The Urinary Catheterization Procedure: Male and Female Catheter Insertion

urinary catheter procedure

In the health care field, it is important to know and understand what a urinary catheter is and how to insert one into a patient.

The process of inserting a urinary catheter is called catheterization and this procedure will change slightly depending on whether you are dealing with a male or female patient.

In this article, I will be walking you through the urinary catheterization procedure for both male and female patients.

Items You Will Need for the Procedure

urinary catheter procedure

The following are the main items you will need to gather for the urinary catheterization procedure:

  • Dressing trolley
  • Catheterization pack and drapes
  • Sterile Lubricant and/or Xylocaine jelly syringe (plain sterile lubricant for infants)
  • Sterile water to inflate the balloon (normal saline can crystallise and render the balloon porous, causing its deflation and the risk of catheter loss)
  • 10 ml Syringe
  • Urinary Drainage Bag
  • Specimen Jar
  • Sterile saline
  • Cotton balls
  • Tape to secure the catheter to the patient’s leg
  • Sterile gloves
  • Urinary Catheter (appropriate size and type)
    • Common catheter size in adult men: 14 to 16 french
    • Common catheter size in adult women: 12 to 14 french

Use the smallest catheter appropriate because too large of a catheter can cause tissue erosion caused by excessive pressure on meatus

Please note: In most cases, most of the items you need will come in a prepackaged sterile tray and so you will only have to worry about the other materials such as the dressing trolley to put your materials on.

Assessing A Patient Before the Urinary Catheterization Procedure

urinary catheter procedure

Before you begin an assessment be sure to introduce yourself to the patient.

Verify that you have the right patient by verifying the patient’s ID and date of birth.

Proceed to explain how the entire procedure will be done so that the patient is well aware and knows what to expect.

Get consent from the patient before proceeding with the procedure.

Perform hand hygiene. Maintain privacy, confidentiality, and dignity.

During the assessment process, you might want to also do the following:

  1. Inspect the abdomen for bladder distension caused by urine retention. Ask the client to let you know if they feel any discomfort.
  2. If the client complains about discomfort, palpating the client’s abdomen for discomfort
  3. Using a bladder scanner, measure the amount of urine inside the bladder. If the amount is more than 500 ml then you can go ahead and catheterize the patient. Be sure to follow your agency’s protocol on catheterization.
  4. Verify that the client is not allergic to latex, iodine, or betadine. If they are allergic to these, replace the catheter in the kit with a silicone one.

Please note that during the insertion of a urinary catheter, use sterile aseptic technique throughout the entire procedure to prevent the transfer of microbes to the patient’s genitalia.

Things to Do to Prepare your Patient for Catheterization

Consider washing the patient’s genital area before the procedure if visibly soiled.

Don non-sterile gloves, wash patient’s genital area thoroughly with foam body cleanser and water prior to starting.

Remove gloves and wash hands or hand hygiene.

Female Urinary Catheter Insertion

Initial Positioning and Preparation

urinary Catheterization procedure

For female catheter insertion, the proper position for a female is to the dorsal recumbent position so go ahead and place your patient in this position.

Place all your supplies on the dressing trolley, Perform Hand hygiene. Be sure to place a pad underneath the patient to protect the bed linen.

Open the Urinary catheter kit.

Using aseptic technique, open the outer plastic wrap to form a sterile field and place the underpad beneath the patient, plastic side down.

Clamp the urinary drainage bag and attach it to the patient’s bed, if you are using an indwelling catheter.

Get a garbage bin ready and close to you. You can use the plastic bag that the sterile kit is in as your bin.

Tape it to the side of the dressing trolley that is within reach and accessible, without contaminating the sterile field during the procedure.

The next step is to use the drapes in the kit to drape over the patient, ensuring that the opening on the drapes exposes the patient’s perineum.

The drape is sterile so when applying the drape use the one-inch border to pick up the drape and apply it with the shiny side down, touching the patient’s skin.

Do not forget that the drape is sterile and so avoid touching areas past the one-inch border unless you are wearing sterile gloves.

Conversely, if you wear a sterile glove avoid touching the areas on the one-inch border as this is the non-sterile area of the drape.

Apply the sterile gloves from the kit using sterile technique

You can place the sterile tray with the catheter between the client’s legs to be used to collect the urine once the catheter has been inserted.

