Urinary Catheter Insertion with Lidocaine 2% Jelly - Adult

Approved by: Urinary Catheter Insertion with Lidocaine 2% Jelly - Adult Vice President and Chief Medical Officer, and Vice President and Chief Operating Officer Corporate Policy & Procedures Manual Number: VII-B-100 Date Approved July 8, 2015 Next Review (3 years from Effective Date) August 2018 Purpose Policy Statement To provide instruction to patient care providers to use Lidocaine 2% jelly to insert male and female urinary catheters, reduce discomfort and/or risk of injury to the patient s urethra and/or prostate. The most responsible health practitioner shall provide a patient care order for Lidocaine 2% Jelly prior to the insertion of a urinary catheter. For males, one attempt at insertion is allowed before staff must seek assistance from an experienced health care professional. After two unsuccessful attempts, the most responsible health practitioner must be consulted For females, two attempts are allowed before staff must seek assistance from an experienced health care professional. After two unsuccessful attempts, the most responsible health practitioner must be consulted Catheter insertion requiring a catheter guide must be performed by a physician. NOTE: If the patient has an allergy to Lidocaine 2% jelly, a water-based lubricant should be used. No patient care order is required when using a waterbased lubricant. Applicability Responsibility This policy and procedure applies to all Covenant Health facilities, staff, members of the medical staff, volunteers, students and any other persons acting on behalf of Covenant Health. The most responsible health practitioner shall demonstrate compliance with this policy/procedure by ensuring that they provide a patient care order for administration of Lidocaine 2% Jelly prior to insertion of a urinary catheter. Before inserting a urinary catheter, the health care professional is responsible to ensure that they have appropriate skills and education, are working within their scope of practice, and align with Covenant Health policies and procedures. Health care professionals who do not have experience/knowledge of catheter insertion, shall complete the learning module accompanying this policy/procedure and demonstrate the successful application of Lidocaine 2% jelly and insertion of a urinary catheter under the direct supervision of a Clinical Nurse Educator or senior staff member trained in this clinical procedure; using the attached checklist as a teaching guide / documentation of competency. The completed checklist is to be witnessed by the Manager/Clinical Nurse Educator and recorded according to the department practice. The health care provider is responsible to keep a copy for their own records. Note: Nursing staff are always constrained by their own level of

VII-B-100 Page 2 of 18 expertise when performing any clinical skill. Principles The application of Lidocaine 2% jelly prior to the insertion of a urinary catheter: assists with the dilation of the posterior urethra; lubricates the urethra to facilitate catheterization; desensitizes the urethra during and after the procedure; and provides psychological benefit by validating that the procedure may be unpleasant and patient understanding that the patient care provider is attempting to reduce discomfort. Definitions Related Documents or Resources Previous Versions Most responsible health practitioner means the health care professional who has responsibility and accountability for the specific treatment/procedure(s) provided to a patient and who is authorized by Covenant Health to perform the duties required to fulfill the delivery of such a treatment/procedure(s), within the scope of his/her practice. Urinary Catheter Insertion with Lidocaine 2% Jelly Learning Module PowerPoint Prevention of Iatrogenic Injuries Covenant Health Policy #VII-B-125, Medication Orders November 1, 2011 References Beynon, M., de Laat, T., Greenwood, J., van Opstal, T., Lindblom., E., Emblem, E.L., (2005). Urethral Catheterization. Section 1: Male Catheterization. European Association of Urology Nurses. Good practices in Health Care. EAUN Board and the EAU Professions Allied to Urology Office. Arnhem. The Netherlands. Canes, D., Thomsen T., Setnik, G. (2006). Male Urethral Catheterization. The New England Journal of Medicine. 355(11). Page 1178-1180. Cathejell 2% Jelly 2% Product Monograph. Retrieved on 7 th April 2015 from; http://www.cathejell.ca/cathejell_mongraph.html Chung, C., Chu, M., Paoloni, R., O Brien, M.J., Demel, T. (2007). Comparison of Lignocaine and Water-Based Lubricating Gels for Female Urethral Catheterization: A Randomized Controlled Trial. Emergency Medicine Australasia. 19(4). Page 315-319. Garbutt, R., Taylor, D., Lee, V., Augello, M. (2008). Delayed Versus Immediate Urethral Catheterization Following Instillation of Local Anesthetic Gel in Men: A Randomized, Controlled Clinical Trial. Emergency Medicine Australasia. Volume 20. Page 328-332. Kashefi, C., Messer, K., Barden, R., Sexton, C., Parson, J.K. (2008). Incidence and Prevention of latrogenic Urethral Injuries. The Journal of Urology. American Urological Association Volume 179. Page 2254-2258. Mercer Smith, J. (2006). Current Concepts in Catheter Management. Chapter 10. In Urinary and Fecal Incontinence. Current Management Concepts by Doughty, D. Elsevier. St. Louis. Missouri. Moore, K. (2006). Pathology and Management of Acute and Chronic Urinary Retention. Chapter 8. In Urinary and Fecal Incontinence. Current Management Concepts by Doughty, D.

