a career that makes a difference in people’s lives? Then, make a move into nursing. Nursing is a meaningful career, and there are not enough nurses to fill all the available positions across the country.

Brookline College has a variety of options to help you move into nursing. From accelerated programs to tuition assistance options, we want to help talented people like you to become a nurse.