Dispense the lubricating gel into the kit tray ready for use when inserting the catheter

Pour the cleansing solution such as iodine or bentadine solution over three cotton balls.

Cleansing the Perineum and the Insertion of the Catheter for Females

To clean the perineum, separate the labia using the non-dominant hand and visualize the meatus.

Take one cotton ball or swab saturated with cleaning solution with the forceps, wipe one side of the labia from top to bottom and discard the cotton ball or swab away from the sterile field.

Take the second cotton ball and swab and wipe the other labia fold from top to bottom and discard.

And then take third cotton ball and swab and wipe the middle part of the perineum, the center of the labia folds and discard.

Remove the plastic sleeve from the catheter and lock the sterile water syringe into the port.

Do not pre-inflate the balloon prior to insertion.

Using the dominant, sterile hand to handle the catheter, cover the tip of the catheter with lubricant. Insert the catheter through the urethra into the bladder.

Instruct the patient to inform you if they are feeling any discomfort with inflation of the balloon.

If the patient is feeling any discomfort, this could mean that the catheter is most likely in the urethra and will need to be deflated and advanced.

To determine that you have reached the bladder in female patients, insert the catheter approximately three inches, wait to see if urine flows, then advance another inch before inflating the balloon.

For unconscious female patients or those with decreased sensation (i.e. paralyzed), insert the catheter slightly further than three inches, to make certain the catheter is in the bladder.

Inflate the balloon slowly, using the entire 10 cc of sterile water.

Withdraw the catheter slowly until there you feel resistance at the bladder neck.

Male Urinary Catheter Insertion

For male catheter insertion, the proper position for a male client is the supine position so be sure to place your male clients in the supine position prior to insertion.

Place all your supplies on the dressing trolley, Perform Hand hygiene. Be sure to place a pad underneath the patient to protect the bed linen.

Open the Urinary catheter kit.

Using aseptic technique, open the outer plastic wrap to form a sterile field and place the underpad beneath the patient, plastic side down.

Clamp the urinary drainage bag and attach it to the patient’s bed, if you are using an indwelling catheter.

Get a garbage bin ready and close to you. You can use the plastic bag that the sterile kit is in as your bin.

Tape it to the side of the dressing trolley that is within reach and accessible, without contaminating the sterile field during the procedure.

The next step is to use the drapes in the kit to drape over the patient, ensuring that the opening on the drapes exposes the patient’s perineum.

The drape is sterile so when applying the drape use the one-inch border to pick up the drape and apply it with the shiny side down, touching the patient’s skin.

Do not forget that the drape is sterile and so avoid touching areas past the one-inch border unless you are wearing sterile gloves.

Conversely, if you wear a sterile glove avoid touching the areas on the one-inch border as this is the non-sterile area of the drape.

Apply the sterile gloves from the kit using sterile technique

You can place the sterile tray with the catheter between the client’s legs to be used to collect the urine once the catheter has been inserted.

Dispense the lubricating gel into the kit tray ready for use when inserting the catheter

Pour the cleansing solution such as iodine or bentadine solution over three cotton balls.

Cleansing the Perineum and the Insertion of the Catheter for Males

urinary catheter insertion procedure

To clean the perineum, retract the foreskin, if present, and hold the shaft of the penis with the non-dominant hand.

Grasp one solution-soaked cotton ball or swab with the forceps. Using a circular motion, wipe the glans from the meatus outward. Discard the cotton ball away from the sterile field.

Repeat the previous step, cleaning in a circular motion with the remaining two solution saturated cotton balls or swab until the glans penis is fully cleansed. Then wipe the area dry with the dry cotton balls.

Remove the plastic sleeve from the catheter and lock the sterile water syringe into the port. Do not pre-inflate the balloon prior to insertion.

Using the dominant, sterile hand to handle the catheter, cover the tip of the catheter with lubricant.

Grasp the penis in an upright position and insert the lubricated catheter firmly into the meatus, through the urethra into the bladder.

Instruct the patient to inform you if they are feeling any discomfort with inflation of the balloon.

If the patient is feeling any discomfort, this could mean that the catheter is most likely in the urethra and will need to be deflated and advanced.

To determine that you have reached the bladder in male patients, advancing the catheter 7 to 9 inches, when urine return is seen, advance the catheter forward another one inch (2.5 cm).

