Download Urinary Catheter Insertion with Lidocaine 2% Jelly

Urinary Catheter Insertion with
Lidocaine 2% Jelly - Adult
Approved by:
Vice President and Chief Medical Officer, and
Vice President and Chief Operating Officer
Corporate Policy & Procedures
Manual
Number: VII-B-100
Date Approved
July 8, 2015
Date Effective
August 7, 2015
Next Review (3 years from Effective Date)
August 2018
Purpose
To provide instruction to patient care providers to use Lidocaine 2% jelly to insert male
and female urinary catheters, reduce discomfort and/or risk of injury to the patient’s
urethra and/or prostate.
Policy
Statement
The most responsible health practitioner shall provide a patient care order for Lidocaine
2% Jelly prior to the insertion of a urinary catheter.
For males, one attempt at insertion is allowed before staff must seek assistance from an
experienced health care professional. After two unsuccessful attempts, the most
responsible health practitioner must be consulted
For females, two attempts are allowed before staff must seek assistance from an
experienced health care professional. After two unsuccessful attempts, the most
responsible health practitioner must be consulted
Catheter insertion requiring a catheter guide must be performed by a physician.
NOTE:
If the patient has an allergy to Lidocaine 2% jelly, a water-based lubricant
should be used. No patient care order is required when using a waterbased lubricant.
Applicability
This policy and procedure applies to all Covenant Health facilities, staff, members of the
medical staff, volunteers, students and any other persons acting on behalf of Covenant
Health.
Responsibility
The most responsible health practitioner shall demonstrate compliance with this
policy/procedure by ensuring that they provide a patient care order for administration of
Lidocaine 2% Jelly prior to insertion of a urinary catheter.
Before inserting a urinary catheter, the health care professional is responsible to ensure
that they have appropriate skills and education, are working within their scope of practice,
and align with Covenant Health policies and procedures. Health care professionals who
do not have experience/knowledge of catheter insertion, shall complete the learning
module accompanying this policy/procedure and demonstrate the successful application
of Lidocaine 2% jelly and insertion of a urinary catheter under the direct supervision of a
Clinical Nurse Educator or senior staff member trained in this clinical procedure; using
the attached checklist as a teaching guide / documentation of competency. The
completed checklist is to be witnessed by the Manager/Clinical Nurse Educator and
recorded according to the department practice. The health care provider is responsible
to keep a copy for their own records.
Note: Nursing staff are always constrained by their own level of
Urinary Catheter Insertion with Lidocaine 2% Jelly - Adult
Date Effective
August 7, 2015
Policy No.
VII-B-100
Page 2 of 18
expertise when performing any clinical skill.
Principles
The application of Lidocaine 2% jelly prior to the insertion of a urinary catheter:
• assists with the dilation of the posterior urethra;
• lubricates the urethra to facilitate catheterization;
• desensitizes the urethra during and after the procedure; and
• provides psychological benefit by validating that the procedure may be unpleasant
and patient understanding that the patient care provider is attempting to reduce
discomfort.
Definitions
Related
Documents or
Resources
Most responsible health practitioner means the health care professional who has
responsibility and accountability for the specific treatment/procedure(s) provided to a
patient and who is authorized by Covenant Health to perform the duties required to fulfill
the delivery of such a treatment/procedure(s), within the scope of his/her practice.
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•
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Urinary Catheter Insertion with Lidocaine 2% Jelly Learning Module
PowerPoint – Prevention of Iatrogenic Injuries
Covenant Health Policy #VII-B-125, Medication Orders
Previous
Versions
November 1, 2011
References
Beynon, M., de Laat, T., Greenwood, J., van Opstal, T., Lindblom., E., Emblem, E.L., (2005).
Urethral Catheterization. Section 1: Male Catheterization. European Association of
Urology Nurses. Good practices in Health Care. EAUN Board and the EAU Professions
Allied to Urology Office. Arnhem. The Netherlands.
Canes, D., Thomsen T., Setnik, G. (2006). Male Urethral Catheterization. The New England
Journal of Medicine. 355(11). Page 1178-1180.
Cathejell 2% Jelly 2% Product Monograph. Retrieved on 7th April 2015 from;
http://www.cathejell.ca/cathejell_mongraph.html
Chung, C., Chu, M., Paoloni, R., O’Brien, M.J., Demel, T. (2007). Comparison of Lignocaine and
Water-Based Lubricating Gels for Female Urethral Catheterization: A Randomized
Controlled Trial. Emergency Medicine Australasia. 19(4). Page 315-319.