Elsevier. St. Louis. Missouri. VII-B-100 Page 3 of 18 Ogden, V. (2003). Anesthetic Gel Insertion During Male Catheterization. Journal of Community Nursing. 17(1). Page 4-6, and 8. Richards S; Pravikoff D; CINAHL Nursing Guide, EBSCO Publishing, 2014 Aug 01 (Nursing Practice and Skill - CEU, image). Urinary Catheter, Indwelling (Foley): Insertion in the Female Adult Patient, accessed on-line through the Nursing Resource Centre June 3, 2015. Robinson, J. (2007). Female Urethral Catheterization. Nursing Standard. 22 (8). Page 48-56. Robinson, J. (2006). Pathology and Management of Postprostatectomy Incontinence. Chapter 9. In Urinary and Fecal Incontinence. Current Management Concepts by Doughty, D. Elsevier. St. Louis. Missouri. Senese, V., Hendricks, M., Morrison, M., Harris, J. (2006). Clinical Practice Guidelines Task Force: Society of Urologic Nurses and Associates. Male Urethral Catheterization. Urologic Nursing. 26(4). Page 314. Shalmovitz, G.Z. (2008). Urethral Catheterization, Men. Retrieved on14th December, 2009, from http://emedicine.medscape.com/article/80716-overview#. Shalmovitz, G.Z. (2009). Urethral Catheterization, Women: Treatment and Medication. Retrieved on14th December, 2009, from http://emedicine.medscape.com/article/80735- treatment. Siderias, J., Guadio, F., Singer, A. (2004). Comparison of Topical Anesthetics and Lubricants Prior to Urethral Catheterization in Males: A Randomized Controlled Trial. ACAD EMERG MED. 11(6). Page 703-706. Walsh K; Pravikoff D; CINAHL Nursing Guide, EBSCO Publishing, 2014 Jul 04 (Nursing Practice and Skill - image, video). Urinary Catheter, Indwelling (Foley): Inserting in the Male Adult Patient. Accessed on-line through the Nursing Resource Centre June 3, 2015. Walsh K; Pravikoff D; CINAHL Nursing Guide, EBSCO Publishing, 2014 May 16 (Nursing Practice and Skill - CEU, image). Urinary Catheter, Indwelling (Coudé): Insertion in the Male Adult Patient. Accessed on-line through the Nursing Resource Centre June 3, 2015. Wilson, Mary; British Journal of Nursing, 2013 May 23; 22 (10): 566-9. (journal article - tables/charts) ISSN: 0966-0461 PMID: 23752454 Catheter lubrication and fixation: interventions. Accessed on-line through the Nursing Resource Centre, June 3, 2015. Wilson M; British Journal of Nursing, 2008 Feb 28-Mar 12; 17 (4): 232, 234, 236-9. (journal article - pictorial, tables/charts) ISSN: 0966-0461 PMID: 18414267. Causes and management of indwelling urinary catheter-related pain. Accessed on-line through the Nursing Resource Centre, June 3, 2015. Wood, T.L. (2010). Urinary Elimination. Chapter 33. In Clinical Nursing Skills and Techniques (7 th Edition) by Perry, A., Potter, P. Elsevier. St. Louis. Missouri. Woodward, S. (2005). Use of Lubricant in Female Urethral Catheterization. British Journal of Nursing. 11(19). Page 1022-1023.

