Considerations
Urinary catheters are used to drain urine when people are unable to urinate on their own or to obtain a sterile urine specimen to test for bacteria. Urinary tract infection can result if the catheter isn't inserted using sterile technique, and the patient may be uncomfortable if the catheter isn't placed properly.
Supplies
Gather supplies ahead of time so you don't fumble at the patient's beside. You need sterile gloves, a sterile urinary catheter and prepackaged swabs or bottled Betadine, an effective antiseptic, to clean the meatus, the opening to the urethra, and the area around it. Sterile gauze and a sterile drape to shield the patient are also needed. Many of the supplies needed are prepackaged in kits. A sterile package of lubricant to moisten the end of the catheter helps the catheter slide into the urethra more easily. If the catheter is going to be left in place, you need a urine collection bag that will be attached to the catheter and a small syringe full of sterile water, which is used to inflate the "balloon" on the catheter after it's inserted. The balloon keeps the catheter from sliding back out of the bladder.
Preparation
Explain to the patient what you're going to do, why you're doing it, and what they'll feel. Have the patient lie on his back, with his legs bent at the knees and flopping slightly to the side. Clean the meatus and surrounding area with Betadine, after explaining to the patient that it will feel cold. Lubricate the tip of the catheter with the sterile lubricant by opening the catheter using sterile technique, opening the lubricant and squirting it onto the tip without touching the package to the catheter. Put on sterile gloves and place the sterile drape over the patient, covering the area around the urethra. Test the balloon after filling the syringe with sterile water; leave the syringe attached to the fill port. Pick up the catheter a few inches from the tip.
Insertion
Males are easier to catheterize than females; they only have one opening that could possibly be the urethra, and it's right out in the open. Women have openings to the vagina and the urethra fairly close together, and it can be difficult to tell one from the other, especially in uncooperative or obese patients. The urethral opening is above the vagina, and it's smaller. Use one hand, which will become your unsterile hand, to grasp the penis, or to gently open the labia in women. Then slowly and gently, but firmly, push the tip of the catheter into the opening. Keep going as long as you don't meet resistance, until urine appears. This is about two inches in women and eight inches in men, according to the University of Ottawa. This indicates you're in the bladder.
Attachment
Inflate the balloon if the catheter is going to stay in. Pull gently to make sure the balloon is in place and ask the patient how it feels. Pinch the catheter gently near the end to stop the flow of urine or use the clamp attached to the bag so you can attach the bag to the catheter without getting urine on yourself. Check that urine is flowing into the bag, and attach the bag to a spot on the bed where it's unlikely to get tangled, stepped on or tripped over.