Garbutt, R., Taylor, D., Lee, V., Augello, M. (2008). Delayed Versus Immediate Urethral
Catheterization Following Instillation of Local Anesthetic Gel in Men: A Randomized,
Controlled Clinical Trial. Emergency Medicine Australasia. Volume 20. Page 328-332.
Kashefi, C., Messer, K., Barden, R., Sexton, C., Parson, J.K. (2008). Incidence and Prevention of
latrogenic Urethral Injuries. The Journal of Urology. American Urological Association
Volume 179. Page 2254-2258.
Mercer Smith, J. (2006). Current Concepts in Catheter Management. Chapter 10. In Urinary and
Fecal Incontinence. Current Management Concepts by Doughty, D. Elsevier. St. Louis.
Missouri.
Moore, K. (2006). Pathology and Management of Acute and Chronic Urinary Retention. Chapter
8. In Urinary and Fecal Incontinence. Current Management Concepts by Doughty, D.
Urinary Catheter Insertion with Lidocaine 2% Jelly - Adult
Date Effective
August 7, 2015
Policy No.
VII-B-100
Page 3 of 18
Elsevier. St. Louis. Missouri.
Ogden, V. (2003). Anesthetic Gel Insertion During Male Catheterization. Journal of Community
Nursing. 17(1). Page 4-6, and 8.
Richards S; Pravikoff D; CINAHL Nursing Guide, EBSCO Publishing, 2014 Aug 01 (Nursing
Practice and Skill - CEU, image). Urinary Catheter, Indwelling (Foley): Insertion in the
Female Adult Patient, accessed on-line through the Nursing Resource Centre June 3,
2015.
Robinson, J. (2007). Female Urethral Catheterization. Nursing Standard. 22 (8). Page 48-56.
Robinson, J. (2006). Pathology and Management of Postprostatectomy Incontinence. Chapter 9.
In Urinary and Fecal Incontinence. Current Management Concepts by Doughty, D.
Elsevier. St. Louis. Missouri.
Senese, V., Hendricks, M., Morrison, M., Harris, J. (2006). Clinical Practice Guidelines Task
Force: Society of Urologic Nurses and Associates. Male Urethral Catheterization.
Urologic Nursing. 26(4). Page 314.
Shalmovitz, G.Z. (2008). Urethral Catheterization, Men. Retrieved on14th December, 2009, from
http://emedicine.medscape.com/article/80716-overview#.
Shalmovitz, G.Z. (2009). Urethral Catheterization, Women: Treatment and Medication.
Retrieved on14th December, 2009, from http://emedicine.medscape.com/article/80735treatment.
Siderias, J., Guadio, F., Singer, A. (2004). Comparison of Topical Anesthetics and Lubricants
Prior to Urethral Catheterization in Males: A Randomized Controlled Trial. ACAD
EMERG MED. 11(6). Page 703-706.
Walsh K; Pravikoff D; CINAHL Nursing Guide, EBSCO Publishing, 2014 Jul 04 (Nursing Practice
and Skill - image, video). Urinary Catheter, Indwelling (Foley): Inserting in the Male
Adult Patient. Accessed on-line through the Nursing Resource Centre June 3, 2015.
Walsh K; Pravikoff D; CINAHL Nursing Guide, EBSCO Publishing, 2014 May 16 (Nursing Practice
and Skill - CEU, image). Urinary Catheter, Indwelling (Coudé): Insertion in the Male
Adult Patient. Accessed on-line through the Nursing Resource Centre June 3, 2015.
Wilson, Mary; British Journal of Nursing, 2013 May 23; 22 (10): 566-9. (journal article tables/charts) ISSN: 0966-0461 PMID: 23752454 Catheter lubrication and fixation:
interventions. Accessed on-line through the Nursing Resource Centre, June 3, 2015.
Wilson M; British Journal of Nursing, 2008 Feb 28-Mar 12; 17 (4): 232, 234, 236-9. (journal article
- pictorial, tables/charts) ISSN: 0966-0461 PMID: 18414267. Causes and management
of indwelling urinary catheter-related pain. Accessed on-line through the Nursing
Resource Centre, June 3, 2015.
Wood, T.L. (2010). Urinary Elimination. Chapter 33. In Clinical Nursing Skills and Techniques
(7th Edition) by Perry, A., Potter, P. Elsevier. St. Louis. Missouri.
