Inserting an indwelling urinary catheter in a male patient

Nursing, Jul 2004 by Pullen, Richard L Jr

YOUR PATIENT may need an indwelling urinary catheter if infection, an enlarged prostate, or urinary tract surgery disrupts normal urination or if his bladder must be kept empty.

DO

* Verify the order. Explain the procedure to your patient, provide privacy, and wash your hands.

* Have him lie on his back with his thighs slightly apart and drape him so his penis is uncovered. Put on clean gloves.

* Wash his penis with soap and water. Rinse and dry it, then remove your gloves and wash your hands.

* Open the sterile catheter kit on a clean surface. Put on sterile gloves.

* Without contaminating the center, place the waterproof drape under your patient's penis on his upper thigh. Place the fenestrated drape over his penis.

* Using supplies in the kit, pour povidone-iodine over the cotton swabs. (Follow facility policy if he's allergic to povidone-iodine.) Follow the manufacturer's recommendations to verify catheter balloon integrity. Lubricate 6 to 7 inches (15 to 17.5 cm) of the catheter tip.

* With your nondominant hand, gently grasp the shaft of your patient's penis, just below the glans. Keep your hand in place, as it's now contaminated. If he's uncircumcised, use the same hand to retract the foreskin.

* With your dominant hand, pick up a saturated cotton swab stick. Clean the meatus, then swab outward in a circular motion to the base of the glans. Discard the cotton swab. Do this three times. Place the catheter tray between your patient's lower legs.

With your dominant hand, pick up the catheter about 3 inches (7.5 cm) from the tip. Use your nondominant hand to lift the penis perpendicular to your patient's body, apply slight traction, and gently press both sides to help open the meatus. Encourage your patient to breathe deeply as you gently insert the catheter tip into the meatus. Advance it 7 to 9 inches (17.5 to 22.5 cm) or until urine starts draining, then advance it another inch (2.5 cm). If you meet any resistance, rotate or withdraw the catheter slightly. Return the retracted foreskin to its original position.

* Holding the catheter in place, inflate the balloon according to the manufacturer's recommendations. Gently tug the catheter until you feel resistance.

Secure the catheter to your patient's lower abdomen or upper thigh, allowing some slack in the tubing. Secure the drainage bag to the bed frame below his bladder level.

* Provide perineal care. Remove your gloves and wash your hands.

* Document the date, time, catheter size and type, and your patient's response. Record the urine amount, odor, color, and consistency and indicate whether you collected a specimen.

DON'T

* Don't use force if you feel resistance during catheter insertion.

* Don't Dull on the catheter while inflating the balloon.

SELECTED REFERENCES

Berman, A., et al. (eds): Kozier & Erb's Techniques in Clinical Nursing, 5th edition. Upper Saddle River, N.J., Pearson Education, Inc., 2002.

Hadfield-Law, L.: "Male Catheterization," Accident and Emergency Nursing. 9(4):257-263, 2001.

BY RICHARD L. PULLENJR., RN, EDD

Richard L Pullen, Jr., is a professor of nursing at Amarillo (Tex.) College. Each month this department illustrates key clinical points for a common nursing procedure. Because of space constraints, ifs not comprehensive.