What is the process of inserting a catheter called?

AHRQ Safety Program for Long-Term Care: CAUTI

Slide 1: Urinary Catheter Types and Being Part of the Insertion Team

Slide 2: Learning Objectives

Upon completion of this session, licensed staff who insert or assist in the insertion of urinary catheters will be able to—

• Explain the similarities and differences between the four different types of urinary catheters;
• Prepare for and insert an indwelling urinary catheter using aseptic technique; and
• Summarize effective strategies in preventing CAUTIs.

Slide 3: Indwelling Urinary Catheters1

Images: Figure l. Routes of entry of uropathogens to catheterized urinary tract.
An image depicts the male and female lower urinary tract system, and the difference in placement of a catheter in the bladder.

Source: Maki DG, Tambyah PA. Engineering out the risk of infection with urinary catheters. Emerg Infect Dis. 2001 Mar-Apr;7(2):342-7.
*CMS, State Operations Manual, 2014.

1. Maki DG, Tambyah PA. Engineering out the risk for infection with urinary catheters. Emerg Infect Dis. 2001;7(2):342-7. PMID: 11294737.

Slide 4: Alternative Catheter Types

Straight Catheters

• Inserted directly into the urethra and bladder.
• Removed after insertion and drainage of bladder.
• Used intermittently.

Suprapubic Catheters

• Placed surgically directly through skin into the bladder.
• Connected by tubing to a bag used to collect and measure urine.

External "Condom" Catheters for Men

• Does not enter the bladder.
• Four different types to adhere to the penis.
• Connected by tubing used to collect and measure urine output.
• Cannot be used to treat acute urinary retention.

Slide 5: Quiz2

Which of the following are appropriate indications for placing an indwelling urinary catheter?

1. Bladder outlet obstruction
2. Urinary incontinence
3. Incontinence and sacral wound
4. Resident's request for end-of-life
5. Transferred from hospital with catheter

2. Gould CV, Umscheid CA, Agarwal RK, et al. Centers for Disease Control and Prevention. Guidelines for prevention of catheter-associated urinary tract infections 2009. Atlanta, GA: US Department of Health and Human Services, CDC; 2009. Accessed January 28, 2016.

Slide 6: Preparing to Place an Indwelling Urinary Catheter

• Review the doctor's order and verify that the catheter is clinically indicated.
• Gather your catheter insertion kit and other supplies.
• Use the buddy system—get a second pair of hands to help!

Image: Section of AHRQ poster showing appropriate indications for a urinary catheter.

Slide 7: Catheter Insertion Kit Contents3

• Drape with opening, sterile gloves.
• Antiseptic solution for periurethral cleaning before insertion, swabs and tongs to use for applying antiseptic solution.
• Single-use packet of lubricant.
• Single-use dose of topical lidocaine jelly.
• Sterile urinary catheter, of smallest size effective for patient (14 or 16 French) connected to tubing and bag.
• Catheter securing device.

3. Willson M, Wilde M, Webb M, et al. Nursing interventions to reduce the risk of catheter-associated urinary tract infection: part 2: staff education, monitoring, and care techniques. J Wound Ostomy Continence Nurs. 2009;36(2):137-54. PMID: 19287262.

Slide 8: Prepping for Catheter Insertion Procedure3

• Cleanse hands and don gloves
• Get your buddy to help at the bedside
• Place resident in the supine position
• For a female—apply topical lidocaine jelly if needed for comfort
• For a male—if uncircumcised, retract foreskin. Inject 10-15 mL of topical lidocaine into urethral meatus; gently pinch tip of penis for several minutes to retain lidocaine
• Inspect catheter kit and remove it from its outer packaging to form a sterile field
• Remove gloves and wash hands!

3. Willson M, Wilde M, Webb M, et al. Nursing interventions to reduce the risk of catheter‐associated urinary tract infection: part 2: staff education, monitoring, and care techniques. J Wound Ostomy Continence Nurs. 2009;36(2):137-54. PMID: 19287262.

Slide 9: Hygiene and Standard PrecautionsCatheter Insertion Procedure2,3

• Don sterile gloves.
• Cover resident's lower abdomen and upper thighs with dignity cover.
• Organize contents of tray on sterile field
  • Pour antiseptic solution over swabs in tray compartment.
  • Squeeze sterile catheter lubricant onto tray.

