The Alberta College of Paramedics

Transcription

1 The Alberta College of Paramedics Alberta Occupational Competency Profile (AOCP) Upgrade Gap Training Program Emergency Medical Technologist - Paramedic (EMT-P) Urinary Catheterization Module Study Guide

2 Table of Contents Acknowledgements & General Information... i Training Program... 1 AOCP s... 2 Overview, Learning Objectives... 3 Learning Activities... 4 Purpose of Urinary Catheterization... 5 Complications... 8 Procedure... 9 Summary Exam Glossary of Terms References Lab Skill Checklists... 21

3 Acknowledgements & General Information INTRODUCTION The overall goal of this program is to provide standardized upgrade gap education to ensure that all regulated practitioners of the Alberta College of Paramedics (College) meet the Health Professions Act, Paramedic Regulation and the scope of practice as defined by the Alberta Occupational Competency Profiles (AOCP) for the profession. The Alberta Occupational Competency Profiles (AOCP) were developed through the facilitation of Dr. Bill DuPerron of Alberta Health and Wellness. Many College regulated practitioners were involved in compiling and organizing information about the roles and functions of paramedics, emergency medical technicians and emergency medical responders into the Profile. The completion of the AOCP for the College is an important milestone for the profession. The document is a result of a collaborative partnership with the College and Alberta Health and Wellness plus the work and effort of members of the College. The Competency Profile describes the vast expanse of competencies in Alberta at the present time as well as additional changes in scope of practice, which are identified in the Upgrade Gap Training Program. Each module in the Gap Training Program covers the additional competencies for a specific Competency Cluster as identified in the AOCP for each of the three disciplines regulated by the College. The Profile includes the knowledge, skills, attitudes, and judgments related to a variety of roles held by registered practitioners of the College. BACKGROUND The Health Professions Act (HPA) governs all regulated health professions in Alberta. The HPA was passed by the Alberta Legislature in May 1999 and in December 2001 the Order in Council proclaiming the Health Professions Act was signed by the Lieutenant Governor. The HPA replaces a regulatory system (the Health Disciplines Act) that included multiple statutes that had different registration, continuing competence and investigation and disciplinary processes. Under the HPA, previous legislated exclusive scopes of practice will be eliminated and replaced with an overlapping scope of practice model based on restricted activities. Restricted activities are health services that only authorized persons may provide. STRUCTURE OF THE HPA The HPA will deal with processes such as registration, continuing competence, professional conduct, restricted activities, investigation and discipline that apply to all the professions. Each of the 28 professions will have their own regulation that will address in detail, profession specific areas such as required qualifications for entry into the profession. The Paramedic profession is expecting to be governed by the HPA in the near future. Alberta College of Paramedics Introduction to the Upgrade Gap Training Program i

4 ABOUT THE AOCP Most of the competencies have been learned in basic education; other competencies have been acquired through advanced education, on the job training, and experience. All EMRs, EMTs and EMT-Ps have the basic competencies; however, competency on the job will vary depending on job requirements, and policy and procedure of the employing agency. The Profile provides a cumulative view of the competencies within the Scope of Practice and within the general and specialized areas of that practice. The College has developed the following educational module for upgrading the knowledge and skills of registered practitioners to meet the Alberta Occupational Competency Profiles (AOCP), the new Regulation and scope of practice. HISTORY OF THE PROCESS On March 4, 2000, the Paramedic Association of Canada adopted the National Occupational Competency Profile (NOCP), which included both a new classification and generic competencies for four professional designation levels of Paramedicine. On March 22, 2000, the Alberta College of Paramedics Council made the commitment that the Alberta College of Paramedics AOCP would meet or exceed the NOCP. ACKNOWLEDGEMENTS Alberta College of Paramedics Continuing Competency Ad Hoc Education Committee Members: Douglas Britton, MEM, EMT-P, Chair Renee Linssen, EMR, Vice-Chair William Coghill, MEM, EMT-P, CHCA Ruth Farrow, EMT-P, MLT Christine Patterson, MEM, EMT Richard Poon, BSc., EMT-P, MEd Marilyn Ringness, BSc., EMT-P Barry Straub, EMT-P Donna Lefurgey, CEO/Registrar Laurie Mitchell, Registration Division Leader Package Development and Design Portage College Prehospital Care Programs Lac La Biche, Alberta In collaboration with Alberta College of Paramedics Continuing Competency Ad Hoc Education Committee Alberta College of Paramedics Introduction to the Upgrade Gap Training Program ii