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VII-B-100 Page 5 of 18 Indications Urinary catheter insertion is indicated for patients undergoing; General anesthesia and/or surgery Patients requiring accurate output monitoring Procedures involving the urethra, abdomen or pelvic region To relieve urinary retention Cautions Patient Teaching Documentation Lidocaine should be used with caution in patients with sepsis and/or traumatized mucosa, since there is potential for rapid systemic absorption. Instruct patient; Explain the purpose and why a urinary catheter is being inserted. Keep the urinary collection bag and tubing below the level of their bladder. This helps prevent reflux of urine from the drainage collection bag into the bladder. Make sure the tubing doesn t kink or loop. Keep the urinary collection bag off the floor (to minimize risk of bacterial contamination). Document on the Patient Care Record: Procedure Check patient care order. Date and time of Urinary catheter insertion Type of catheter French size Amount of fluid used to inflate catheter balloon Ease of insertion Any problems (i.e. resistance to insertion, bleeding, pain) with insertion Amount and description of urine returned If urine collection specimen is sent Patient's response to urinary catheter insertion Patient teaching provided Clean area per instruction in Clinical Nursing Skills & Techniques textbook, Perry, Potter (8 th Edition). When setting up equipment, using aseptic technique, open the packaging containing Lidocaine 2% jelly syringe onto the sterile field. NOTE: Needles are never used for administration of Lidocaine 2% jelly After the syringe of Lidocaine 2% jelly has been used, discard to prevent contamination of sterile work area. Application of Lidocaine 2% Jelly on Males: 1. After cleansing the urethra meatus, instill Lidocaine 2% jelly (approximately 5-10 ml) into the urethra. Allow the gel to dwell for approximately 5 minutes (no longer

VII-B-100 Page 6 of 18 than 15 minutes) before starting catheter insertion. A sterile gauze pad may be placed over the meatus to help prevent spillage of anesthetic jelly. The urethral opening should then be held closed (by the nurse or the patient) for 3 to 5 minutes. 2. Hold penis at 90 to the body and apply a generous mound of Lidocaine 2% jelly (approximately 5-10 ml) on the tip of the penis in a pyramid shape. 3. Gently slide the catheter through the pyramid of gel and then into the penis. Application of Lidocaine 2% Jelly on Females: 1. After cleansing the labia majora. Place nozzle of Lidocaine 2% jelly near the urethral orifice and apply some gel in a pyramid shape. Gently place nozzle approximating the entrance of the urethra and slowly squeeze gel onto the urethra, expel at least 5 ml. 2. Allow the gel to dwell for approximately 5 minutes (no longer than 15 minutes) before starting catheter insertion. A sterile gauze pad may be placed over the meatus to help prevent spillage of anesthetic jelly. 3. Lubricate 2.5 to 5 cm of the catheter and then gently slide the catheter through the pyramid of gel into the urethra.

VII-B-100 Page 7 of 18 URINARY CATHETER INSERTION WITH LIDOCAINE 2% JELLY Learning Module August 2011 Prepared by: Sharon Dawson & Anne Le-Vander Leeuw Clinical Surgery Educator, GNCH Revised: May 2015 By: Colleen Kasa. Clinical Surgery Educator, MCH Anne Le. Clinical Surgery Educator, GNCH