Woodward, S. (2005). Use of Lubricant in Female Urethral Catheterization. British Journal of
Nursing. 11(19). Page 1022-1023.
Urinary Catheter Insertion with Lidocaine 2% Jelly - Adult
Date Effective
August 7, 2015
Policy No.
VII-B-100
Page 4 of 18
Urinary Catheter Insertion with Lidocaine 2% Jelly - Adult
Indications
Date Effective
August 7, 2015
Policy No.
VII-B-100
Page 5 of 18
Urinary catheter insertion is indicated for patients undergoing;
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General anesthesia and/or surgery
Patients requiring accurate output monitoring
Procedures involving the urethra, abdomen or pelvic region
To relieve urinary retention
Cautions
Lidocaine should be used with caution in patients with sepsis and/or traumatized mucosa,
since there is potential for rapid systemic absorption.
Patient
Teaching
Instruct patient;
• Explain the purpose and why a urinary catheter is being inserted.
• Keep the urinary collection bag and tubing below the level of their bladder.
This helps prevent reflux of urine from the drainage collection bag into the
bladder.
• Make sure the tubing doesn’t kink or loop.
• Keep the urinary collection bag off the floor (to minimize risk of bacterial
contamination).
Documentation
Document on the Patient Care Record:
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Procedure
Date and time of Urinary catheter insertion
Type of catheter
French size
Amount of fluid used to inflate catheter balloon
Ease of insertion
Any problems (i.e. resistance to insertion, bleeding, pain) with insertion
Amount and description of urine returned
If urine collection specimen is sent
Patient's response to urinary catheter insertion
Patient teaching provided
•
Check patient care order.
•
Clean area per instruction in “Clinical Nursing Skills & Techniques” textbook,
Perry, Potter (8th Edition).
•
When setting up equipment, using aseptic technique, open the packaging
containing Lidocaine 2% jelly syringe onto the sterile field.
NOTE: Needles are never used for administration of Lidocaine 2% jelly
•
After the syringe of Lidocaine 2% jelly has been used, discard to prevent
contamination of sterile work area.
Application of Lidocaine 2% Jelly on Males:
1.
After cleansing the urethra meatus, instill Lidocaine 2% jelly (approximately 5-10
mL) into the urethra. Allow the gel to dwell for approximately 5 minutes (no longer
Urinary Catheter Insertion with Lidocaine 2% Jelly - Adult
Date Effective
August 7, 2015
Policy No.
VII-B-100
Page 6 of 18
than 15 minutes) before starting catheter insertion. A sterile gauze pad may be
placed over the meatus to help prevent spillage of anesthetic jelly. The urethral
opening should then be held closed (by the nurse or the patient) for 3 to 5
minutes.
2.
Hold penis at 90˚ to the body and apply a generous mound of Lidocaine 2% jelly
(approximately 5-10 mL) on the tip of the penis in a ‘pyramid’ shape.
3.
Gently slide the catheter through the ‘pyramid’of gel and then into the penis.
Application of Lidocaine 2% Jelly on Females:
1.
After cleansing the labia majora. Place nozzle of Lidocaine 2% jelly near the
urethral orifice and apply some gel in a ‘pyramid’ shape. Gently place nozzle
approximating the entrance of the urethra and slowly squeeze gel onto the
urethra, expel at least 5 mL.
2.
Allow the gel to dwell for approximately 5 minutes (no longer than 15 minutes)
before starting catheter insertion. A sterile gauze pad may be placed over the
meatus to help prevent spillage of anesthetic jelly.
3.
Lubricate 2.5 to 5 cm of the catheter and then gently slide the catheter through
the ‘pyramid’of gel into the urethra.
Urinary Catheter Insertion with Lidocaine 2% Jelly - Adult
Date Effective
August 7, 2015
Policy No.
VII-B-100
URINARY CATHETER INSERTION WITH
LIDOCAINE 2% JELLY
Learning Module
August 2011
Prepared by: Sharon Dawson & Anne Le-Vander Leeuw
Clinical Surgery Educator, GNCH
Revised: May 2015
By: Colleen Kasa. Clinical Surgery Educator, MCH
Anne Le. Clinical Surgery Educator, GNCH
Page 7 of 18
Urinary Catheter Insertion with Lidocaine 2% Jelly - Adult
Date Effective
August 7, 2015
Policy No.