5 Module Creation and Research Portage College Prehospital Care Programs Lac La Biche, Alberta In collaboration with Alberta College of Paramedics Continuing Competency Ad Hoc Education Committee About the Authors (Portage College) Portage College (formerly Alberta Vocational Center, Lac La Biche) was established in The College currently offers over 30 certificate and diploma programs in six areas of study: Business, Human Services, Native Cultural Arts, Trades and Technical, Health and Wellness and Academic Upgrading. Over 1800 students are served annually through campuses in 13 northern Alberta communities, with another 1,300 taking short term or customized training programs each year. Portage College has been offering prehospital care training program since the mid 1980s. Portage College is currently approved by the Alberta College of Paramedics for the following Paramedicine programs: Emergency Medical Responder (EMR) Emergency Medical Technician (EMT) Emergency Medical Technologist-Paramedic (EMT-P) Disclaimer Portage College and the Alberta College of Paramedics have attempted to ensure that the information is in context relevant to the practitioner and is as concise as possible. Portage College has used a variety of resource materials in order to provide a solid base of up-to-date information. If any of the information contained within this module contradicts the direction you have received from your employer/medical director, the policy of your employer should take precedence over the information in this module. As a regulated practitioner of the Alberta College of Paramedics, while under the Health Disciplines Act, you may only deliver health services which fall within your scope of practice and is in accordance with the provisions of the Health Disciplines Act or the Health Professions Act when the HPA is implemented. Any content contained in this module that is beyond your scope or not within your current competence does not authorize you to deliver those health services. That is, if a given health service is not within your scope of practice and/or you have not yet attained the competency, you may not deliver that health service. Alberta College of Paramedics Introduction to the Upgrade Gap Training Program iii

6 Alberta Occupational Competency Profile (AOCP) Training Program Learning Goal This educational training is intended to review and upgrade the competencies of the Alberta College of Paramedics registered practitioners in order to meet the requirements of the new regulation under the Health Professions Act (2000) including the Alberta Occupational Competency Profile (AOCP) and scope of practice. Program Objective To provide standardized education to registered practitioners to ensure that all regulated practitioners of the Alberta College of Paramedics meet the regulation and defined scope of practice for the profession. Program Format The Alberta Occupational Competency Profile (AOCP) training program will combine independent study modules and scheduled lab skills assessment sessions. Certification will be granted on successful completion of all program requirements. Independent Study Modules There are ten EMT-P AOCP continuing education modules to be completed. 1. Intraosseous 2. Transcutaneous Pacing 3. Blood Products 4. Urinary Catheterization 5. Monitoring Chest Tubes 6. Arterial Blood Gas Samples 7. Intrapartal Examination 8. Suturing and Hemostat Application 9. Femoral Venipuncture 10. Nasotracheal Intubation Lab Skill Assessment All skills identified for each module will be assessed during the lab skills assessment for that module. Exam Mastery of the each module s content will be assessed through multiple-choice exams during the lab sessions. These exams are open book and can be found in each module following the module summary. EMT-P Urinary Catherterization 1

7 EMT- P Urinary Catheterization Competencies This module meets the following competencies of the Alberta Occupational Competency Profile (AOCP). I-15 Perform Urinary Catheterization I-15-1 Demonstrate knowledge of indications for urinary catheterization: Diagnostic Urine output monitoring Study anatomy of the urinary tract Therapeutic Acute urinary retention Chronic obstruction causing hydronephrosis Intermittent bladder decompression for neurogenic bladder Chronically bed-ridden patients I-15-2 I-15-3 Demonstrate knowledge and ability to perform urinary catheterization: Understands indications / contraindications Educates / prepares patient Identifies proper landmarks Uses sterile technique Performs procedure correctly Understands potential complications and their management Demonstration knowledge of contraindications and complications of urinary catheterization: Urethral injury Inability to locate urethra Vaginal catheterization Urethral stricture Enlarged prostate Urinary tract infection EMT-P Urinary Catherterization 2

8 Urinary Catheterization Module Overview Introduction The urinary system plays a major role in homeostasis by performing several functions. It assists in the regulation of blood volume and blood pressure, it regulates the concentrations of plasma ions, and it contributes to the homeostasis of blood ph and prevents the loss of nutrients such as glucose and amino acids, while eliminating organic waste products. The healthy urinary system works efficiently at eliminating urine from the bladder. There are, however, certain situations when it is necessary to aid in the removal of urine from the bladder by placing a urinary catheter. Learning Objectives Upon completion of this module the Paramedic will be able to: 1. Discuss the purpose of urinary catheterization. 2. List the complications of urinary catheterization. 3. Demonstrate the knowledge and correct procedure for urinary catheterization. EMT-P Urinary Catherterization 3