VII-B-100 Page 8 of 18 This learning module is to be used in conjunction with Policy/Procedure #VII-B-100, Urinary Catheter Insertion with Lidocaine 2% Jelly Check patient care order. 1.0 OBJECTIVES Urinary catheterization can be a difficult and painful procedure - especially for males when there may be inadequate lubrication because of the greater urethral length and the prostatic curve, a urethral stricture, inability to thread the catheter through the S-shaped bulbar urethra, or excessive resistance at the bulbomembraneous urethra, with tightening of the external sphincter. Upon completion of this learning module, the patient care provider staff will be able to: 1. Reduce discomfort and reduce the risk of injury to the patient s urethra and/or male prostate, by applying Lidocaine 2% jelly before inserting a urinary catheter. 2.0 CRITERIA FOR SUCCESSFUL COMPLETION 1. The staff member will be asked to read this module and the policy Urinary Catheter Insertion with Lidocaine 2% Jelly. 2. The staff member will perform their first catheter insertion under the supervision of a clinical educator or senior staff member. 3. The clinical educator/senior staff member will ensure the staff member appropriately completes the clinical practice elements (see Checklist). 3.0 EDUCATION REQUIREMENTS Qualified staff who have demonstrated the skill to a Clinical Nurse Educator on a mannequin or patient may independently perform male urinary catheter insertion. Once completed, the checklist will be given to the appropriate Clinical Nurse Educator for record keeping purposes. The patient care provider is responsible to keep a copy for their own records. NOTE: The nurse is always constrained by their own level of expertise.

VII-B-100 Page 9 of 18 4.0 INDICATIONS Urinary catheter insertion is indicated for patients undergoing: General anaesthesia and / or surgery Patients requiring accurate output monitoring Procedures involving the urethra, abdomen or pelvic region To relive urinary retention. 5.0 PROCEDURE FOR MALE CATHETERIZATION Table 1 - Equipment for Male Urinary Catheter Insertion Table 2 - Nursing Action & Rationale for Urinary Catheter Insertion Table 3 - Procedure for Male Urinary Catheter Insertion Using Lidocaine 2% Jelly Table 1 - EQUIPMENT FOR MALE URINARY CATHETER INSERTION EQUIPMENT Lidocaine 2% jelly in prefilled syringe Commercial single use urethral catheterization tray. Should contain: Sterile drapes Sterile povidine iodine solution for cleansing Sterile water soluble lubricant gel Sterile water in a 10 ml syringe Sterile gloves Urethral catheter RATIONALE To decrease patient sensation during urinary catheter insertion To maintain aseptic technique Purpose is to drain urine. Consider appropriate catheter size and type for the patient 1. Male: size 14-16 French urinary catheter Select the smallest size appropriate for patient. Note: If a patient has never had a catheter inserted, use a size 14 French urinary catheter 2. Male passing blood: size 20-24 French Three Way urinary catheter. If the third port is not being used for continuous bladder irrigation (CBI), then plug the unused port with an approved catheter plug. Check the hospital stores catalog for order number. 3. Coude-tipped catheter Indicated for gross hematuria in adults. Larger French size is easier for clots and blood to drain. Used for older men if prostatic enlargement is

VII-B-100 Page 10 of 18 EQUIPMENT Coude catheters are inserted with the tip pointed upward (toward the patient's umbilicus) in the 12 o'clock position, throughout insertion. An arrow or raised bump on the catheter shaft indicates the position of the tip during insertion. Coude catheter is passed through the urethra using steady gentle pressure. Note: Do NOT force if firm resistance is met. If a Coude catheter cannot be inserted in accordance with these guidelines after 1 attempt, the patient should be referred to senior staff or a urologist (if available at site). 4. Silicone catheters are made of pure silicone. Preferred urinary catheter for patients with a latex allergy. Note: Silicone catheters - the balloon should be checked every 2 weeks and sterile water added as needed RATIONALE suspected, or when initial catheterization attempt with a urinary catheter is unsuccessful. Coude catheters: Have a firm curved tip designed to negotiate the male prostatic curve. Designed to overcome urethral obstruction which a more flexible catheter cannot pass. The elbow on the tip of the catheter should face anteriorly (the 12 o clock position) to allow the small rounded ball on the tip of the catheter to move through the urogenital diaphragm. For long term placement (i.e.> 2 weeks and up to 12 weeks), to prevent urethral meatus erosion and to decrease risk of urinary infection. The permeability of the silicone balloon results in loss of fluid over time. 5. Silastic catheters are latex catheters that have a silicone coating. 6. Silver alloy and antibiotic impregnated catheters must be ordered by the Physician or Nurse Practitioner. These catheters are Direct Purchase Orders. Collection drainage device such as, urometer or leg bag as appropriate Catheter stabilizing device is required (e.g. StatLock for catheter) Garbage receptacle within easy reach To measure and collect urine output. To minimize trauma to urethra. Commercial prepared devices i.e. StatLock are preferred when available.

