Introduction Introduce yourself – state your name and role Confirm patient details – name / DOB Ensure a chaperone is present Explain procedure: “I need to insert a catheter to allow monitoring of your urine output.“ “This will involve inserting a thin flexible tube into the penis to reach the bladder.” “The procedure will feel a little uncomfortable but shouldn’t be painful.” “I’ll insert some local anaesthetic into the penis to make the procedure as comfortable as possible.” “One of the nursing staff will be present and acting as a chaperone.” Gain consent – “Do you understand everything I’ve said?” “Are you happy to go ahead with the procedure?” 5. Position the patient: Position the patient supine Ensure the bed is at an appropriate height for you to comfortably carry out the procedure Expose the patient’s genitalia (or ask your chaperone to do this) 6. Wash hands again and don sterile gloves 7. Place sterile absorbent pad underneath patient’s genital area 8. Clean the penis: Hold the penis with your non-dominant hand using some sterile gauze Ensure the foreskin is retracted Pick up the wet cotton balls and begin to clean the penis Clean in the direction away from the meatus 9. Discard used gloves, wash hands and don a new pair of sterile gloves 10. Place sterile drape over the patient’s penis and place sterile receiver below the penis 11. Insert the anaesthetic gel: Check the expiry date and ensure the gel is the correct medication Warn the patient that the anaesthetic might initially sting, but will go numb quickly Hold the penis vertically with your non-dominant hand using sterile gauze With your dominant hand place the nozzle of the syringe of anesthetic gel into the penile meatus Empty the entire 10mls of anaesthetic gel into the urethra – at a slow steady pace Continue to hold to penis in the vertical position to ensure the gel remains within the urethra Give the gel 3-5 minutes to take full effect Inserting the catheter The catheter should be on your sterile field in a plastic wrapper. 1. Remove the tear-away portion of the wrapper near the catheter tip – don’t touch the catheter! 2. Hold the penis again using gauze with your dirty hand 3. Insert the exposed catheter tip into the urethral meatus using your clean hand – warn patient 4. Advance the catheter slowly but firmly – slowly removing the wrapper to expose more catheter The key to removing the wrapper without also pulling the catheter back out is to ensure a good grip on the penis as you pull back on the wrapper. 5. As you pass the prostate you may notice some resistance and the patient may feel more discomfort If the resistance is significant and the patient is in a lot of discomfort, you should remove the catheter and consider a repeat attempt or input from urology. 6. As you enter the bladder you will see urine begin to drain from the catheter 7. You should continue to advance the catheter until it is fully inserted 8. Once fully inserted, inflate the catheter balloon with your 10ml syringe of water Ask the patient to let you know immediately if they feel any discomfort during this 9. Once the balloon is fully inflated, withdraw the catheter until resistance is felt This confirms the catheter is held firmly within the bladder 10. Attach the catheter bag tubing to the end of the catheter, ensuring a tight seal 11. Place the catheter below the level of the patient 12. Replace the patient’s retracted foreskin – failure to do so can result in paraphimosis 13. Clean up the patient and dispose of your equipment 14. Allow the patient to get dressed To complete the procedure… Thank patient Wash hands Ask nursing staff to monitor urine output. Document the procedure, making sure to include: Your details – name / grade / GMC number Date / time Consent gained Chaperone present Reason for catheterisation Volume of water inserted into balloon – e.g. 10mls Size of catheter Use of local anaesthetic Any complications during the procedure Residual volume of urine drained Appearance of urine – golden / haematuria Source
