Procedure for female catheterisation

Prior to opening packs and commencing the procedure, it is necessary to cleanse the genital area with soap and water.
Catheter insertion, including Intermittent Catheterisation when carried out by nursing staff should always be a strict aseptic technique¹⁵.

Equipment

• Sterile dressing pack
• Appropriate catheter + unopened spare
• Sterile syringe
• Alcohol hand rub
• Prefilled syringe to inflate balloon (sterile water or glycerine solution)
• Sterile closed urinary drainage bag
• Fixation device
• Sterile nitrile gloves (1 pair)
• Disposable pad
• Instillagel¹⁵
• Drainage bag or valve
• PPE
• Non-sterile latex/non-latex gloves (1 pair)
• Clinical waste bag in accordance with Waste Management Policy.

Procedure

Preparation and pre catheter insertion procedure

1. Explain the procedure to the patient.
   Reassure patient and obtain consent for procedure to be performed.
2. Assist the patient to get into the supine position with the legs extended.
   Do not expose the patient at this stage of the procedure.

Catheter removal

3. Decontaminate hands as per the WHO 5 moments for hand hygiene.
4. Put on PPE
5. Using a 10ml syringe, deflate catheter balloon fully.
6. Gently remove and dispose of catheter appropriately.
7. Remove PPE and dispose of as per waste management policy and decontaminate hands as per the WHO 5 moments for hand hygiene.
8. The basin must be removed from the bedside prior to setting up for sterile procedure.

Catheter insertion procedure

9. Decontaminate hands as per the WHO 5 moments for hand hygiene.
10. Prepare equipment required on a clean/sterile working surface.
11. Open the outer cover of the dressing pack.
12. Using an aseptic technique, open the supplementary packs.
13. Decontaminate hands as per the WHO 5 moments for hand hygiene.
14. Put on PPE.
15. Place sterile drape under buttocks when in lithotomy position.
16. Cleanse meatal area with sterile solution.
17. Prime Instillagel tube. Insert Instillagel (6mls) into the urethra (Instillagel, pharmacy have drawn attention to chlorhexidine contents, be aware of risk of anaphylaxis, consult patients GP especially on first use). Squeeze the gel into the urethra. Gel should be left in situ for 5 minutes¹⁶. This minimises urethral trauma and infection.
18. Insert the catheter into the urethra up to bifurcation of catheter.
19. Observe for 30-50mls of urine prior to inflating the balloon.
20. Inflate the balloon according to the manufacturer’s direction with sterile water, and ensure the catheter is draining properly beforehand.
    Inadvertent inflation of the balloon in the urethra causes pain and urethral trauma. Deflate the balloon, remove immediately and seek advice.
21. Withdraw the catheter slightly and attach it to the sterile drainage system.
22. Ensure the patient is comfortable.

Post insertion

23. Remove PPE and decontaminate hands as per the WHO 5 moments for hand hygiene.
24. Dispose of equipment as per Waste Management Policy.
25. Implement appropriate documentation stating, date and time and reason for catheterisation, size, type and length of catheter, balloon volume, batch number, expiry date. Record batch number, volume and expiry date of Instillagel.
26. Ensure patient has contact telephone number for the Named Nurse (Community).
27. Review regularly the patient’s clinical need for continuing urinary catheterisation and remove the catheter as soon as possible if no longer required.
28. Provide patients with written information in relation to the maintenance and action to be taken if catheter should be accidentally removed.