VII-B-100 Page 11 of 18 TABLE 2 - NURSING ACTION AND RATIONALE FOR URINARY CATHETER INSERTION Action Check physician orders. A patient care order is required by a physician or nurse practitioner to administer Lidocaine 2% Jelly via the urethra prior to inserting a urinary catheter. Rationale Required operational practice. Confirm patient has provided consent. This is the responsibility of the ordering practitioner; i.e. physician, nurse practitioner. Identify patient per policy/procedure #VII-B-25, Identification of Patient, Resident, or Client Using Two Identifiers. Review the medical history before attempting to insert the catheter Patient history, and identifying complicating factors include; Asking patient if they have had a urinary catheter inserted previously. Lidocaine/Lidocaine allergy: use water soluble lubricant. Latex allergy: use silicone catheter (for more information please see Table 2). History of: o Urethral trauma / strictures? o Prostatic enlargement o Prostate surgery Explain procedure to patient. Gather supplies (see Table 1) To identify patients who may have difficulty with insertion. The patient s history helps guide choice of catheter type and size. If catheter cannot be inserted the patient should be referred to a Urologist (if available at site). To identify patients who may have difficulty with Urinary catheter insertion. Latex allergy Assess other catheter options, such as a silicone catheter. Note: Individuals with a history of allergies to bananas, avocado, kiwi, or chestnuts may cross-react to latex. Strict latex precautions, including use of latex-free catheter kits should be followed. Latex reactions from indwelling catheters can range from: Severe anaphylaxis with respiratory distress and generalized urticaria Redness and swelling of the urinary meatus Meatal discharge Complaints of bladder pain Localized urticaria involving the skin in contact with the catheter Promotes cooperation. Before beginning the procedure, ensure sterile packaging is intact and expiry dates are checked.

VII-B-100 Page 12 of 18 Action Ensure bed or stretcher is positioned at comfortable working height. Position patient in supine position and adjust the bed linen. Before beginning sterile preparation, ensure pericare is completed. Leave patient genitalia covered until the supplies have been set up. Rationale Correct ergonomics To ease access to the urethra. To minimize bacterial contamination into the urethra during catheter insertion. Respect and maintain patient dignity.

VII-B-100 Page 13 of 18 Table 3 - PROCEDURE FOR MALE URINARY CATHETER INSERTION using Lidocaine 2% Jelly Wash hands ACTION Expose patient s genitalia, identify urethra, ensure positioning is appropriate and lighting is adequate Note: For uncircumcised patients, the foreskin is retracted for iodine cleansing and for catheter insertion. Failure to return the foreskin back to its original position can cause paraphimosis RATIONALE To minimize risk of bacterial contamination during catheter insertion. Particular caution should be used when inserting a catheter into an uncircumcised patient with severe penile and / or scrotal edema because it may be very difficult to reposition the foreskin once the catheter has been inserted. Patients with severe edema are also at greater risk for penile erosion. Wash hands Place the catheter tray on a clean, dry, firm surface i.e. bedside table Maintaining the sterile field; 1. Open catheter tray 2. Open and place the urinary catheter on the sterile field 3. Don sterile gloves maintaining aseptic technique 4. Open the iodine preparatory solution / swab sticks 5. Open sterile lubricant and place package on sterile field 6. Open Lidocaine 2% jelly according to manufacturer s instructions. Prime the Lidocaine 2% jelly to expel air, making sure that jelly is on the tip of the syringe. Ensure no plastic particles from breaking the syringe seal remains. Position sterile drapes over patient, creating a sterile field Place the urine collection tray holding the urinary catheter, iodine swab sticks, package of lubricant on the sterile field, between the patient s legs Use your non-dominant hand to hold the penis at a 90 0 angle For ease of insertion and collection of urine. This hand is now considered to be non-sterile and is used to hold the penis throughout the procedure. Use your dominant sterile hand and sterile

