a procedure for removing urine by means of a urinary catheter introduced through the urinary meatus and urethra into the bladder. The procedure is performed for relief of distension if voluntary micturition is not possible (such as after trauma or surgery), as a preparation for and during anesthesia, or if a specimen of urine from the bladder is required or medication is to be instilled into the bladder. A straight catheter or a retention catheter with a balloon may be used. A French size 12 to 16 catheter is usually selected for straight drainage. See also catheterization, male catheterization.
method The necessary sterile equipment is usually available in a sterile catheterization kit and includes cotton swabs, a bowl for collecting urine, a disposable catheter, a sponge stick for holding the swabs, a disinfectant for washing the urinary meatus and the perineal area adjacent to it, gloves, a lubricant for the catheter tip, and a drape. Often a preassembled kit of disposable sterile equipment is available, leaving only the separately packaged catheter to be selected. The patient is positioned on her back, with knees flexed and legs abducted, and is then draped. A bright light is directed at the perineum. The nurse then scrubs the hands, dries them well, and opens the catheterization kit or tray carefully, not touching the inside of the wrapper or the contents. Sterile gloves are put on, and the tray is lifted and placed between the patient's legs. The small sterile drape in the kit is placed over the patient so that the window in it allows access to the urinary meatus. With the thumb and the forefinger of the nurse's nondominant hand, the labia are separated and the tissues are retracted, exposing the meatus. The area is cleansed from the front to the back, using one pledget or swab for each stroke. Each pledget is discarded before beginning another stroke. Three or more strokes are made, and the location of the meatus is verified while the area is cleaned. The catheter is picked up approximately 1.5 inches from its tip with the sterile hand, the tip is lubricated, and the end is placed in the basin. The catheter is inserted approximately 3 inches until the urine begins to flow. When the urine stops flowing, the catheter is slowly withdrawn or left indwelling as ordered. A sterile sponge is gently pressed to the meatus to remove any lubricant and to dry the area. The urine is measured, and the odor, color, and any abnormal precipitate are noted. A specimen for bacteriological culture and antibiotic sensitivity is often secured, labeled, and sent to the laboratory.
interventions Catheterization is ordered by a physician for an individual patient, or the conditions under which a catheterization is to be performed are stated in written standing orders. Careful explanation of the procedure ensures the patient's cooperation. Having the woman take a deep breath through the mouth may cause the meatus to open slightly, revealing its presence, and asking her to bear down slightly may minimize the momentary discomfort that commonly accompanies the insertion of the catheter into the bladder. Voluntary micturition is almost always preferable, and the nurse encourages the woman to try to void spontaneously. Signs of infection are carefully observed. If a woman is to be catheterized more than twice, an indwelling catheter is usually preferred to a third catheterization.
outcome criteria Catheterization predisposes the urinary tract to infection, and traumatic catheterization further increases the risk. Care, gentleness, and asepsis are essential. If the bladder is distended with urine, it may cause damage to the bladder, chills, and shock. Certain conditions, including radical vulvectomy, postoperative swelling, or structural anomalies, may obscure the urinary meatus. The indication for catheterization, the age of the patient, and the condition and size of the urethra affect the choice of catheter style and size.