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 is able to help student learn self-care skills
- Students who require urinary catheterization frequently have cloudy, foul smelling and sometimes bloody urine. Notify parent if there is a change in urine as health care provider should be notified
- Many students who require urinary catheterization may also have bowel issues such as constipation or stool leakage. The student may be on a daily bowel regimen at home
Supplies:
- Gloves
- Clean straight catheter (_____ french, per healthcare provider’s order)
- Catheter storage bag or container (toothbrush holder, non-airtight plastic bag)
- Disposable wipes or mild soap and water
- Urinal or receptacle for urine if procedure is not performed on the toilet
- Water based lubricant such as K-Y Jelly® or Lubafax Jelly®
- Disposable pad to place under student if procedure is done on a cot/bed
- Extra change of clothing
- Student’s Individualized Health Plan (IHP) and/or healthcare provider’s order
- Review IHP and/or healthcare provider’s orders
- Gather equipment and place on clean surface
- Explain the procedure to the student at his level of understanding
- Encourage the student to assist in the procedure as much as he is able to help student learn self-care skills
- If the student is completing procedure or assisting in procedure, have student wash hands
- Assist student with undressing, as needed
- Position the student
- If student is lying on a cot/bed, place a disposal pad under the student
- Wash hands
- Arrange equipment
- Put on clean gloves
- Lubricate the tip of the catheter with a water soluble lubricant and place on a clean surface
- Use a generous amount of lubricant along the length of the catheter since dry catheters may cause excoriations in the urethra, leading to an entry point for bacteria contamination
- Grasp sides of penis below the glans
- Gently retract foreskin if uncircumcised
- Wash the glans with soapy cotton ball or student specific cleaning supplies
- Begin at urethral opening and in a circular motion wash away from the meatus toward the base of the penis
- Repeat procedure a total of 3 times, using a clean cotton ball each time
- Gently straighten the penis for ease of insertion
- Have student take a deep breath and do other relaxation techniques
- Slowly insert the catheter until urine begins to flow and then about an inch more
- If you meet resistance try the following (resistance in male catheterization is normal at about the level of the prostate):
- Rotate the catheter
- Have the student sit or lie in a different position
- If you are still unable to insert the catheter or the student experiences pain remove the catheter and follow up with parents/guardian and healthcare provider
- If resistance continues or the student experiences pain, stop insertion. Never force the catheter
- When urine flow has stopped, pinch the catheter and remove it slowly
- If student is uncircumcised, pull the foreskin over the glans when finished
- This is extremely important as failing to do this can result in a paraphimosis which is an emergent situation
- Remove gloves
- Wash hands
- Assist student in dressing, as needed
- Have student wash hands
- Put on gloves
- 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
- If present, assess student for signs of urinary tract infection:
- Measure urine per healthcare provider’s order
- Discard bodily fluids and catheter per infection control procedures and school district policy
- Clean and store equipment as appropriate
- Remove gloves
- Wash hands
- Document assessment, intervention and outcome in student’s healthcare record
- Update student’s parents/guardian, as needed
Cleaning for catheter that will be used again during the school day:
- Put on clean gloves
- Clean catheter with mild soap and warm water
- Forcefully rinse the catheter lumen with tap water
- Place catheter on clean surface and allow to air dry
- Remove gloves
- 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
References:
Bowden, V. R., & Greenberg, C. S. (2012). Pediatric nursing procedures (Third Edition). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Bray. L., & Sanders, C. (2007). Teaching Children and Young People Intermittent Self-Catheterization. Urologic Nursing, 27(3), 203-09.
Children’s Hospitals and Clinics of Minnesota. (2013). Catheterizing a boy (intermittent). Available at: http://www.childrensmn.org/manuals/pfs/homecare/018323.pdf
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
Gould, C.V., Umscheid, C.A., Agarwal, R.K., Kuntz, G., Pegues, D.A. (2009). Healthcare Infection Control Practices Advisory Committee (HICPAC). Guideline for prevention of catheter-associated urinary tract infections 2009. Atlanta (GA): Centers for Disease Control and Prevention (CDC), 67, 281. Available at: http://guideline.gov/content.aspx?id=15519&search=urinary
Katrancha, E.D. (2008). Clean Intermittent Catheterization in the School Setting. The Journal of School Nursing, 24: 197-204.
Lacroix, L.A., Vunda, A., Bajwa, N.M., Galetto-Lacour, A., and Gervaix, A. (2010). Catheterization of the Urethra in Male Children. New England Journal of Medicine, 363(14), e19-21.
Newman, D.K. & Willson, M.M. (2011). Review of Intermittent Catheterization and Current Best Practices. Urological Nursing, 31(1), 12-48.
National Institute for Health and Clinical Excellence (NICE). (2012). Infection. Prevention and control of healthcare-associated infections in primary and community care.
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
Acknowledgement of Update Reviewer:
Katie Aussem, RN, MSN, CPNP
Nurse Practitioner
Pediatric Urology
Children’s Hospital of Wisconsin
Acknowledgment of Original Reviewers:
Katie Aussem, 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: June 28, 2021
Page last updated: June 28, 2021
The information and materials presented in this Website are intended for informational purposes only and are not designed to diagnose or treat a health problem or disease, or assist in diagnosis or treatment of the same. The information is not intended to substitute for, supplement or replace clinical judgment. If there are any concerns or questions about or relating to a nursing or medical procedure, contact the individual’s healthcare provider. The information provided on this Website is not intended to be a substitute for medical orders and persons without the proper education, training, supervision and/or licensure should not perform the procedures.