VII-B-100
Page 8 of 18
This learning module is to be used in conjunction with
Policy/Procedure #VII-B-100, Urinary Catheter Insertion with Lidocaine 2% Jelly
Check patient care order.
1.0
OBJECTIVES
Urinary catheterization can be a difficult and painful procedure - especially for males when
there may be inadequate lubrication because of the greater urethral length and the prostatic
curve, a urethral stricture, inability to thread the catheter through the S-shaped bulbar urethra,
or excessive resistance at the bulbomembraneous urethra, with tightening of the external
sphincter.
Upon completion of this learning module, the patient care provider staff will be able to:
1.
2.0
3.0
Reduce discomfort and reduce the risk of injury to the patient’s urethra and/or male
prostate, by applying Lidocaine 2% jelly before inserting a urinary catheter.
CRITERIA FOR SUCCESSFUL COMPLETION
1.
The staff member will be asked to read this module and the policy Urinary Catheter
Insertion with Lidocaine 2% Jelly.
2.
The staff member will perform their first catheter insertion under the supervision of a
clinical educator or senior staff member.
3.
The clinical educator/senior staff member will ensure the staff member appropriately
completes the clinical practice elements (see Checklist).
EDUCATION REQUIREMENTS
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NOTE:
Qualified staff who have demonstrated the skill to a Clinical Nurse Educator on a
mannequin or patient may independently perform male urinary catheter insertion.
Once completed, the checklist will be given to the appropriate Clinical Nurse Educator for
record keeping purposes.
The patient care provider is responsible to keep a copy for their own records.
The nurse is always constrained by their own level of expertise.
Urinary Catheter Insertion with Lidocaine 2% Jelly - Adult
4.0
Date Effective
August 7, 2015
Policy No.
VII-B-100
Page 9 of 18
INDICATIONS
Urinary catheter insertion is indicated for patients undergoing:
• General anaesthesia and / or surgery
• Patients requiring accurate output monitoring
• Procedures involving the urethra, abdomen or pelvic region
• To relive urinary retention.
5.0 PROCEDURE FOR MALE CATHETERIZATION
Table 1 - Equipment for Male Urinary Catheter Insertion
Table 2 - Nursing Action & Rationale for Urinary Catheter Insertion
Table 3 - Procedure for Male Urinary Catheter Insertion Using Lidocaine 2% Jelly
Table 1 - EQUIPMENT FOR MALE URINARY CATHETER INSERTION
EQUIPMENT
Lidocaine 2% jelly in prefilled syringe
RATIONALE
To decrease patient sensation during urinary catheter
insertion
Commercial single use urethral catheterization
tray. Should contain:
• Sterile drapes
• Sterile povidine iodine solution for
cleansing
• Sterile water soluble lubricant gel
• Sterile water in a 10 ml syringe
Sterile gloves
To maintain aseptic technique
Urethral catheter
Purpose is to drain urine.
Consider appropriate catheter size and type for
the patient
1. Male: size 14 - 16 French urinary catheter
Select the smallest size appropriate for patient.
Note: If a patient has never had a catheter
inserted, use a size 14 French urinary catheter
2. Male passing blood: size 20-24 French Three
Way urinary catheter. If the third port is not being
used for continuous bladder irrigation (CBI), then
plug the unused port with an approved catheter
plug. Check the hospital stores catalog for order
number.
Indicated for gross hematuria in adults. Larger French
size is easier for clots and blood to drain.
3. Coude-tipped catheter
Used for older men if prostatic enlargement is
Urinary Catheter Insertion with Lidocaine 2% Jelly - Adult
EQUIPMENT
Coude catheters are inserted with the tip pointed
upward (toward the patient's umbilicus) in the 12
o'clock position, throughout insertion.
An arrow or raised bump on the catheter shaft
indicates the position of the tip during insertion.
Coude catheter is passed through the urethra
using steady gentle pressure.
Note: Do NOT force if firm resistance is met.
If a Coude catheter cannot be inserted in
accordance with these guidelines after 1
attempt, the patient should be referred to
senior staff or a urologist (if available at site).
4. Silicone catheters are made of pure silicone.
Preferred urinary catheter for patients with a latex
allergy.
Date Effective
August 7, 2015
Policy No.
VII-B-100
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RATIONALE
suspected, or when initial catheterization attempt with a
urinary catheter is unsuccessful.
