1. Preparation:

Ensure there is medical authorisation for catheter insertion. Inform the person of the procedure, ensure privacy.
Obtain consent given for the procedure.
Place bed at appropriate height.

• An informed consent process will maximise the person's co-operation during the procedure and in the ongoing care of the catheter.
• Urethral catheterisation is an invasive procedure.
• Meet OH&S manual handling policies.

• Refer to Hand Hygiene protocol

• Refer to Selecting a urinary catheter section in this document
• Assist to maintain aspetic technique  
• Refer to Aseptic Technique Policy.

• Ensuring the area is recently cleaned reduces the risk of developing infection.

5. Positioning the person:

Semirecumbant position for people with a penis

Dorsal position with knees flexed and abducted for people without a penis

Place bluey under the buttocks and cover the person with blanket
Position the light source
With unsterile gloves, remove catheter if insitu.

• To remove a catheter, refer to Removal of an indwelling catheter in this document

• Refer to Hand Hygiene protocol

7. Equipment:

• Don sterile gloves
• Lubricate the catheter using anaesthetic lubricant
• Draw up sterile water to inflate the catheter balloon

• Lubricant is recommended to reduce urethral trauma, pain and infection for all urinary catheter insertions.
• Sterile water is used to inflate the balloon. 

8. Draping:

Drape the genital area to expose the genitals and the surrounding area to create an aseptic field

• A fenestrated towel may be supplied in some catheter packs.
• Draping creates an aseptic field.

9. Cleansing the genital area:

• Cleanse the area surrounding the urethral meatus to minimise the introduction of bacteria
• If there is a foreskin, retract and clean beneath
• If there are labia, clean the labia majora, then the labia minora moving inwardly until cleaned.  Clean with one swab at a time in a downward direction

• The urethral opening is usually situated at either the end of the penis or between the clitoris and vagina, depending on the anatomy of the person
• Using the non-dominate hand, hold the genital area to expose the urethra.  This allows the dominant hand to handle the catheter and aspetically clean equipment during insertion of the catheter

10. Application of lubricant:

• Lidocaine (Lignocaine) 2% Gel - 10g/10ml syringe is used for people with a penis, those with painful catheter insertions or following a painful catheter removal
• Lidocaine (Lignocaine) 2% Gel - 10g/10ml syringe is applied to the length of the catheter and the remainder of the syringe inserted into the tip of the penis (if applicable)
• Water based lubricant is suitable for people with a short urethra (without a penis)

• Catheterisation can be uncomfortable, the use of a local anaesthetic in the lubricant increases comfort
• Inadequate lubrication has been associated with urethral trauma, pain and associated infection risk.
• Lubrication assists the catheter to slide easily along the tract.

11. Inserting the catheter following cleansing

• Locate the urethral meatus, Insert the catheter without touching the surrounding tissues
• If the person has a penis, hold it perpendicular to the body and insert the catheter to the Y bifurcation.  There may be some resistance when passing by the prostate gland, gentle pressure is applied to prevent forming a blind fistula
• Ensure the catheter is inserted into the bladder before inflating the balloon
• Inflate the catheter balloon with sterile water (the amount of solution is indicated on the catheter packaging
• If the person has a foreskin that has been retracted, replace the skin to its resting position

• If the urethral meatus is not clearly visible, ask the person to cough, this may bring the meatus into view. A folded towel/cushion under the buttocks may also assist
• Urethral trauma and discomfort is minimised by using a sterile lubricant or anaesthetic gel
• Advancing the catheter another 5 cms prior to inflating the balloon ensures the balloon is in the bladder and not in the urethra or bladder neck
• Urine may not flow immediately the catheter enters the bladder if the catheter tip is covered by the lubricant or the bladder is empty. Wait a few moments to watch the catheter while holding it insitu, observe urine beginning to flow before inflating the balloon.
• Exhaling whilst advancing the catheter assists with relaxing the pelvic floor muscles.
• Advancing the catheter to the level of the ‘Y’ bifurcationfor people with a penis ensures that balloon is in the bladder and notl in the urethra or bladder neck.  Inflation of the balloon while it is still in the urethra may cause trauma and pain

12. Securing the catheter

• Urethral catheters are anchored to the thigh with a cathstrap or equivelant product
• Connect the drainage bag of choice
• Replace clothing / bedding, leave the person warm, dry and comfortable.
• Attend to hand hygiene.

