SUBJECT REVISED DATE 06/2015

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1 MANUAL Nursing Policy and Procedure SECTION C EFFECTIVE DATE 01/2008 POLICY AND PROCEDURE SUBJECT APPLIES TO Catheters Insertion and Care Nursing Indwelling, Straight, Suprapubic and External REVISED DATE 06/2015 POLICY It is the policy of this home that the resident with a urinary catheter will be provided services in a safe and appropriate manner in order to minimize the risks of urinary tract complications. Catheters will not be used unless the resident / patient s clinical condition demonstrates that catheterization is necessary and a physician s order is obtained. Urinary catheter is acceptable for the following conditions: 1. To relieve urinary retention that Is causing persistent overflow incontinence, symptomatic infections and / or renal dysfunction Cannot be corrected surgically or with medication Cannot be managed practically with intermittent catheter use 2. To protect skin wounds, pressure ulcers or irritations that are being contaminated by urine 3. To provide comfort during terminal illness or several impairment which makes bed and clothing changes uncomfortable or disruptive (i.e. as in the case of intractable pain) Physician order is required for all catheters. Order should contain the following: Type of catheter, size of catheter and size of bulb Frequency to change catheter PROCEDURE - STRAIGHT CATHETER - INSERTION 1. Sterile, disposable indwelling catheterization tray 2. Sterile, indwelling (Foley) catheter in the size ordered by the physician 3. Protective bed pad RN/LVN to insert straight catheter using following procedure: 1. Check physician s orders for straight catheter order. 2. Identify resident and explain reason for procedure. 3. Screen and drape resident for maximum privacy. 4. Wash hands. 5. Assist resident to dorsal recumbent position with knees flexed and separated; drape to expose perineum only. 6. Place protective bed pad beneath resident s buttocks (female) or beneath resident s penis (male). 7. Lift sterile tray from plastic cover (DO NOT CONTAMINATE) and place on dry working surface. 8. Open sterile wrap. 9. If catheter is packaged separately, open and place on sterile field. 10. Put on sterile gloves. 11. Open antiseptic solution applicators and place on sterile field. June 2015 / March 2012 L:\Clinical\Policy Manual\Catheters - Insertion and Care 1 of 6

2 12. Follow procedure for insertion of straight catheter for male or female resident. Females: a. Drape resident with sterile drape, leaving urinary meatus visible. b. Open outer labia with thumb and index finger, exposing urinary meatus. Cleanse outer labia using one stroke downward and discarding antiseptic applicator, clean inner labia in the same manner using a clean antiseptic applicator. c. Cleanse directly over the urinary meatus with a clean antiseptic applicator, one stroke downward and discard. d. Lubricate tip of catheter and grasp three to four inches from tip. e. Insert catheter about one and one-half inches into the urinary meatus at an upward angle (Do not use force). Advance catheter until urine flow begins. Place other end in sterile container. f. If catheter is mistakenly placed in vagina, repeat entire procedure with another sterile catheter. Males: a. Drape resident with sterile drape, leaving end of penis visible. b. The penis is held upright at right angle to the resident s body when the catheter is inserted. c. Grasp the penis firmly, but gently, and retract the foreskin if resident is not circumcised. d. Cleanse directly over the urinary meatus with a clean antiseptic applicator, using concentric circles from the meatus outward. Discard applicator after each circle. Clean entire head of penis. e. Holding penis at 90-degree angle, insert catheter about one and one-half inches into the urinary meatus (Do not use force). f. Lower penis to 60-degree angle and advance catheter until urine flows freely. Place other end of catheter into sterile container. GENERAL GUIDELINES FOR FEMALE AND MALE 1. If slight resistance is felt, this may be overcome by asking the resident to breathe deeply through the mouth. 2. Pinch catheter when flow of urine ceases. DO NOT REMOVE MORE THAN 1000 cc s AT A TIME. Hold catheter in place. 3. If medication is to be instilled, insert sterile irrigation syringe barrel only; tilt barrel and pour medication as ordered, in the specified amount, slowly down the barrel of the syringe. Allow to flow in by gravity. 4. Withdraw catheter gently and slowly. 5. Give peri-care and leave resident clean and comfortable with call light within reach. For uncircumcised males reposition foreskin. 6. If specimen is required, complete laboratory request form. Label bottle with resident s name, date, and physician. Place specimen in proper refrigerator and record proper information in laboratory log. Notify laboratory that the specimen is ready for pick up. 7. Document the date, time, procedure, amount of urine, color, consistency, odor, presence of blood, June 2015 / March 2012 L:\Clinical\Policy Manual\Catheters - Insertion and Care 2 of 6