VII-B-100 Page 14 of 18 ACTION iodine swab sticks, or sterile forceps with cotton gauze in iodine solution to cleanse the urethra and the surrounding glans. Use a circular motion with at least three different applications. Slowly instill the Lidocaine 2% jelly prefilled syringe directly into the urethra Note: Needles are never used for administration of Lidocaine2% Jelly RATIONALE Inadequate lubrication can cause urethral trauma and pain; this can also result in an inability to pass the catheter through the prostatic urethra. This distends and places the lubricant high in the urethra; reducing discomfort and preventing urethral spasm. Instilling too fast may cause gel to over flow. Hold the penis at a 90 0 angle. Allow approximately 5 minutes (Cathejell Jelly 2%. Pharmazeutische Fabrik Montavit. Austria) for the anesthetic to take effect before proceeding with the urethral catheterization. Sterile gauze maybe placed over the meatus post instillation and the urethral opening should be held closed (by the nurse or patient). Apply a generous mound of lubricant on the tip of the penis, over the urethral meatus Pre-testing the catheter balloon is NOT recommended If a sterile urine sample is to be collected, ensure that the sterile specimen container is open and positioned for ease of access Assists with opening passage for Lidocaine 2% jelly to pass. NOTE: When jelly is cold, this may lead to spasm and the viscosity of the drug may make it difficult to flow. Instillation and dwell (no more than 15 minutes) of the Lidocaine 2% jelly directly into the urethra allows anesthesia and dilation of the urethra before catheter insertion. The entire length of the catheter passes through the urethral meatus, allowing for continuous lubrication of the entire length of the catheter as it is advanced. Inadequate lubrication can cause urethral trauma, pain and may also result in inability to pass the catheter through the prostatic urethra. Pre-testing catheter balloon is not required. The manufacturer has pre-tested the integrity of the catheter balloon (Mercer Smith, 2006). For the silicone catheter, the balloon does not return to its original shape after inflation, and the enlarged balloon area can form a cuff or crease that can traumatize the urethra during catheter insertion. To minimize risk of bacterial contamination during catheter insertion. At this time urine for routine microscopy,

VII-B-100 Page 15 of 18 ACTION culture and sensitivity should be obtained as required per unit specific practice Hold the penis with the non dominant hand at approximately 90 degrees to the bed; gently stretch the penis upward to straighten out the penile urethra. Using the dominant hand gently introduce the catheter into the urethra using a slow steady pressure Continue to advance the catheter until the proximal y shaped port (bifurcation) is at the urethral meatus. Recoil out of the urethra should be minimal if the catheter is properly placed. If mild resistance is noted while advancing the catheter, instruct the patient to cough, or bear down as if to void or perform deep breathing exercises. Then slightly rotate the catheter very gently. If this troubleshooting does not allow the catheter to pass through the urethra, do NOT continue to force the catheter. Stop Remove catheter Notify doctor Request Urological consult Note: Do NOT force if firm resistance is met. If a urinary catheter cannot be inserted in accordance with these guidelines after 1 attempt, the patient should be referred to senior staff or a urologist (if available at care facility). Wait for urine to drain from the end of the catheter. The lubricant gel filled distal catheter openings may delay urine return. If no spontaneous return of urine occurs within a minute of catheter insertion 1. Ensure catheter is inserted to bifurcation 2. Ensure there is minimal catheter recoil 3. Attach a 60 ml syringe to gently aspirate the urine 4. The bladder scanner may be used RATIONALE To ease insertion and prevent urethral trauma. To avoid inflation of the balloon in the urethra. To relax the urethral sphincter, at which point the catheter is passed. Traumatic insertion can lead to the formation of a false passage, when the catheter is pushed into tissues alongside the urethra. This is a serious condition that can lead to urethral strictures, bleeding, and infection. This may require surgical intervention. Trauma to the urethra is considered a serious complication to be avoided. To ensure that the distal end of the catheter is in the bladder. Catheter irrigation is not recommended unless obstruction with clots or mucus is anticipated. Catheter irrigation solution should be instilled with gentle pressure. Vigorous irrigation and aspiration should be avoided as this can result in damage to the bladder mucosa.