• Anchoring the catheter to the upper thigh reduces the risk of pressure and trauma to the bladder neck or inadvertent removal of the catheter with the balloon inflated.
• Arrange for supply of a Cathstrap for discharge.
• Change taping/cathstrap to alternate legs daily to reduce the risk of trauma to the urethra
• Ensure there is no tension on the catheter

13. Complete MR/497.0

• Complete Indwelling Urinary Catheter form MR/497.0
• File in medical record
• Provide a copy of the form to the person or carer

• The MR/497.0 is a required form and will assist the person to manage their ongoing catheter care and product supply

Acute Ward Setting

Ambulant & non-ambulant people

• A sterile leg bag is changed on a weekly basis or with catheter changes.
• A sterile 2 litre/overnight bag with a tap is changed weekly (when no leg bag) or daily when used with a leg bag.

• The tap facilitates emptying and avoids splashing of urine when the leg bag is used with an over night bag/bottle.  Ensure the tap is opened.
• Ensure the catheter and drainage bags are well secured with no tension on the catheter
• Drainage bag is emptied each shift, PRN or when 3/4 full.  Use a clean container for each person, ensuring that the container does not come into contact with the tap on the drainage bag.
• Drainage bags are situated below the level of the bladder to prevent reflux of urine
• Drainage bags are kept on a hanger and not in contact with the floor.
• More frequent bag changes do not reduce the risk of UTI in people with long term indwelling catheters (level 1 evidence)
• Document urine colour and any debris
• Ensure the leg bag and catheter straps are placed on alternate legs daily to reduce the risk of trauma to the urethral meatus.
• People in a low/low bed the bag can place their bag into a pillow case and then in the bed

Sub-Acute Ward Setting

• Ambulant & non-ambulant people
• A sterile leg bag is changed on a weekly basis or when the catheter is changed.
• The leg bag can be connected to a sterile overnight drainage system bag or drainage bottle
• A catheter valve may be used if clinically indicated. Seek advice from  a urologist or continence nurse to determine if a catheter valve would be appropriate

• The catheter and drainage bags are well secured with no tension on the catheter
• Drainage bags are emptied each shift or when >3/4 full.  Use a clean container for each person, ensuring that the container does not come into contact with the tap on the drainage bag.
• Drainage bags are kept situated below the level of the bladder to prevent reflux of urine
• Meatal hygeine is performed daily
• Replace the drainage bag weekly
• Over night drainage systems are emptied each morning, the drainage bag/bottle and tubing is washed with warm soapy water and rinsed.
• The drainage bag is replaced weekly
• If using a drainage bottle this is for extended use
• Drainage bags are kept on a hanger and not in contact with the floor.
• Document urine colour and any debris
• The leg bag and catheter straps are placed on alternate legs daily to reduce the risk of trauma to the urethral meatus.
• People in a low/low bed can place their bag into a pillow case and then in the bed

Community Setting

1. Ambulant people

• A sterile leg bag is changed on a weekly basis or when the catheter is changed
• The leg bag can be connected to an overnight drainage system bag or bottle

• A catheter valve may be used but depends on the reason the catheter is required
• Seek advice from a urologist or continence nurse to determine if a catheter valve would be appropriate
• Overnight bags are emptied each morning and the bottle and tubing washed with warm soapy water and rinsed. 
• Leg drainage bag are emptied when >3/4 full.  Use a clean container ensuring that the container does not come into contact with the tap on the drainage bag.
• Drainage bags are kept situated below the level of the bladder to prevent reflux of urine
• Meatal hygeine is performed daily
• Keep theovernight bag in a dry clean place for the following nights use.
• Drainage bags must be on a hanger and not in contact with the floor.
• Ensure the leg bag and catheter straps are placed on alternate legs daily to reduce the risk of trauma to the urethral meatus.

Residential Aged Care Setting

• Ambulant & non-ambulant people
• A sterile leg bag is changed on a weekly basis
• The leg bag can be connected to a sterile overnight drainage bag or drainage bottle. The drainage bottle/bag must be well labelled with person’s name. 
• A catheter valve may be used if clinically indicated.  Seek advice from  a urologist or continence nurse to determine if a catheter valve would be appropriate

• Always ensure the catheter and drainage bags are well secured with no tension on the catheter
• Leg drainage bag to be emptied PRN or when 3/4 full.  Use a clean container ensuring that the container does not come into contact with the tap on the drainage bag.
• Drainage bags are kept situated below the level of the bladder to prevent reflux of urine
• Meatal hygeine is performed daily
• Replace the bag weekly
• Overnight drainage systems are emptied each morning and the drainage bag/bottle and tubing is washed with warm soapy water and rinsed. Stored to drain and dry in clean place.
• The drainage bag is replaced weekly
• If using a drainage bottle this is for extended use
• Drainage bags must be on a hanger and not in contact with the floor.
• Ensure the leg bag and catheter straps are placed on alternate legs daily to reduce the risk of trauma to the urethral meatus.
• People in a low/low bed can be put into a pillow case and placed in the bed

1. Preparation

• Gather equipment
• Inform the person of procedure, ensure privacy.
• Place bed at appropriate height.