Coude catheters:
• Have a firm curved tip designed to negotiate the
male prostatic curve.
• Designed to overcome urethral obstruction which
a more flexible catheter cannot pass.
• The elbow on the tip of the catheter should face
anteriorly (the 12 o’clock position) to allow the
small rounded ball on the tip of the catheter to
move through the urogenital diaphragm.
For long term placement (i.e.> 2 weeks and up to 12
weeks), to prevent urethral meatus erosion and to
decrease risk of urinary infection.
Note: Silicone catheters - the balloon should be The permeability of the silicone balloon results in loss of
checked every 2 weeks and sterile water added as fluid over time.
needed
5. Silastic catheters are latex catheters that have a
silicone coating.
6. Silver alloy and antibiotic impregnated catheters
must be ordered by the Physician or Nurse
Practitioner. These catheters are Direct Purchase
Orders.
Collection drainage device such as,
urometer or leg bag as appropriate
Catheter stabilizing device is required (e.g.
StatLock for catheter)
Garbage receptacle within easy reach
To measure and collect urine output.
To minimize trauma to urethra.
Commercial prepared devices i.e. StatLock are preferred
when available.
Urinary Catheter Insertion with Lidocaine 2% Jelly - Adult
Date Effective
August 7, 2015
Policy No.
VII-B-100
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TABLE 2 - NURSING ACTION AND RATIONALE FOR URINARY CATHETER INSERTION
Action
• Check physician orders. A patient care order is
required by a physician or nurse practitioner to
administer Lidocaine 2% Jelly via the urethra
prior to inserting a urinary catheter.
Rationale
Required operational practice.
• Confirm patient has provided consent. This is
the responsibility of the ordering practitioner; i.e.
physician, nurse practitioner.
• Identify patient per policy/procedure #VII-B-25,
Identification of Patient, Resident, or Client
Using Two Identifiers.
Review the medical history before attempting to
insert the catheter
To identify patients who may have difficulty with
insertion.
Patient history, and identifying complicating
factors include;
The patient’s history helps guide choice of catheter type
and size.
If catheter cannot be inserted the patient should be
referred to a Urologist (if available at site).
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Asking patient if they have had a urinary
catheter inserted previously.
Lidocaine/Lidocaine allergy: use water soluble
lubricant.
Latex allergy: use silicone catheter (for more
information please see Table 2).
History of:
o
Urethral trauma / strictures?
o
Prostatic enlargement
o
Prostate surgery
Explain procedure to patient.
Gather supplies (see Table 1)
To identify patients who may have difficulty with Urinary
catheter insertion.
Latex allergy
Assess other catheter options, such as a silicone
catheter.
Note: Individuals with a history of allergies to bananas,
avocado, kiwi, or chestnuts may cross-react to latex.
Strict latex precautions, including use of latex-free
catheter kits should be followed.
Latex reactions from indwelling catheters can range
from:
• Severe anaphylaxis with respiratory distress and
generalized urticaria
• Redness and swelling of the urinary meatus
• Meatal discharge
• Complaints of bladder pain
• Localized urticaria involving the skin in contact
with the catheter
Promotes cooperation.
Before beginning the procedure, ensure sterile
packaging is intact and expiry dates are checked.
Urinary Catheter Insertion with Lidocaine 2% Jelly - Adult
Action
Ensure bed or stretcher is positioned at
comfortable working height.
Position patient in supine position and adjust the
bed linen.
Before beginning sterile preparation, ensure pericare is completed.
Leave patient genitalia covered until the supplies
have been set up.
Date Effective
August 7, 2015
Policy No.
VII-B-100
Page 12 of
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Rationale
Correct ergonomics
To ease access to the urethra.
To minimize bacterial contamination into the urethra
during catheter insertion.
Respect and maintain patient dignity.
Urinary Catheter Insertion with Lidocaine 2% Jelly - Adult
Date Effective
August 7, 2015
Policy No.
VII-B-100
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Table 3 - PROCEDURE FOR MALE URINARY CATHETER INSERTION using Lidocaine 2% Jelly
ACTION
Wash hands
RATIONALE
To minimize risk of bacterial contamination during
catheter insertion.
Expose patient’s genitalia, identify urethra,
ensure positioning is appropriate and
lighting is adequate
Note: For uncircumcised patients, the
foreskin is retracted for iodine cleansing
and for catheter insertion.
