Assessing 

1. Medication orders: Check the medication order, the aims of urinary catheterization and the name and the bed number of the patient.

2. The patient:

Systemic conditions: The patient’s condition at present, vital signs, the condition of consciousness, treatment, ability to self-care, the amount of fluid intake and the habit of emiction.

Local conditions: the condition of urinary bladder sufficiency, the skin and mucous membrane of perineum.

Psychological status: The presence or absence of tension and anxiety, and the degree of the patient’s cooperation.

Healthy knowledge: The importance of fluid intake enough and the normal habit of emiction. The patient has common knowledge about urinary catheterization or not.

2. Environment: The ward being in the presence or absence of clean, safety and secluded. The door and the windows are in good condition or not.

3. Equipment: Check the period of validity and effects of a sterile catheterization kit and sterile gloves. Check the effectual dosage of an antiseptic solution.

Planning

1. Expected objectives:

（1)The patient is satisfied with the procedure and urine retention is relieved.

（2)The patient understands the aims of urinary catheterization and actively cooperates with the nurse.

（3)No bad reactions happen.

（4)Finish the procedure in the given time (15 minutes) correctly.

2. Preparing:

（1)The nurse: The unit, cap, shoes and mask. Wash your hands. 

（2)The patient: The patient understands the aims of urinary catheterization and actively cooperates with the nurse. The tension or the fears is lessened. Ask the patient rinse the perineum himself (herself). Assist the patient to do it, if he (she) can not leave the bad.

（3)Assemble equipment: A sterile catheterization kit containing: a fenestrated drape, a cup with some cotton balls, gauze squares, two hemostat forceps, a water-soluble lubricant, two catheters of appropriate size, two kidney basins, two specimen containers. A bottle of an antiseptic solution, a sterile container and sterile forceps, sterile gloves, a treatment bowl with some sterile cotton balls, two hemostat forceps, a kidney basin, a turkish towel, a waterproof absorbent pad, a drape, a curtain, talcum powder, a bedpan and a cover, a pen. Assemble equipment shall be arranged according to used order and meet convenient principles.

（4)Environment: Close the door and the windows. Curtain off the area. Adjust the indoor temperature.

Action

1. Carry the equipment to the bedside. Check the bed card of招生简章 the patient.

2. Explain the procedure to the patient.

3. Ask the patient rinse the perineum herself. Assist the patient to do it, if she can not leave the bed.

4. Loosen the foot of the top bedcovers. Put off opposite trousers and cover the right leg, cover the left leg and foot with a turkish towel.

5. Assist the patient to a supine position with knees flexed and thighs externally rotated.

6. Clean the perineum.

（1)Place a waterproof absorbent pad and a drape under the buttocks.

（2)Place a kidney basin near the perineum and the treatment bowl between the patient’s thighs. Pour the antiseptic solution over the cotton balls in the treatment bowl.

（3)Glove the hands. Nip the cotton balls with antiseptic solution and clean the pubic area, labia majoria and labia minus from outside to inside, and move downward from pubic area to the anus. Use a cotton ball only once.

（4)Place cotton balls, hemostat forceps and gloves used into the kidney basin. Place the kidney basin and the treatment bowl on the underlayer of the cart.

7. Open the sterile catheterization kit.

（1)Place the sterile catheterization kit between the patient’s thighs and open it. Open the lining of the kit with the aseptic technique.

（2)Unfold the cup with the sterile forceps. Pour the antiseptic solution into the cup.

（3)Glove the hands. Drape the patient with a fenestrated drape.

8. Disinfect the perineum.

（1)Arrange the equipment according to the used order. Lubricate the tip of the catheter. Place it in the kidney basin aside ready for use and the other kidney basin near the perineum.

（2)Separate the labia majora with the thumb and index finger and expose the urinary meatus. Nip the cotton balls with antiseptic solution to clean the meatus first, then labia minus, anus last. Once the meatus is cleaned, do not allow the labia to close over it.

（3)Place cotton balls and hemostat forceps used into the kidney basin. Move the kidney basin to the edge of the kit. Do not move the thumb and index finger of the left hand.

9. Insert the catheter.

（1)Gently insert the catheter into the urinary meatus about 4-6 cm for an adult, until urine flows.

（2)Insert the catheter in the direction of the urethra. If the catheter meets resistance during insertion, do not force it. Ask the patient to take deep breaths. If this does not relieve the resistance, discontinue the procedure, and report the problem to the responsible nurse.

（3)When the urine flows, insert the catheter 1 to 2 cm more.

10. Introduce the urine into the kidney basin. Collect a urine specimen, if required, after the urine has flowed for a few seconds. Pinch the catheter before transferring the drainage end of it into the sterile specimen bottle. Usually 5 ml of urine is sufficient for a specimen.

11. If the kidney basin is full of the urine, nip the catheter and pour the urine into the bedpan.

12. Empty the bladder and remove the catheter lightly and slowly. Take away the fenestrated drape. Dry the patient’s perineum with a drape.

13. Take off the gloves and put them into the kidney basin. Take away the turkish towel, the waterproof absorbent pad and the drape.

14. Assist the patient to put on the trousers and in a comfortable position. Arrange the top bedcovers and unit in order.

15. Wash the hands. Record the reason for catheterization and any other pertinent observations, such as the color and amount of the urine.

16. Heath education: explain the aims of urinary catheterization and the way of cooperation with the nurse to the patient during inserting the tube. Tell the patient some knowledge of the disease.

17. Send the specimen to the laboratory in time.

Evaluating

1. The patient is comfortable and understands the meaning of inserting the tube. Actively cooperates with the nurse and learns knowledge about health care. There is no injury.

2. The clothes and lines are clear without stains.

3. The nurse has carrying out the procedure expertly and correctly and insisted on the sterile principles during the procedure.

4. Finish the procedure in the given time correctly.

Aims

Its goals are:

1. To relieve discomfort due to bladder distention and to provide gradual decompression of an overdistended bladder.

2. To assist to diagnosis or obtain a urine specimen from the bladder directly to assess the presence of abnormal constituents and the characteristics of the urine. It can assess the volume and the pressure of the bladder. It can also measure the amount of residual urine to differentiate between anuria and urinary retention.

3. To treat the bladder tumor through irrigating medicine.

4. To empty the bladder completely prior to surgery so as to prevent inadvertent injury to adjacent organs such as the rectum or vagina.

5. To retain a catheter for a patient who is coma, or has urinary incontinence or injury of the perineum to keep the local skin dry and cleanwww.med126.com. It can also be done for the patient after surgery of the urinary system to promote recovering the function of the bladder and heal up the incision.

6. To record the volume of urine and specific gravity in order to observe the function of the kidney, when saving a shock or critical patient.

Precautions:

1. The equipment should be sterilized strictly and the procedure be carried out with the aseptic technique, which can avoid the infection of the urethra.

2. Keep the patient’s privacy and explain the procedure to the patient. The environment should be shielded.

3. Select the catheters of appropriate size. Carry out the procedure gentle to avoid damaging the mucous membrane of the urethra.

4. Change the other catheter and insert it into the urethra, if inserting a catheter into a female vagina by mistake.

5. For weak adult patients experiencing urinary retention, it is recommended that no more than 1000 ml be removed at one time, which can avoid collapse and hematuria. These result in the descending pressure of the abdomen and the bladder which can lead to blood remaining in the blood vessels of the abdomen, the descending blood pressure and the congesting mucous membrane of the bladder.