71
SKILL 29 Urinary Catheterization
EQUIPMENT
Catheter, straight or indwelling
Urethral catheterization tray:
Gloves, sterile
Cotton balls and povidone-iodine or Betadine swab sticks
or cleansing solution specified by agency policy
Sterile, water-soluble lubricant
10 cc syringe, sterile
Sterile water
Light source
Blanket
Closed drainage system (for indwelling catheter)
Catheter plug (for children going to X ray)
Tape or other tube securing device
RECOMMENDED SIZE AND TYPE OF
CATHETER
< 3 Kg 5 French feeding tube or straight catheter
3–8 Kg 5–8 French straight or indwelling catheter
8–11 Kg 8–10 French straight or indwelling catheter
11–14 Kg 10 French straight or indwelling catheter
14–24 Kg 10–12 French straight or indwelling catheter
24–32 Kg 12 French straight or indwelling catheter
PROCEDURE
1. Check chart for order.
2. Gather equipment. Promotes organization and effi-
ciency.
3. Wash hands. Reduces transmission of microorganisms.
4. Provide for privacy.
5. Explain procedure to child and family. Enhances cooper-
ation and participation and reduces anxiety and fear.
a. Explanation should include that povidone-iodine or
cleansing solution may feel cold, as catheter is passed
may feel urge to urinate, and deep breathing or
“panting” will help to pass catheter.
6. Place child on back in a recumbent position. Place a
chux or other protection under the child’s buttocks.
7. Adjust light source to provide maximum lighting.
8. If needed, put on nonsterile gloves and cleanse per-
ineum of stool. Protects from contact with body fluids.
Reduces risk of introducing fecal material into genito-
urinary tract.
9. Remove gloves. Wash hands. Reduces transmission of
microorganisms.
10. Prepare sterile field maintaining strict aseptic tech-
nique. Open catheterization tray or sterile gloves, and
drop sterile catheter and syringe onto sterile field.
Copyright © 2007 by Thomson Delmar Learning, a division of Thomson Learning, Inc. All rights reserved.
11. Put on sterile gloves. Reduces transmission of microor-
ganisms.
12. If using catheterization tray, unfold waterproof under-
pad and place under child’s buttocks. DO NOT contam-
inate gloves while doing this.
13. Prepare povidone-iodine or agency-prescribed cleansing
solution and cotton balls or have asssistant open
povidone-iodine swabs.
14. Open sterile lubricant. If lubricant not part of catheteri-
zation tray have assistant open and squeeze lubricant
onto sterile field.
15. Maintaining sterile technique fill syringe with sterile
water.
NOTE: Some catheterization trays come with prefilled
syringe.
16. Check catheter balloon prior to insertion by inflating
and deflating it with sterile water. Ensures functioning of
catheter.
17. Cleanse area and insert catheter.
a. Male
1. Grasp shaft of penis gently but firmly with non-
dominant hand. This hand is now contaminated
and stays in place throughout the procedure. A
firm pressure rather than a light pressure helps
avoid an erection.
NOTE: Never catheterize a child with an erection.
2. Clean the meatus and then clean outward in a cir-
cular motion. Use each swab or cotton ball (gen-
erally held with forceps) only once. Be careful not
to touch the penis with the sterile glove.
NOTE: If child is uncircumcised retract the foreskin.
Do not leave the foreskin retracted following the proce-
dure.
3. Pick up the catheter with free (sterile) hand and
lubricate the tip.
4. Hold the penis shaft perpendicular to the body
and insert the catheter slowly and gently.
5. Insert the catheter to the hub. Ensures balloon
will inflate in bladder, not in urethra.
6. Inflate the balloon with the recommended
amount of water.
b. Female
1. Separate labia using thumb and forefinger of non-
dominant hand. This hand is now contaminated
and stays in place during the procedure.
continued
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SKILL 29 Urinary Catheterization continued

2. Clean the labia and meatus from front to back DOCUMENTATION

using each swab or cotton ball (generally held 1. Procedure and time done.
with forceps) only once. Cleanse each side and
2. Size of catheter.
then directly over the meatus. Be careful not to
touch area with sterile glove. 3. Amount of urine output.
3. Pick up the catheter with the free (sterile) hand 4. Color and character of urine.
and lubricate the tip. 5. Child’s response and how tolerated.
4. Align catheter opposite the meatus and insert
gently downward.
5. Insert to the hub. Ensures balloon will inflate in
the bladder, not in urethra.
6. Inflate balloon with the recommended amount of
water.
18. Connect catheter to closed drainage system.
19. Attach drainage bag to bed below level of bladder and
position catheter tubing in a loop on the bed. Promotes
drainage of urine.
20. Secure catheter with tape or tube holder.
a. Male: On abdomen or outer thigh.
b. Female: Inner thigh.
21. Clean the perineum to remove all Betadine.
22. Make child comfortable.
NOTE: The procedure for a straight catheterization
(not indwelling) is the same as described above.
However, the catheter is inserted only long enough to
obtain a urine specimen or to completely drain the
bladder.

Copyright © 2007 by Thomson Delmar Learning, a division of Thomson Learning, Inc. All rights reserved.