Lesson Plan

On
Name of College: Sylhet Women’s Nursing College.
Name of program: Post Basic B.Sc in Nursing
Level of Student: 1st Year
Name of Subject: Nursing Education & Curriculum Development
Topic: Catheterization
Venue: Laboratory
Duration Class: 1 Hour
Method of Teaching: Demonstration

Submitted to:

Shofiqul Islam
Lecturer
Sylhet Women’s Nursing College

Submitted by:

Khadiza Jannat
Roll No: 14
Sylhet Women’s Nursing College
Date of Submission: 15-06-2023

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 CONTENTS
Sl No Topic Page No
01 Introduction 3
02 Indication Indication 4
03 Contraindication 5
04 Types Of Catheters 6
05 Procedure (In Male Patient) 7-9
06 References 10

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 Definition

An Invasive procedure to drain out the urine from urinary bladder with the help
of specifically designed articles called Catheter. This procedure may apply for
injecting the medicine or contrast for therapeutic or diagnostic purpose.

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 Objectives

General Objective: Help the student acquire knowledge about Catheterization.

Sepcific Objective:

 Identify the indications and contraindications for a Left Heart

Catheterization.
 Be able to use the risk vs. benefit model to determine if a patient is
suitable for an invasive procedure.
 Identify the importance of pre-procedure screening.
 Familiarize with the equipment used for a Left Heart Catheterization.
 Understand how and where catheters are placed into the body during a
diagnostic Left Heart Catheterization.
 Identify what is being assessed for each: Coronary Angiography, Left
Ventriculography and Right Heart Catheterization.
 Define the role of hemodynamic data as it relates to the diagnostic
process during a right heart catheterization.
 Determine the chambers that pressures and blood samples are being
collected in during a right heart catheterization.
 Identify the methods of calculating the cardiac output during a right heart
catheterization.

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 INTRODUCTION

Urinary catheterization involves insertion of hollow tubular instrument into

urinary bladder via urethra through urinary meatus. Few indwelling catheters
can be secured in bladder by inflating the balloon. In males, catheterization is
found to be more difficult because of natural curvature, narrow (anatomical)
sites and its long length compared to females. One should be very cautious
while putting urinary catheter in an individual with urethral stricture or
suspected urethral injury to avoid false passage.

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 INDICATION

• Acute urinary retention

• Chronic urinary retention if associated with symptoms or have back pressure

changes

• Monitoring of renal function

• Postoperative period

• To bypass any obstruction

• To collect sterile urine specimen.

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 CONTRAINDICATION

Absolute Suspected traumatic injury to lower urinary tract, which may be

indicated by history of pelvic or straddle type injury. The signs of suspicious
injury are high ridding or boggy prostrate, perineal hematoma or blood at the
external urinary meatus.

Relative

• Urethral stricture

• Recent urethral or bladder surgery

• Uncooperative patient.

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 TYPES OF CATHETERS

• Foley catheter: This is an indwelling urinary catheter, which prevent the tube
from sliding out because of balloon at the tip, which can be inflated with sterile
water.

Robinson catheter: These are catheter usually used for short term or as
intermittent catheterization.

• Coudé catheter: This catheter is designed for the cases where negotiation of
catheter is difficult in prostatic urethra (swollen prostrate); the upward curvature
of the tip of the catheter facilitates the passage through the natural curvature of
prostatic urethra.

• Hematuria catheter: This is a triple or double-lumen catheter used for post

TURP patients to control hemostasis. This is a variant of Foley catheter.

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 PROCEDURE (IN MALE PATIENT)

• Steps should be explained to the patient at the beginning (explaining the steps
and what we want from patient will relax the patient and avoid the anxiety of
the patients).

• Ask the patient to lie on his back with leg should be open (this maneuver will
relax the bladder and urethra). Proper position for catheterization is supine with
frog-leg position, with knees flexed. It is difficult to insert catheter in tense
urethra and may cause complication (opening the leg will ensure the penis is
accessible).

• Wash hand properly and put on the gloves (gloves are important part of
personal protective equipment of health care worker and it make the procedure
sterile and minimize the risk of infection).

• Open the appropriate size Foley catheter in sterile manner and make all other
arrangements ready, like, sterile syringe, Urobag, sterile water and cleansing
solution and drapes. Choose correct size of catheter. If contaminated urine is
expected than the accepted size is 16 Fr but if gross contamination or hematuria
is likely than 18 Fr catheter size will be more appropriate.1-3 It is also
important to check the competency of the balloon and the patency of the
catheter before insertion.