9 Learning Activities Recommended Resources Each module identifies specific content students must cover to meet the module learning objectives. Key Terms Students are to define the Key Terms identified for each learning objective. Exam Mastery of the module content will be assessed through a multiple-choice exam during the lab sessions. This exam is open book and can be found in this module following the module summary. Lab Skills Practice Students are to review the skills identified in the Lab Skills Checklist provided in Appendix A. Review of these checklists is essential preparation for the lab skill assessments, which are mandatory for successful completion of this module. EMT-P Urinary Catherterization 4

10 Objective 1 Discuss the Purpose of Urinary Catheterization Anatomy and Physiology The urinary system is composed of the kidneys, ureters, the urinary bladder and the urethra. On a daily basis the kidneys can filter the entire circulatory volume close to 40 times. The ureters carry urine from the kidneys to the urinary bladder. Although the kidneys continuously produce urine, the bladder can temporarily store the urine until it is convenient to empty the contents. As the bladder fills, stretch receptors in the bladder walls send signals to the brain resulting in sympathetic stimulation causing inhibition of the detrusor muscle (muscular layer of the bladder), and contraction of the internal and external urethral sphincters. Once approximately 200 ml of urine has accumulated, the stretch receptors send a signal to the brain relaying a message to empty the bladder. The detrusor muscles rhythmically contract under the control of the parasympathetic division. Although the sympathetic division influences contraction of the external urethral sphincter by activating the pudendal nerve, relaxation is under voluntary control. If an individual decides not to void, stimuli from the stretch receptors subside until an additional ml of urine is produced and the cycle starts again. Under voluntary control, the external urethral sphincter relaxes and the urine is expelled through the urethra. Indications The placement of a urinary catheter is indicated in the following circumstances: Urine Output Monitoring Patients with low cardiac output, impaired renal function or suffering from conditions such as rhabdomyolysis or acute immune hemolytic reactions often require urinary catheterization to accurately monitor urine output. Chronically Bed-ridden Patients Patients who are confined to their beds and unable to use bedpans are candidates for urinary catheterization. The unconscious patient and patient s with spinal injuries or urinary incontinence are some examples. EMT-P Urinary Catherterization 5

11 Acute Urinary Retention Conditions or situations that can cause urinary retention requiring urinary catheterizations include but are not limited to: Postoperative retention- urine retention as a result of surgery. Postpartum perineal trauma - Most often a result of swelling of the urinary meatus due to the trauma of a vaginal delivery. Bladder papilloma A benign tumor of the bladder, which interferes with the drainage of urine. Cystocele - A condition when the wall between the bladder and the vagina weakens. The bladder droops into the vagina and can interfere with the drainage of urine. Neurogenic bladder - A condition where nervous impulses between the bladder and the brain are no longer functioning resulting in the inability to void. Prostate conditions - Any condition resulting in changes in the prostate size such as prostate cancer, benign prostate hyperplasia and prostatitis that interferes with the flow of urine. Urethral stricture - Any condition resulting in the narrowing of the urethra such as scarring, trauma or chronic infections that interferes with the flow of urine. When urinary retention is not treated with decompression of the bladder by catheterization, increased urine collection can result in decreased or permanent loss of bladder tone. The obstruction of urine can also cause hydronephrosis (swelling of the kidneys), which can lead to renal failure. Contraindication The main contraindication for urethral catheterization involves the suspicion of urethral injury following pelvic trauma. Blood at the urethral meatus, bruising to the scrotum or significant mechanism of trauma involving the pelvic region are indications to withhold catheterization until a physician can assess the patient. Another contraindication is acute urethral and prostate infection. Urinary catheterization is cautioned in patients with suspected acute myocardial infarction (AMI) and a candidate for thrombolytic therapy. EMT-P Urinary Catherterization 6

12 Objective 1: Key Terms Ureters Detrusor muscle Rhabdomyolysis Acute immune hemolytic reaction Urethral stricture Hydronephrosis Urethral meatus EMT-P Urinary Catherterization 7