2. Gould CV, Umscheid CA, Agarwal RK, et al. Centers for Disease Control and Prevention. Guidelines for prevention of catheter-associated urinary tract infections 2009. Atlanta, GA: US Department of Health and Human Services, CDC; 2009. Accessed January 28, 2016.
3. Willson M, Wilde M, Webb M, et al. Nursing interventions to reduce the risk of catheter‐associated urinary tract infection: part 2: staff education, monitoring, and care techniques. J Wound Ostomy Continence Nurs. 2009;36(2):137-54. PMID: 19287262.

Slide 10: Male Catheter Insertion Procedure

• Using gloved nondominant hand, grasp penis taut and perpendicular to the plane of the resident's body.
• Cleanse the glans of penis using the antiseptic soaked swabs using tongs, in expanding circular motion. Discard used swabs away from sterile field.
• Keep nondominant hand in this position, do not remove!
• Lubricate tip of catheter with sterile lubricant jelly.
• Holding the coiled catheter in dominant hand, gently introduce the catheter tip into the urethral meatus.
  • If using coude catheter, point catheter tip upward to 12 o'clock position.
• Slowly advance the catheter through the urethra into the bladder. If substantial resistance is met, do not force the catheter!
• If tip of catheter is accidentally contaminated by touching anything that is not sterile, discard, and get a new one.

Slide 11: Female Catheter Insertion Procedure

• Using gloved nondominant hand, identify urethra by spreading the labia
  • Spread inner labia slightly with gentle traction and pull upwards toward resident's head.
  • Clean periurethral area and urethral opening using antiseptic soaked swabs using tongs, in expanding circular motion. Discard used swabs away from sterile field.
• Lubricate tip of catheter with sterile lubricant jelly.
• Holding the coiled catheter in dominant hand, gently introduce the catheter tip into the urethral meatus.
• Slowly advance the catheter through the urethra into the bladder. If substantial resistance is met, do not force the catheter!
• If catheter is accidentally contaminated by touching anything that is not sterile, discard, and get a new one.
• If catheter is accidentally inserted in to vagina, discard, and get a new one.

Slide 12: Securing Drainage Bag

• Advance tubing another 3-5 cm once you see urine in the tubing
  • Inflate balloon with 10 cc sterile water
• Once inflated, pull gently on catheter to make sure it's secure
• Secure catheter to medial thigh
• Place drainage bag below the level of the bladder
• Remove personal protective equipment and wash hands immediately

Slide 13: Insertion Avoiding Common Mistakes4

• Wash hands BEFORE and AFTER procedure
• Put on your sterile gloves after opening catheter kit
  • If sterile, gloved hand gets contaminated or glove rips, then remove glove, wash hands, and don NEW sterile gloves
• Sterile urinary catheters can get contaminated by touching labia, being inserted into vagina, or touching any other part of body besides cleansed urethra
  • If this happens, STOP procedure and get NEW sterile catheter to use
• Use tongs to cleanse the urethral area with your sterile hand
• Do not switch hands

4. Manojlovich M, Saint S, Meddings J, et al. Indwelling urinary catheter insertion practices in the emergency department: an observational study. Infect Control Hosp Epidemiol. 2016;37(1):117-9. PMID: 26434781.

Slide 14: References

1. Maki DG, Tambyah PA. Engineering out the risk for infection with urinary catheters. Emerg Infect Dis. 2001;7(2):342-7. PMID: 11294737.
2. Gould CV, Umscheid CA, Agarwal RK, et al. Centers for Disease Control and Prevention. Guidelines for prevention of catheter-associated urinary tract infections 2009. Atlanta, GA: US Department of Health and Human Services, CDC; 2009. Accessed January 28, 2016.
3. Willson M, Wilde M, Webb M, et al. Nursing interventions to reduce the risk of catheter‐associated urinary tract infection: part 2: staff education, monitoring, and care techniques. J Wound Ostomy Continence Nurs. 2009;36(2):137-54. PMID: 19287262.
4. Manojlovich M, Saint S, Meddings J, et al. Indwelling urinary catheter insertion practices in the emergency department: an observational study. Infect Control Hosp Epidemiol. 2016;37(1):117-9. PMID: 26434781.