• Paint the genital area with cleansing solution, lift the penis, paint it, clean the
foreskin and then retract the foreskin; if foreskin is present for proper exposure
of glans by using gauze swab. It should be kept in mind that cleansing should be
done from inside to outside not in reverse manner (Fig. 3).

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• Drape should be placed properly in sterile manner (the genital should be
exposed properly for inserting the catheter but meanwhile other area should be
covered to maintain the sterility). By lifting the penis, penile urethra can be
made straightens which facilitates the catheterization (Fig. 4).4,5

• Apply lubricant to the distal part of the catheter with balloon deflated, insert
10–15 mL of local anesthetic gel in the urethra slowly (Fig. 5), after inserting
gel penis should be held properly to close external urethral meatus between the
thumb and finger (Fig. 6) to avoid leakage of gel.2,6 It is mandatory to wait for
2 to 4 minutes after putting lidocaine jelly in urethra.2,4,5 This will minimize
the discomfort to the patient by pain relief and will also reduce the friction of
catheter to mucosal surface, which will facilitate smooth insertion while
catheterization.

• The gloves should be replaced with new sterile gloves after this stage and
place new sterile drape around the penis (this will prepare sterile filed for
catheterization).

• Hold the penis in one hand and insert the catheter into the urethral meatus with
other hand taking care of sterility (Fig. 7). The catheter should be advance in the
urethra gently (2–3 cm at a time)1 and once urine flow begins continue to push
the catheter into the bladder another 2 inches to ensure that it has reached the
bladder6 preferably insert the catheter up to bifurcation mark (Fig. 8) and
palpate the catheter against bladder neck. Always ensure that urine is flowing
from the catheter (Fig. 9). In case there is no flow of urine even after pushing
whole of the catheter, a gentle pressure should be applied over the pubic
symphysis area.7,8 Also ensure that lumen is not kinked/blocked which usually
occur in smaller size catheter. Do not inflate the balloon unless the urine flow is
seen.

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• Inflate the balloon with appropriate volume of sterile water (Fig. 10) as
indicated on the catheter.8,9 The volume of the balloon varies according to the
size of Foley catheter like it is 5 mL for pediatric Foley and it ranged from 10
mL to 30 mL depending on the size and type of Foley, but care should be taken
that amount installed in balloon should not exceed the upper limit as mentioned
on the Foley.1 The following substance should be avoided for filling the balloon
—air, nonsterile water and normal saline.

• Withdraw the catheter slightly to place it in the dependable position and attach
the drainage bag (Fig. 11) (withdrawing the catheter will ensure proper
placement of catheter at bladder base for optimal drainage of urine). On desire
of patient catheter may be secured taking care that the catheter is not taut.

• Clean the glans after the procedure. It is very important to reposit the foreskin
(retraction of the prepuce) to avoid paraphimosis after catheterization.

• Amount of the urine should be measured after catheterization and it is better to

collect the specimen of urine for laboratory examination.

• Record the information relevant document like reason for catheterization,

residual volume, date and time of catheterization, catheter type and size, amount
of water instilled into the balloon and any problem during negotiation of
catheter (to provide point of reference or comparison in event of later queries).

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 REFERENCES

1. Pomfret I. Catheter care—trouble shooting. J Community Nurs.

1999;13(6):20-4.

2. Carr HA. A short history of the Foley catheter: from handmade instrument to
infectionprevention device. J Endourol. 2000;14(1):5-8.

3. McGill S.Cathetermanagement:it’s the size that’s important.NursMirror.

1982;154(14): 48-9.

4. Bandy JP, Moors J. Urology for Nurses. Oxford: Blackwell Scientific

Publication; 1996.

5. Baxter A. Urinary catheterization. In: Mallet J, Dougherty L (Eds). Manual of

Clinical Nursing Procedures, 5th edition. Oxford: Blackwell Publishing; 2000.
pp. 600-12.

6. Hadfied-Law L. Male catheterization. Accid Emerg Nurs. 2001;9(4):257-63.

7. Lowthian P. The dangers of long-term catheter drainage. Br J Nurs.

1998;7(7):366-8.

8. Trout S, Dattolo J, Hansbrough JF. Catheterization: how far should you go?
RN. 1993; 56(8):52-4.

9. Winn C. Complications with urinary catheters. Prof Nurse. 1998;13(5):S7-10.

10. Wilson J. Control and prevention of infection in catheter care. Community

Nurse. 1997; 3(5):39-40.

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