VII-B-100 Page 16 of 18 ACTION at this point to verify the presence of urine. If urine return is still not visible after all the techniques outlined above have been utilized, withdraw the catheter and reattempt the procedure. If the patient s foreskin has been retracted return to the normal position over the glans penis. After visualization of urine return, inflate the distal balloon by injecting sterile water through the inflation port of the catheter RATIONALE Failure to reduce the foreskin can cause paraphimosis. Inflation of the balloon inside of the urethra will result in severe pain, gross hematuria and possible urethral tear. The balloon should inflate with little resistance when in the correct location. Insert the exact volume of sterile water indicated. Check the manufacturer s instructions on the urinary catheter package. Secure the catheter to the patient s upper thigh using a catheter stabilization device. Ensure there is no tension on the catheter. An improperly filled balloon expands asymmetrically which increases the potential for erosion of the bladder mucosa. Placement of the catheter stabilizing device on the upper thigh decreases the potential for pressure necrosis, urethral erosion at the penile-scrotal junction and pistoning. Pistoning increases the risk of bacteria transferring into the bladder as areas of catheter previously outside the body travel into the urethra. Unsecured catheters can lead to bleeding, traumas, pressure sores, penile erosion, and bladder spasms from pressure and inadvertent tractions. Following completion of procedure ensure peri-care is completed Cover and reposition patient for comfort Ensure drainage system is working properly Dispose of used supplies Empty garbage Label/send any urine specimens to laboratory Document as per site policy/ procedure (for Edmonton Acute, Policy #V-20, Patient Chart Documentation). Securement devices stabilize the catheter. Preventing tension and drag, thus reducing trauma within the urethra and bladder.

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VII-B-100 Page 18 of 18 Insertion of Urinary Male Catheter Criteria Checklist Critical Practice Elements Met Not Met 1. Confirms order for catheter insertion and application of Lidocaine 2% Jelly via the urethra prior to insertion of a urinary catheter. Reviews policy and procedure Two patient identifier Hand hygiene, identifies urethra and provides peri-care 2. Gathers necessary equipment. Is able to verbalize the procedure before entering the patient room. Identifies risks of insertion procedure and when to abort the procedure (i.e. unable to advance the catheter to proximal "y" shaped ports (bifurcation) and/or resistance is met. Explains procedure to patient and verifies understanding and cooperation as appropriate. Washes hands. Wears appropriate PPE. 3. Provides peri-care prior to performing procedure 4. Positions the patient for comfort and ease of access to urethral meatus. Positions bed at level comfortable working height. 5. Apply Lidocaine Jelly 2% as outlined and allow 5 minutes for anesthetising agent to take effect. 6. Aseptic technique is maintained throughout catheter insertion procedure. Cleanses insertion site and lubricate catheter as outlined. Mound of jelly applied to meatus for insertion. 7. Discontinues procedure if resistance is met when attempting to advance N/A urinary catheter. 8. Inserts catheter to bifurcation, absence of recoil Waits for urine return. 9. Inflates urinary balloon with amount of sterile water specified on the urinary catheter package. 10. Peri-care completed following procedure and patient's genitalia is covered appropriately. If patient is uncircumcised, the foreskin is returned to its original position 11. Apply stabilization device to upper thigh 12. Disposes of used equipment appropriately 13. Provides patient instruction as outlined. 14. Documents in patient care record. Passed (completed/verbalized all elements above) Needs to Repeat under Direct Supervision Staff Name: Unit: Validated by (print name): Date: Signature: * Staff person to keep a copy for their own records