Catheterization of an Artificial Bladder Channel

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Considerations:

  • Be sure to take steps to ensure patient privacy when performing procedure
  • Encourage the student to assist in the procedure as much as he/she is able to help student learn self-care skills
  • There may be a small amount of urine leakage through the artificial opening
  • There may be some resistance when attempting to catheterize the artificial opening because the channel goes through abdominal muscle wall. The student, parent/guardian may be able to provide some suggestions on how best to pass the catheter and access the bladder

Supplies:

  • Gloves
  • Clean or sterile straight catheter
  • Catheter storage bag
  • Disposable wipes or soap and water
  • Urinal or receptacle for urine if procedure is not performed on the toilet
  • Water based lubricant
  • Disposable pad to place under student if procedure is done on a cot/bed
  • Student’s Individualized Health Plan (IHP) and/or healthcare provider’s order

procedure download skill competency

  1. Review IHP and/or healthcare provider’s order
  2. Gather equipment and place on clean surface
  3. Explain the procedure to the student at his/her level of understanding
  4. Encourage the student to assist in the procedure as much as he/she is able to help student learn self-care skills
  5. If the student is completing procedure or assisting in procedure, have student wash hands
  6. Assist student with undressing, as needed
  7. Position the student
  8. If student is lying on a cot/bed, place a disposal pad under the student
  9. Wash hands
  10. Arrange equipment
  11. Put on gloves
  12. Lubricate the tip of the catheter with a water soluble lubricant and place on a clean surface
  13. Wash the stoma with soapy cotton ball, cleansing wipe, or student specific cleaning supplies in a circular motion, moving from the opening out
  14. Repeat procedure a total of 3 times
  15. Slowly insert the catheter into stoma until urine begins to flow
  16. Insert the catheter 1-2 inches further
  17. Having the student contract their abdominal muscles or crede bladder may assist in removing all the urine from the bladder
  18. When urine flow has stopped, slowly pull catheter out. You may notice more urine starting to flow into the container as you pull it out. Continue to drain the bladder and completely remove catheter
  19. Remove gloves
  20. Wash hands
  21. Reapply bandage or gauze on stoma if present
  22. Assist student in dressing, as needed
  23. Have student wash hands
  24. Put on gloves
  25. Assess urine for cloudiness and/or foul smell
    • If present, assess student for signs of urinary tract infection:
      •  fever
      • abdominal pain
      • blood in urine
      • vomiting
      • chills
  26. Measure urine per student’s order
  27. Discard bodily fluids and catheter per infection control procedures and school district policy
  28. Wash the used catheters with warm soapy water
  29. Rinse them thoroughly with water
  30. Let them air dry on a clean surface
    • Catheters should be discarded if they:
      • can no longer be thoroughly cleaned
      • smell bad
      • become too stiff (brittle)
  31. Remove gloves
  32. Wash hands
  33. Document assessment, intervention and outcome in student’s healthcare record
  34. Update student’s parents/guardian and healthcare provider, as needed

Cleaning for catheter that will be used again during the school day:

  1. Put on clean gloves
  2. Clean catheter with mild soap and warm water
  3. Forcefully rinse the catheter lumen with tap water
  4. Place catheter on clean surface and allow to air dry
  5. Remove gloves
  6. After equipment is dry, store as appropriate
    • Catheter can be used for up to a month
    • Should be discarded if becomes too stiff or has any discoloration

If ordered by healthcare provider, sterilize the catheters once a day:

  1. Put on clean gloves
  2. Clean the catheter as above with soap and water.
  3. Prepare a solution of 1 teaspoon liquid bleach to 8 ounces water in a clean, tightly covered container
    • Use a pure, fragrance-free and additive-free bleach, such as Hilex® or Clorox®
    • Prepare a new solution every day.
  4. Soak catheters in bleach solution for at least 30 to 60 minutes
  5. After soaking, rinse well with warm water and air dry on a clean towel

References:

Bowden, V. R., & Greenberg, C. S. (2012). Pediatric nursing procedures (Third Edition). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Connecticut State Department of Education. (2012). Clinical Procedure Guidelines for Connecticut School Nurses. Available at:
http://www.sde.ct.gov/sde/lib/sde/pdf/publications/clinical_guidelines/clinical_guidelines.pdf

National Institute for Health and Clinical Excellence (NICE). (2012). Infection. Prevention and control of healthcare-associated infections in primary and community care. Available at:
http://www.nice.org.uk/nicemedia/live/13684/58656/58656.pdf

National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). (2010). Urostomy and Continent Urinary Diversion. Available at: http://kidney.niddk.nih.gov/kudiseases/pubs/urostomy/#urostomy

Porter, S., Haynie M.D., Bierle, T., Caldwell, T. & Palfrey, J. (1997). Children and Youth Assisted by Medical Technology in Educational Settings. Guidelines for Care. Second Edition. Paul H. Brookes Publishing Co., P.O. Box 10624, Baltimore, MD 21285-0624

United Ostomy Association of America. (2009). Continent Urostomy Guide. Available at:
http://www.ostomy.org/ostomy_info/pubs/ContinentUrostomyGuide.pdf

Acknowledgment of Reviewers:

Katie Kressin, RN, MSN, CPNP
Nurse Practitioner
Pediatric Urology
Children’s Hospital of Wisconsin

Mary Kay Logemann, RN, BSN, Med
School Nurse
Platteville Public Schools

Kerri Schmidt, BSN, RN, NCSN
School Nurse
Rhinelander School District

Heidi Vanderpool, RN, MSN, CPNP
Nurse Practitioner
Pediatric Urology
Children’s Hospital of Wisconsin

Page last reviewed: November 18, 2015
Page last updated: April 6, 2015