Checklist
| Preparation | Wash – Name – Explain | |
| Chaperone | ||
| Check for allergies | ||
| Allow to undress | ||
| Position appropriately for procedure | ||
| Cover with sheet | ||
| Clean preparation surface | ||
| Gather equipment | Wash hands | |
| Female urinary catheter of appropriate size | ||
| Catheter urine collection bag | ||
| Catheterisation pack | ||
| Anaesthetic lubricant | ||
| Sterile cleaning solution (water/saline) | ||
| Two pairs of sterile gloves | ||
| Create sterile field | ||
| Patient preparation | Drape patient to create clean field | |
| Wash hands and put on sterile gloves | ||
| Assistant opens sterile cleaning fluid and pours into pot | ||
| Identify ‘clean’ hand and ‘dirty’ hand | ||
| Part labia with ‘dirty’ hand & gauze | ||
| Clean urethra with ‘clean’ hand and cotton wool/water | ||
| Insert anaesthetic lubricant into urethra | ||
| Dispose of cleaning waste | ||
| Catheter insertion | Wash hands and put on 2nd pair of sterile gloves | |
| Place kidney dish between patient’s legs | ||
| Tear off tip of catheter packaging | ||
| Part labia with ‘dirty’ hand | ||
| Insert catheter into urethra, touching packaging only | ||
| Advance catheter fully | ||
| Inflate balloon with sterile water | ||
| Pull back gently on catheter until resistance felt | ||
| Attach urine collection bag | ||
| Finishing | Observe urine in collection bag | |
| Dispose of all waste appropriately | ||
| Wash hands | ||
| Document procedure in patient notes |
Explanation
Preparation
Wash, name, explain:
- Wash your hands
- Introduce yourself by name and role
- Check the patient’s name and date of birth
- Explain the task and get consent
- Explain the presence and purpose of the chaperone
“Hello, I’m one of the doctors. I have been asked to insert a catheter. This involves inserting a flexible tube into the bladder to allow urine to flow freely. You may feel some pressure, but I will insert some local anaesthetic jelly so it should not be painful. You can ask me to stop at any time. A chaperone will be present whilst I carry out this procedure. Is that okay with you?”
Ask the patient to remove their clothing from the waist down. Position the patient on the examination couch, in a supine position. Cover the patient with a sheet for privacy until you are ready to begin the examination.
Clean your preparation space, typically a clinical trolley, using appropriate surface cleaning agents.
Gather Equipment
Wash your hands again after cleaning surfaces.
Gather the following equipment and place it on your clean surface:
- Female urinary catheter – ensure you choose an appropriate size (diameter) for your patient, e.g., 12Fr, 14Fr, etc.
- Urine collection bag
- Catheterisation pack – this should include a kidney dish, cotton wool balls, tweezers, gauze, and a sterile patient drape
- Anaesthetic lubricant – containing lidocaine, e.g., Instillagel
- Sterile cleaning solution – usually sterile water or 0.9% NaCl for cleaning the genitalia prior to catheter insertion
- Two pairs of sterile gloves
Check the expiry dates on the equipment above. Once you have all your equipment ready, set up your sterile field on your clean trolley.
Open the external packaging of the catheter pack and dispose of it, placing the contents on your trolley. Now open the catheter pack inner packaging by unfolding one corner at a time and only touching the underside of the packaging. The inside of the packaging now forms your sterile field. Do not touch anything inside this field unless wearing sterile gloves.
Open the outer packaging of the catheter and, without touching the catheter inside, drop it onto the sterile field. Repeat this with the anaesthetic lubricant.
Open the urine collection bag and place it next to the patient’s legs so it is easy to locate later on.
Patient Preparation
Return to the patient and conform that they are still happy to proceed. Open your first pair of sterile gloves on your clean trolley surface and put them on, taking care not to touch the outside of the gloves with your hands. Your chaperone should now act as your assistant to help maintain sterility.
Ask your assistant to uncover the patient. Unfold the sterile drape and place it over the patient, ensuring that the external genitalia are accessible through the cut-out.
Arrange the sterile equipment from the catheter pack within the sterile field. Ask your assistant to pour your cleaning solution into the sterile container. Identify your ‘clean’ hand (usually your dominant hand) and your ‘dirty’ hand (usually your non-dominant hand). Your ‘clean’ hand may return to the sterile field while your ‘dirty’ hand should remain outside it.
Clean around the urethral meatus to prepare for catheter insertion. Using gauze and your ‘dirty’ hand, part the labia. Using your ‘clean’ hand, clean the urethral meatus and surrounding genitalia using the tweezers to hold the cotton wool balls dipped in the cleaning fluid. Clean from the meatus downwards, using as many cotton wool balls as necessary to ensure thorough cleaning of the area. Dispose of the cotton balls and tweezers as you finish using them.
Using your ‘clean’ hand, instil the anaesthetic lubricant into the urethra. The patient should feel the benefit of anaesthetic after around 3-5 minutes.
Remove your first pair of sterile gloves and dispose of them.
Catheter Insertion
Wash your hands and put on the second pair of sterile gloves.
Remove the tear–off section of the catheter inner packaging and hold the catheter by the top of the remaining packaging with your ‘clean’ hand. Hold the labia apart with your ‘dirty’ hand and gently place the catheter tip into the urethra, touching only the packaging. Advance the catheter a little, then pull the packaging a little further down the catheter to expose more of the tube, then repeat these two steps until the catheter is advanced fully.
Once the catheter is fully advanced, dispose of the inner packaging. Inflate the balloon with the sterile water, ensuring that the patient is not experiencing significant pain. Once the balloon is inflated, gently withdraw the catheter until slight resistance is felt, confirming correct positioning within the bladder.
Attach the urine collection bag to the catheter.
Finishing
Observe the urine flow into the collection bag, noting the colour, consistency, and volume.
Dispose of all waste appropriately, then clean your trolley. Wash your hands. Document the procedure in the patient’s notes, recording the date, time, indication, catheter size, volume of water in the balloon, residual volume and chaperone details.
Last updated Mar 2025
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