13 Objective 2 List the Complications of Urinary Catheterization Despite our best effort to perform urinary catheterization without complications, they are a possibility. It is necessary for the practitioner to recognize these complications and report them should they occur as a result of this procedure. Infection The insertion of a urinary catheter provides a direct route for bacteria to enter the urinary tract. Hand washing, proper preparation of the site, and strict aseptic technique is critical to reduce this complication. Trauma Inserting a urinary catheter can cause trauma to the urethra. Ensuring the catheter is lubricated with sterile water-soluble lubricant up to 5 cm for females and 17.5 cm for males will reduce the incidence of trauma to the urethral canal and eases insertion. Never force the catheter against resistance. If resistance is felt ask the patient to bear down as if to void. This may cause the external sphincter to relax allowing further advancement of the catheter. Restricted Canal Urethral stricture or an enlarged prostate gland can reduce the passageway of the urethra. If the patient has a known or suspected history of this, consider using a smaller catheter. Vaginal Catheterization Inadvertent catheterization of the vaginal canal is a complication of urinary catheterization. This will manifest as the absence of urine return despite ease of insertion. Proper patient positioning can reduce the incidence of this occurring. If vaginal catheterization is suspected, remove the catheter and discard it as it is now contaminated. Reattempt urinary catheterization with a new catheter. (Note: Some practitioners will leave this catheter in place to aid in locating the urethral meatus prior to the next attempt) Inability to Locate Urethra The incidence of the inability to locate the urethra in female patients can be reduced by proper preparation. Correct patient positioning and thorough cleansing of the site will aid in the landmarking process Paraphimosis Paraphimosis is the retraction and constriction of the foreskin behind the glans penis. To prevent this complication, be sure to reduce the foreskin after catheterization. EMT-P Urinary Catherterization 8

14 Objective 2: Key Terms Paraphimosis EMT-P Urinary Catherterization 9

15 Objective 3 Demonstrate the Knowledge and Correct Procedure for Urinary Catheterization Urinary catheterization has a high frequency of infections so all efforts should be directed at maintaining an aseptic (free of pathogens) area to work in. Position the patient supine. Females need to flex their knees and relax their thighs so the hip joints can be rotated externally. Male patients should have their thighs slightly abducted. Keep the patient covered leaving the genitalia exposed. Have the drainage bag prepared and ready to connect to the catheter. Open the catheterization kit following the manufacturer s instructions and put on sterile disposable gloves. Organize the contents of the kit while maintaining a sterile field. Test the catheter balloon prior to insertion and discard the catheter if the balloon leaks or does not expand. EMT-P Urinary Catherterization 10

16 Lubricate the catheter end (5 cm for females, 17.5 cm for males) to ease insertion into the urethra. Drape (sterile) the patient leaving the genitalia exposed. Position the catheterization kit between the patient s legs on the sterile drape. Clean the patient s urethral meatus. For females, pull back on the labia with the non-dominant hand and identify the urethral opening. The labia must be kept back during the entire process of urinary catheterization to maintain cleanliness. Use the dominant hand to pick up cotton balls soaked in antiseptic solution with the forceps and clean the perineum from front to back. For males, retract the foreskin, if applicable, with the non-dominant hand. The foreskin must be retracted throughout the entire procedure to maintain cleanliness. Use the dominant hand to pick up cotton balls soaked in antiseptic solution with the forceps and clean the urethral meatus in a circular motion down to the base of the glans. With the dominant hand, place the distal end of the catheter in the collection tray and insert the proximal end into the urethra. EMT-P Urinary Catherterization 11

17 Insert the catheter until urine appears. Continue insertion another cm and inflate the balloon with the stated amount of sterile water listed on the catheter. Pull gently on the catheter to seat the balloon. Connect the drainage bag to the catheter. Tape the catheter to the patient s leg leaving enough slack to allow for patient movement and document the entire procedure appropriately. EMT-P Urinary Catherterization 12

18 Objective 3: Key Terms Aseptic Non-dominant hand Dominant hand EMT-P Urinary Catherterization 13

19 Summary This module is designed to give the Paramedic an overview of the indications, contraindications, and possible complications of performing urinary catheterization. It is the Paramedic s responsibility to review this procedure regularly to ensure proper technique and minimize the possibility for complications as a result of this procedure. EMT-P Urinary Catherterization 14