A slight lean toward the umbilicus may be necessary if resistance in advancing the catheter is met at the prostate.

The return of urine does not assure that the catheter is placed correctly in males since there is residual urine in the penis.

Inserting the catheter to the bifurcation of the Y is the standard for assurance of proper placement.

Inflate the balloon slowly, using the entire 10 cc (ml) of sterile water.

Withdraw the catheter slowly until there you feel resistance at the bladder neck.

If the foreskin was retracted, re position it after placement.

Note: If catheter placement is in question (i.e. no urine return or unable to fully insert the catheter) do not inflate the balloon and contact the physician.

If resistance is met do not attempt forceful catheter insertion; apply continuous gentle pressure and ask the patient to take slow deep breaths to help relax or instruct.

Securing the Urinary Drainage Bag

urinary catheter insertion procedure

Be sure to secure the catheter to the patient’s thigh with hospital approved catheter securement device (ie: Stat Lock) to prevent movement, irritation, and to decrease the risk of infection.

To improve urine flow, some men may need to have the catheter secured slightly upward.

For males with long-term catheters, the catheter should be taped to the abdomen to prevent damage to the inferior urethra.

Position the bag to avoid urine reflux into the bladder, kinking, or gross contamination of the bag.

For inpatient setting, position the bag hanger on the bed rail near the foot of the bed using the clip to secure the drainage tube to the sheet.

Keep the bag below the level of the bladder at all times to prevent the backflow of urine and decrease the risk of infection.

Things to Avoid When Dealing with Urinary Catheters

Do not leave the catheter hanging to be pulled by the weight of the bag.

Do not leave the bag laying on the floor unless it is necessary due to patient positioning (i.e. Trendelenburg position in the Operating Room).

Do not irrigate a Foley catheter unless indicated for post urology /genitourinary trauma, surgery, or in the ICU to relieve an obstruction.

Documenting the Catheterization Procedure

urinary catheter procedure

After the procedure, be sure to document the procedure, including the size of the catheter placed, the color, amount, and clarity of urine returned after the initial placement and patient response.

I hope this article helps you to understand the urinary catheterization procedure.

If you have any comments, feedback or questions. I would like to hear from you.

kindly share them in the comment section below.

Thank you for reading!

10 Replies to “The Urinary Catheterization Procedure: Male and Female Catheter Insertion”

  1. Thanks for this most informative article. I’m about to become an in-patient for a bit and was warned that I would need a catheter. Although I know what that is, until I read your article I didn’t know what to expect so the nerves were up there. A better understanding certainly helps and your article has provided that. Thanks and thanks for helping those who at times can’t help themselves.

    1. Hi Mike,

      I am glad to hear that you found this post helpful. I encourage you to read about the procedure a couple more times so that you will be comfortable with it when the time comes. And most nurses will explain the procedure to you but you can ask them what exactly they will be doing if they don’t. I wish you all the best.

      Regards,

      Pam

  2. Very interesting article and even more interesting niche. I could seriously binge read on this site all day, as it’s interesting to see how certain procedures work. This would be great for anyone unsure of how a particular procedure is performed or might have some questions regarding one if they have to undergo it. Well written, relevant imagery, too.

  3. Thank you, you have provided a super detailed description of this procedure which I am sure will provide nurses with the skills and knowledge they need to feel confident in their catheterisation of patients. Well done on such a terrific resource.

  4. This article was extremely informative and helpful! I had no idea of the work and effort this procedure takes to do until i read your article and I am very thankful to all you nurses and doctors out there.

  5. What a nice post you wrote! I really enjoyed reading it and I could not be silent about your post so I decided to leave my comment here and say Thank You! For sharing this quality post with others.
    Actually this is exactly the information that I was looking for about urinary catheterization and when I landed to your website and read this post, it answered all my questions in details.
    So I’m happy that you decided to write about this topic and share it with people. It’s very useful and can definitely be used as a great source for urinary catheterization procedure.
    I will come back to your website again for sure and I’m looking forward to read your new posts.)

    Thanks!

    1. Hi Ali,

      I am happy to hear that you found this post useful. And that this post answered all your question about urinary catheterization. I hope you have a great day
      Thank you for your comment
      Regards

      Pam

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