- Depending on the student’s underlying health condition, their urinary anatomy may have been altered surgically so may not have the typical appearance
Considerations:
- Be sure to take steps to ensure patient privacy when performing procedure
- Encourage the student to assist in the procedure as much as she 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 healthcare provider should be notified
- The school nurse should be aware of the student’s baseline urine characteristics to identify any concerning changes that may need intervention
- Depending on the student’s underlying health condition, their urinary anatomy may have been altered surgically so may not have the typical appearance
- 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
- Discuss with the health care provider if the student uses a new catheter for each catheterization or reuses the same catheter
- If the student reuses the catheter, discuss with the healthcare provider how long the catheter should be reused (i.e. 5 days, one week, etc.)
Supplies:
- Clean gloves
- Clean catheter (_____ french, per healthcare provider’s order)
- Disposable wipes or mild soap and water or hand sanitizer
- Urinal or receptacle for urine if procedure is not performed on the toilet
- Water based lubricant such as K-Y Jelly® or Lubafax Jelly® if catheter is not prelubricated in packaging
- Disposable pad to place under student if procedure is done on a cot/bed
- Mirror (for assisting student in identifying urethra)
- Extra change of clothing
- Student’s Individualized Healthcare Plan (IHP) and healthcare provider’s order
- Parent/Guardian authorization plan
Procedure:
- Review IHP and healthcare provider’s orders
- Ensure proper documentation of parent/guardian authorization to perform this procedure
- Gather equipment and place on clean surface
- Explain the procedure to the student at her level of understanding
- Encourage the student to assist in the procedure as much as she is able to help student learn self-care skills
- If the student is completing procedure or assisting in procedure, have student wash hands or use hand sanitizer
- 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 1-2 inches of the catheter tip 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
- Using your thumb and one finger of nondominant hand, separate the labia (vaginal lips) and hold open with fingers
- Be prepared to maintain separation of the labia with one hand until the catheter is inserted and the urine is flowing well and continuously
- Using your dominant hand, wash the area with cleaning wipes, disposable wash cloth, mild soapy cotton ball or student specific cleaning supplies starting at the top of the labia moving toward the anus
- Repeat procedure a total of 3 times, once down each side and once down the middle, using a clean cotton ball (wipe or wash cloth) each time
- Locate the urinary meatus
- Helpful hint: urinary meatus is located just under the clitoris above the vaginal opening. If the catheter is inserted and there is no return of urine, leave the catheter in place and use another catheter to locate the meatus. DO NOT reintroduce the first catheter into the urinary meatus
- Using your dominant hand, hold the catheter 2 to 3 inches from the tip and gently insert the catheter
- Advance the catheter until their is return of urine
- If you meet resistance try the following:
- 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
- When urine begins to flow, insert the catheter one inch further
- When urine flow has stopped remove the catheter slowly
- Remove gloves
- Wash hands
- Assist student in dressing, as needed
- Have student wash hands
- Put on clean 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
- 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 water
- Forcefully rinse the catheter lumen with tap water
- Place catheter on clean surface and allow to air dry
- Remove gloves
- Wash hands
- After equipment is dry, store as appropriate
- Review healthcare provider’s order to determine how long the catheter can be used for
- Catheter should be discarded if becomes too stiff or has any discoloration
References:
Bradley E. (2020). Achieving independence in toileting: Self-catheterization efficacy and the role of the school nurse. NASN school nurse (Print), 35(6), 314–318. https://doi.org/10.1177/1942602X20942533
Children’s Minnesota. (2017, July). Catheterizing a girl-intermittent. Retrieved June 20, 2023, from https://www.childrensmn.org/educationmaterials/childrensmn/article/15538/catheterizing-a-girl-intermittent/
Cincinnati Children’s. (2021, July). Intermittent catheterization-females. Retrieved June 20, 2023, from https://www.cincinnatichildrens.org/health/i/catheterize-female
Fortuna, S. M., Korcal, L., & Thomas, G. (2018). Bladder management in children: Intermittent catheterization education. NASN school nurse (Print), 33(3), 178–185. https://doi.org/10.1177/1942602X18756164
Lynn, P. (2019). Catheterizing the female urinary bladder. In Skill checklists for Taylor’s clinical nursing skills. A nursing process approach. (5th ed.). (pp. 268-270).
Perry, A. G., Potter, P.A., Ostendorf, W., & Laplante, N. (2021). Skill 34.1 insertion of a straight or an indwelling urinary catheter. In Clinical nursing skills and techniques. (10th ed.). (pp. 997-1008). St. Louis, MO: Elsevier.
Porter, S.M., Page, D., Engholm. H., & Somppi, C. (2019). Students supported by medical technology. In Selekman, J. (Ed.), School nursing, a comprehensive text (3rd ed.) (pp. 721-740). Philadelphia PA.: F.A. Davis Co.
Spina Bifida Association. (n.d.). Continence management in schools. Retrieved June 20, 2023, from https://www.spinabifidaassociation.org/wp-content/uploads/Beyond-Crayons-info-sheet-Continence-Management.pdf
Tobias, N.E. (2017). Practical considerations and current best practice for pediatric clean intermittent catheterization. Pediatric nursing, 43(6), 267-273.
Toothaker, R., & Cook, P. (2018). A review of four health procedures that school nurses may encounter. NASN school nurse (Print), 33(1), 19–22. https://doi.org/10.1177/1942602X17725885
Page last reviewed: March 3, 2025
Page last updated: March 3, 2025
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.