3 PROCEDURE - INDWELLING CATHETER - INSERTION 1. Sterile, disposable indwelling catheterization tray 2. Sterile, indwelling (Foley) catheter in the size ordered by the physician 3. Protective bed pad 4. Tape or catheter strap RN/LVN to insert catheter using following procedure: 1. Follow procedure for insertion of straight catheter (Steps 1-12). 2. Advance catheter one to one and one-half inches beyond the point of free flow of urine. 3. Check size of balloon; attach pre-filled syringe to the balloon port on the catheter. 4. Fill balloon to appropriate size. DO NOT force water into balloon. If resistance is encountered or the resident complains of pain, deflate balloon, advance farther into the bladder and inflate. 5. Tug gently on catheter until resistance is felt. 6. Secure urinary drainage bag below the level of the bladder and keep off the floor. Coil extra tubing and secure. 7. Attach catheter strap to leg to assist in securing tubing. 8. Place catheter drainage bag in a cover to preserve dignity of the resident. 9. If specimen is required, complete laboratory request form. Label bottle with resident s name, date, and physician. Place specimen in proper refrigerator and record proper information in laboratory log. Notify laboratory that the specimen is ready for pick up. 10. Document the date, time, procedure, amount of urine, color, consistency, odor, presence of blood, PROCEDURE - INDWELLING CATHETER - REMOVAL 1. Disposable gloves 2. Syringe (same capacity as balloon of catheter) RN/LVN to remove indwelling catheter using following procedure: 1. Check physician s order for discontinuance of catheter. 2. Collect equipment and bring to bedside. 3. Identify resident and explain procedure; screen for privacy. 4. Assist resident to dorsal recumbent position and drape to expose perineum only. 5. Place protective bed pad beneath resident s buttocks. 6. Remove catheter strap. 7. Put on disposable gloves. 8. Attach syringe to balloon port of catheter and aspirate entire amount of sterile water in balloon. 9. Pinch catheter and withdraw gently and slowly. 10. Give peri-care and leave resident clean and comfortable. 11. Properly dispose of equipment. 12. Document the date, time, procedure, amount of urine, color, consistency, odor, presence of blood, June 2015 / March 2012 L:\Clinical\Policy Manual\Catheters - Insertion and Care 3 of 6

4 PROCEDURE - INDWELLING CATHETER - CARE 1. Perineal Cleanser 2. Towel and washcloth or disposable wipes 3. Disposable gloves 4. Bedpan RN/LVN/CNA to provide catheter care using the following procedure: 1. Position resident in semi-fowler s position on bedpan if tolerated. 2. Put on gloves. 3. Cleanse perineum using soap and water or pre-moistened wipes, taking care to wash from front to back. 4. NOTE: Do not contaminate areas with feces. If resident has had an involuntary bowel movement, clean this area first. Wash hands and obtain clean equipment for catheter care. 5. Cleanse area well at catheter insertion, taking care not to pull on catheter or advance further into urethra. 6. All debris must be removed from catheter at insertion site. 7. Rinse well with warm water and pat dry gently with clean towel. 8. Discard disposable equipment properly. 9. Discard linen properly. 10. Position resident comfortably with call light within reach. PROCEDURE SUPRA-PUBIC CATHETER - INSERTION 1. Sterile catheter insertion set (including gloves and pre-filled syringe) 2. Sterile indwelling catheter of the size and type ordered by the physician RN/LVN to insert supra-pubic catheter using following procedure: 1. Check physician s order for catheter change. (CATHETER IS TO BE CHANGED ONLY UPON THE ORDER OF A PHYSICIAN.) 2. Identify resident and explain reason for procedure. 3. Wash hands. 4. Assist resident to dorsal recumbent position and drape for privacy. 5. Peel back wrapper of catheter insertion set. DO NOT CONTAMINATE CONTENTS. Place on dry working surface. 6. Open sterile wrap to provide sterile field. 7. Put on sterile gloves. 8. Place protective pad below opening for catheter. 9. Place sterile drape over opening for catheter. 10. Open lubricating jelly and squeeze onto catheter tip. 11. Begin to clean edges of skin around supra-pubic stoma using provided antiseptic cleaner. Use a clean antiseptic applicator for each cleansing. Begin at edges of opening and cleanse in concentric circles moving outward. 12. Clean directly over opening with last antiseptic applicator, taking care not to let solution run into opening. June 2015 / March 2012 L:\Clinical\Policy Manual\Catheters - Insertion and Care 4 of 6