20 Exam 1. The placement for a urinary catheter is contraindicated in the following patients: a. 43y/o male with isolated crush injuries to both lower legs b. 24y/o female presenting with a sudden onset of lumbar pain, fever and hypotension during a transfusion of packed red cells c. 16y/o male with isolated crush injuries to the pelvis d. 53y/o female in septic shock on a dopamine drip with a systolic of 80 mmhg 2. The placement of a urinary catheter in a patient who recently delivered a baby is often due to: a. Inability to void due to swelling of the urinary meatus caused from the trauma of delivery b. Dysuria from the micro tears caused from the trauma of delivery c. Occlusion of the urinary meatus from clotting of the blood from the micro tears caused from the trauma of delivery d. The patient s inability to walk to the washroom after delivery 3. Bladder papilloma interferes with the drainage of urine due to: a. Cervical swelling b. Tumor growth impinging upon the urethral opening in the bladder c. An occluded congenital shunt between the bladder and the papilloma gland d. The thick, purulent secretions from an infected papilloma gland 4. Rhabdomyolysis. a. Will result in decreased bladder tone b. Has no effect on the kidneys and urine production c. Occurs regularly in chronically bed-ridden patients d. Requires accurate monitoring or urine output 5. Stretch receptors within the bladder signal the brain to empty the bladder once ml of urine has accumulated within the bladder. a. 500 b. 400 c. 300 d. 200 EMT-P Urinary Catherterization 15

21 6. Which of the following will NOT minimize infection when inserting a urinary catheter? a. Hand washing b. Sterile gloves c. Using sterile drapes d. Size of catheter 7. Which of the following is NOT a complication that can be minimized with proper positioning, patient preparation and technique? a. Infection b. Trauma c. Restricted canal d. Vaginal catheterization 8. When resistance is met while inserting a urinary catheter, the patient is asked to bear down. This is done to: a. Stimulate a parasympathetic response that will stimulate contractions of the detrusor muscles. b. Relax the external sphincter muscle. c. Encourage the patient to void in hopes to negate the indication of catheterization. d. Stimulate a parasympathetic response that will slow the heart rate of a patient going through a stressful procedure. 9. The best defense against urethra trauma is: a. Lubricate the catheter with a water-soluble gel, prior to insertion. b. Never place a urinary catheter into a trauma patient. c. Wash your hands prior to the procedure. d. Correct patient positioning and thorough cleansing of the site. 10. In the event of vaginal catheterization: a. Landmark and reattempt with the same catheter. b. Remove the catheter and discard it. c. Move to the other side of the patient and reattempt the procedure. d. Do not continue with the procedure. 11. Use your dominant hand to: a. Hold the labia and penis when inserting the catheter. b. Handle the sterile equipment and supplies. c. Hold the patient s legs apart. d. Open the catheterization kit. EMT-P Urinary Catherterization 16

22 12. The catheter balloon should be inflated with: a. 5 ml of sterile water b. sterile water to dilate the balloon 2.5 cm c. 30 ml of sterile water d. sterile water at the volume specified by the catheter 13. The catheter balloon should be inflated: a. Once the catheter is inserted far enough for urine return. b. Once the catheter is inserted to the specified marking. c. Once the catheter is inserted cm past the point when urine returns. d. Once resistance is felt to facilitate dilation of the external sphincter. 14. The proximal catheter is lubricated with a water-soluble lubricant up to 5 cm for female patients, and 17.5 cm for male patients. The reason for this is because: a. Male patient s urethras are longer than females. b. Male patient s urethras lining is more fragile than females. c. Male patient s urethras are predominantly smaller in diameter than females. d. The Bartholin glands in females provide enough lubrication so little extra is needed. 15. The female patient s labia must be retracted with the non-dominant hand throughout the entire process of urinary catheterization. The reason for this is: a. The labia obscure the visualization of the vaginal opening. b. The labia are considered contaminated. c. The retraction of the labia induces relaxation of the external sphincter. d. It allows for easy landmarking of the vaginal opening. EMT-P Urinary Catherterization 17

23 Glossary of Terms Objective 1: Key Terms Ureters - Carry urine from the kidneys to the urinary bladder. Detrusor muscle - Muscular layer of the bladder. Rhabdomyolysis - The destruction of skeletal muscle tissue that is accompanied by the release of muscle cell contents into the bloodstream. Acute immune hemolytic reactions - An immune reaction following the transfusion of blood products to an unintended recipient resulting in the hemolysis of the donor red blood cells. Urethral stricture - Any condition resulting in the narrowing of the urethra such as scarring, trauma or chronic infections that interferes with the flow of urine. Hydronephrosis - Swelling of the kidneys. Urinary meatus - Distal opening of the urethra. Objective 2: Key terms Paraphimosis - The retraction and constriction of the foreskin behind the glans penis. Objective 3: Key Terms Aseptic - Freedom from infection or infectious material. Non-dominant hand - The hand in which a person is weaker. Dominant hand - The hand in which a person is stronger. EMT-P Urinary Catherterization 18