• Equipment will include appropriate bag and leg straps

2. Procedure

• Hand hygiene, gloves and eye protection.
• Using an aseptic technique, loosen the cap on the new drainage bag, disconnect the old tubing from the catheter.
• Completely remove the cap on the new drainage bag and connect it to the catheter without contaminating the clean tubing
• Ensure urine is draining freely into the new bag

• Care must be taken to minimise the risk of contamination of the catheter/bag connection as this is a possible entry point for microbes.
• Refer to Hand Hygiene / Aseptic Technique protocol
• A catheter should not remain disconnected from the drainage bag. 
• A closed drainage system minimises the risk of catheter related urinary tract infections.

3. Secure catheter and drainage bag:

• The tap of the new bag is closed and urine is draining freely into the new tubing.
• The catheter is strapped to the upper thigh by a catheter strap
• The leg bag is strapped into position either above or below the knee depending on the person’s preference.
• The straps are firm and comfortable.
• Replace leg straps if they are soiled

• Straps that are too loose will not adequately support the full leg bag and may result in traction on the catheter causing pressure areas on the genitals and on the bladder neck, as well as discomfort for the person. 
• Short tube bags (1-5cm tubes) are worn above the knee and long tube bags are worn below the knee.
• The length of the tubing on leg bags with the corrugated tubing can be altered.
• Ensure the leg bag and catheter straps are placed on alternate legs daily to reduce the risk of trauma to the urethral meatus.

4. Completion of procedure:

• Replace clothing / bedding, leave the person warm, dry and comfortable.
• Observe urine in changed bag for color, odour, sediment and measure as required.
• Dispose of urine, wash receptacle, remove gloves and eye protection. Hand hygiene.

1. Preparation:

• Obtain consent
• Inform the person of the procedure, ensure privacy.
• Place bed at appropriate height.

• To conform with OH&S manual handling policies.
• Preparing the person well will reduce anxiety and assist resumption of voiding post-removal of the catheter

2. Hand hygiene:

• Attend to hand hygiene – Alcohol based hand rub, put on gloves and eye protection.

• Refer to Hand Hygiene protocol

3. Position client

Semirecumbant position for people with a penis

Dorsal position with knees flexed and abducted for people without a penis

4. Deflate balloon

• Attach the syringe to the inflation port on the side/end of the catheter.  Withdraw fluid from the balloon. Document the amount withdrawn

• Sterile water instilled can permeate into the bladder through the balloon walls, it is common to withdraw 2 or 3 mls less than the amount used to inflate it.
• Draw back very gently if at all on the syringe when deflating the balloon
• For removal of a catheter refer to Removal of an indwelling urethral catheter in this document

5. Remove catheter

• Slowly pull the catheter out until it is completely removed. 
• Observe the condition of the catheter tip, document the amount of sediment, colour and any abnormalities.
• If there is resistance while withdrawing the catheter and you are sure the balloon is completely deflated, instruct the patient to relax and breathe deeply. Apply firm but gentle traction to remove the catheter.
• A wide bore needle can be inserted into the balloon port to release air if there is doubt about the deflation of the balloon.
• If the catheter is 100% Silicone, a ridge may have developed on the balloon despite its complete deflation.  Re-inflate the balloon with 0.5ml of sterile water to smooth out the ridge if present and then attempt to remove once more.
• If unable to remove the catheter with all reasonable efforts, leave the catheter insitu and ensure drainage system is in place, and report to the appropriate medical staff member

• If the catheter tip has a large amount of sediment this may indicate the catheter requires more frequent changes.
• Resistance may be related to sediment, anxiety causing the person to contract the urinary sphincter.  The development of a stricture, incomplete deflation of the balloon or the presence of a ridge or defect on the balloon after deflation. A gentle twist of the catheter may dislodge any sediment or free it from any tissue formation at the bladder neck that may impede removal.

6. Attend Hand hygiene

• Assist the person to dress
• Leave them dry and comfortable.

7. Documentation

• Document time / date / reason for removal of urinary catheter and any difficulties noted
• Document when the person has voided post removal of catheter