5 13. Gently, without force, insert lubricated catheter into opening about one to one and one-half inches. Note: if any difficulty or resistance is encountered, stop and call physician. 14. Place other end of catheter into specimen container. 15. After specimen is obtained (if required), inflate balloon to capacity as stated on catheter and physician order. 16. Attach catheter to drainage bag. Properly position bag below level of bladder (must not touch floor) and secure to bed frame (never to side rail). 17. Place catheter in cover to preserve the dignity of the resident. 18. Check flow of urine, note color, amount, and consistency. 19. Leave the resident clean, dry and in a comfortable position with call light within reach. 20. Document the date, time, procedure, amount of urine, color, consistency, odor, presence of blood, PROCEDURE SUPRA-PUBIC CATHETER - CARE 1. Soap and warm water or pre-moistened perineal wipes 2. Antiseptic ointment 3. Towel and washcloth or pre-moistened perineal wipes 4. Gloves RN/LVN/CNA to provide supra-pubic catheter care using the following procedure: 1. Check physician s orders for catheter care. 2. Identify resident and explain reason for procedure. 3. Wash hands. 4. Assist resident to dorsal recumbent position and drape for privacy. 5. Clean area around catheter well with soap and warm water or pre-moistened perineal wipes. 6. Clean any crusted material from catheter at insertion site. Note: DO NOT PULL ON CATHETER OR ADVANCE CATHETER INTO BLADDER. 7. Rinse and dry area well. 8. Apply thin film of antiseptic ointment to edges of opening for supra-pubic catheter. 9. Question resident and observe for adverse signs and/or symptoms of infection. 10. Leave resident clean, dry and in a comfortable position with call light within reach. PROCEDURE EXTERNAL CATHETER - APPLYING 1. External Catheter 2. Incontinent catheter sheath holder 3. Soap, water, and washcloth or disposable peri wipe 4. Gloves June 2015 / March 2012 L:\Clinical\Policy Manual\Catheters - Insertion and Care 5 of 6

6 RN/LVN/CNA to apply external catheter using following procedure: 1. Identify resident and explain reason for procedure. 2. Screen and drape resident for maximum privacy. 3. Wash hands, put on gloves. 4. Position resident on back and drape to expose genitalia. Avoid unnecessary exposure. 5. Wash and dry penis. 6. Roll external catheter over penis gently. 7. Leave a reservoir of one to two inches between the end of the penis and connecting tube. 8. Secure the external catheter sheath firmly, but not tightly, about three-fourths to one inch from the base of the penis with the incontinent sheath holder. This should completely encircle the penis. 9. Do not cover the edge of the external catheter or skin of the penis with tape. Circulation can be impaired even if the flow of urine is not obstructed. 10. If using an external catheter with an inflation cuff, follow the manufacturer s instructions. 11. Check catheter for patency and inspect skin every eight hours. 12. Release at least every eight hours, cleanse penis and dry well. 13. Connect external catheter to drainage bag as ordered. 14. Change external catheter as necessary. 15. Observe skin for signs of irritation, break in integrity or infection. 16. Discard disposable items appropriately. 17. Remove gloves and wash hands. 18. Leave resident in a comfortable position with call light within reach. June 2015 / March 2012 L:\Clinical\Policy Manual\Catheters - Insertion and Care 6 of 6

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