Catheterization: Female

For a child who has a history of intermittent catheterization, there should be no pain with completing the procedure. Before beginning the procedure, be sure to plan for privacy while the procedure is being performed. Review the steps in the procedure, be familiar with the delegated task by the school nurse, and follow the healthcare provider’s orders provided to the school from the family. Each learner has unique healthcare needs. The following steps provide a framework for the school nurse in delegation and additional steps, if applicable, from the child’s healthcare provider.  The instructional steps assist the registered nurse working under the auspices of the school or program in professional judgement and accountability of delegation. Additional steps may be required depending on the learner’s health needs.

Steps

1. Provide privacy
2. Gather the necessary equipment.
3. Place the equipment of a clean surface using a disposable pad.
4. Explain the procedure at the level of the student’s understanding.
5. Encourage the student to participate in the procedure (if developmentally appropriate and as much as possible)
6. Position the student on a cot or bed, unless otherwise stated.
7. Assist the student with undressing their lower half.
8. Place a clean disposal pad underneath the student’s lower half.
9. Wash your hands. Have or help the student wash their hands.
10. Arrange the equipment so that you have easy access to it during the procedure on the clean disposable pad.
11. Put on clean gloves.
12. Lubricate the tip of the catheter by rolling the tip in a water-soluble lubricant.
13. Place the lubricated catheter on the clean disposable pad that has the supplies.
14. Encourage the student to take deep breaths or other relaxation techniques.
15. With your non-dominant gloved hand, separate the labia and gently hold open with your fingers.
16. Using your dominant gloved hand, cleanse the area by wiping with cleansing wipes or a wash cloth, starting at the top of the left side of the labia and moving towards the anus (do not re-use wipes or wash cloth)
17. Using your dominant gloved hand and a new cleansing wipe or wash cloth, cleanse the area by wiping with cleansing wipes or a wash cloth, starting at the top of the right side of the labia and moving towards the anus (do not re-use wipes or wash cloth)
18. Using your dominant gloved hand and a new cleansing wipe or wash cloth, cleanse the area by wiping with cleansing wipes or a wash cloth, starting at the top of the center of the labia and moving towards the anus (do not re-use wipes or wash cloth)
19. Locate the urinary meatus.
20. Using your dominant hand, grab the urine container and place the non-lubricated catheter end in the urinary container at the same height or below the urinary meatus to allow for gravity.
21. Using your dominant hand, slide your gloved hand up the catheter to pick up the catheter and the lubricated tip.
22. Gently insert the catheter in the urinary meatus
    1. If you meet resistance, gently rotate (roll) the catheter without advancing. If unsuccessful, stop.
       1. Have the student sit or lie in a different position and rebegin steps
    2. If the student experiences discomfort, stop.
23. When urine begins to flow in the urinary storage container, insert the catheter 1 inch and hold in  place until urine stops flowing.
24. When urine has stopped flowing, remove the catheter gently.
25. Using a cleaning wipe or dry washcloth, wipe the student from front to back one time.
26. Measure the urine and flush it in the toilet using infection control procedures.
27. Rinse out the urinary container and dispose of used supplies.
28. If the student re-uses the catheter, clean and store it as instructed
29. Remove your gloves
30. Assist the student with redressing.
31. Wash your hands. Have or help the student wash their hands.
32. Document the date, time, the procedure completed, the amount of urinary output, any unusual color, odor, or appearance, the student’s response, your initials, and your signature.
33. Update the school nurse, parent, or guardian as instructed or needed.