24 References Bladder Papilloma [n.d.] < (2005, February) Cystocele [n.d.] < (2005, February) Foley (Urethral) Catheterization [n.d.] < (2005, February) Hydronephrosis [n.d.] < (2005, February) Kozier, B., & Erb, G., (1987). Fundamentals of Nursing Concepts and Procedures (3 rd ed.). Menlo Park: Addison-Wesley Marieb, E., (2004). Human Anatomy and Physiology (6 th ed.). San Fransisco: Pearson Benjamin Cummings Martini, F., & Bartholomew, E., (2000) Essentials of Anatomy and Physiology (2 nd ed.). Upper Saddle River: Prentice-Hall Miller Keane (1997), Encyclopedia & Dictionary of Medicine, Nursing & Allied Health Sixth Edition, W.B. Saunders Company Neurogenic Bladder [n.d.] < (2005, February) Perry, A., & Potter P., (2002). Clinical Nursing Skills and Techniques (5 th ed.). St. Louis: Mosby Prostate Conditions [n.d.] < (2005, February) Urethral Stricture [n.d.] < (2005, February) Urinary Catheter Insertion [n.d.] < (2005, February) EMT-P Urinary Catherterization 19

25 Appendix A EMT-P Urinary Catherterization 20

26 Lab Skills Checklist URINARY CATHETERIZATION MALE Apply PPE precautions. Perform patient assessment. Obtain history and baseline vital signs. Determine treatment plan. List indications, contraindications and complications for this procedure. Explain procedure to patient and obtains consent. Assemble equipment/ supplies and prepare patient for procedure. Using sterile gloves, place a sterile drape under the patient s penis and another above the penis to cover the abdomen. Apply antiseptic solution and saturates the sterile sponges and lubricate 17.5 cm of the proximal end of the catheter. Holding the penis with the non-dominant hand, retract the foreskin (if applicable) and clean the glans with a sterile sponge, and discard the sponge. Repeat this procedure x 3. Apply gentle upright traction on the penis to straighten the penile urethra and pass the tip of the catheter through the meatus; insert the catheter until urine returns and continue insertion for cm to ensure the balloon is within the bladder. Inflate the balloon with the appropriate amount of sterile water and gently pull on the catheter to seat the balloon. Reposition the foreskin (if applicable). Attach the catheter to the drainage bag, ensure the bag is lower than the level of the patient and tape the catheter to the patient s leg leaving enough slack to allow for patient movement. Reassess patient and note any complications. Document: size and type of catheter, volume of sterile water used to inflate the balloon and the color, clarity and amount of urine drained during the procedure. Comments: Instructor Name & Initials: Date: EMT-P Urinary Catherterization 21

27 Lab Skills Checklist URINARY CATHETERIZATION FEMALE Apply PPE precautions. Perform patient assessment. Obtain history and baseline vital signs. Determine treatment plan. List indications, contraindications and complications for this procedure. Explain procedure to patient and obtains consent. Assemble equipment/ supplies and prepare patient for procedure. Using sterile gloves, place a sterile drape under the patient s buttocks and over the legs and abdomen leaving the genitalia exposed. Apply antiseptic solution and saturates the sterile sponges and lubricate 5 cm of the proximal end of the catheter. Retract the labia with the non-dominant hand, clean the area with a sterile sponge wiping front to back, and discard the sponge. Repeat the procedure x 3. Locate the urethral opening and pass the tip of the catheter through the meatus; insert the catheter until urine returns and continue insertion for cm to ensure the balloon is within the bladder. Inflate the balloon with the appropriate amount of sterile water and gently pull on the catheter to seat the balloon. Attach the catheter to the drainage bag, ensure the bag is lower than the level of the patient and tape the catheter to the patient s leg leaving enough slack to allow for patient movement. Reassess patient and note any complications. Document: size and type of catheter, volume of sterile water used to inflate the balloon and the color, clarity and amount of urine drained during the procedure. Comments: Instructor Name & Initials: Date: EMT-P Urinary Catherterization 22