Failure to return the foreskin back to its
original position can cause paraphimosis
Particular caution should be used when inserting a
catheter into an uncircumcised patient with severe
penile and / or scrotal edema because it may be very
difficult to reposition the foreskin once the catheter has
been inserted.
Patients with severe edema are also at greater risk for
penile erosion.
Wash hands
Place the catheter tray on a clean, dry, firm
surface i.e. bedside table
Maintaining the sterile field;
1. Open catheter tray
2. Open and place the urinary
catheter on the sterile field
3. Don sterile gloves maintaining
aseptic technique
4. Open the iodine preparatory
solution / swab sticks
5. Open sterile lubricant and place
package on sterile field
6. Open Lidocaine 2% jelly according
to manufacturer’s instructions.
Prime the Lidocaine 2% jelly to
expel air, making sure that jelly is
on the tip of the syringe.
Ensure no plastic particles from breaking the syringe
seal remains.
Position sterile drapes over patient,
creating a sterile field
Place the urine collection tray holding the
urinary catheter, iodine swab sticks,
package of lubricant on the sterile field,
between the patient’s legs
For ease of insertion and collection of urine.
Use your non-dominant hand to hold the
penis at a 900 angle
This hand is now considered to be non-sterile and is
used to hold the penis throughout the procedure.
Use your dominant sterile hand and sterile
Urinary Catheter Insertion with Lidocaine 2% Jelly - Adult
ACTION
iodine swab sticks, or sterile forceps with
cotton gauze in iodine solution to cleanse
the urethra and the surrounding glans.
Use a circular motion with at least three
different applications.
Slowly instill the Lidocaine 2% jelly prefilled syringe directly into the urethra
Note: Needles are never used for
administration of Lidocaine2% Jelly
Date Effective
August 7, 2015
Policy No.
VII-B-100
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RATIONALE
Inadequate lubrication can cause urethral trauma and
pain; this can also result in an inability to pass the
catheter through the prostatic urethra.
This distends and places the lubricant high in the
urethra; reducing discomfort and preventing urethral
spasm.
Instilling too fast may cause gel to over flow.
Hold the penis at a 900 angle.
Assists with opening passage for Lidocaine 2% jelly to
pass. NOTE: When jelly is cold, this may lead to
spasm and the viscosity of the drug may make it
difficult to flow.
Allow approximately 5 minutes (Cathejell
Jelly 2%. Pharmazeutische Fabrik
Montavit. Austria) for the anesthetic to take
effect before proceeding with the urethral
catheterization. Sterile gauze maybe
placed over the meatus post instillation
and the urethral opening should be held
closed (by the nurse or patient).
Instillation and dwell (no more than 15 minutes) of the
Lidocaine 2% jelly directly into the urethra allows
anesthesia and dilation of the urethra before catheter
insertion.
Apply a generous mound of lubricant on
the tip of the penis, over the urethral
meatus
Pre-testing the catheter balloon is NOT
recommended
If a sterile urine sample is to be collected,
ensure that the sterile specimen container
is open and positioned for ease of access
At this time urine for routine microscopy,
The entire length of the catheter passes through the
urethral meatus, allowing for continuous lubrication of
the entire length of the catheter as it is advanced.
Inadequate lubrication can cause urethral trauma, pain
and may also result in inability to pass the catheter
through the prostatic urethra.
Pre-testing catheter balloon is not required. The
manufacturer has pre-tested the integrity of the
catheter balloon (Mercer Smith, 2006).
For the silicone catheter, the balloon does not return to
its original shape after inflation, and the enlarged
balloon area can form a cuff or crease that can
traumatize the urethra during catheter insertion.
To minimize risk of bacterial contamination during
catheter insertion.
Urinary Catheter Insertion with Lidocaine 2% Jelly - Adult
ACTION
culture and sensitivity should be obtained
as required per unit specific practice
Hold the penis with the non dominant hand
at approximately 90 degrees to the bed;
gently stretch the penis upward to
straighten out the penile urethra. Using
the dominant hand gently introduce the
catheter into the urethra using a slow
steady pressure
Continue to advance the catheter until
the proximal “y” shaped port
(bifurcation) is at the urethral meatus.
Recoil out of the urethra should be minimal
if the catheter is properly placed.
If mild resistance is noted while advancing
the catheter, instruct the patient to cough,
or bear down as if to void or perform deep
breathing exercises. Then slightly rotate
the catheter very gently.
If this troubleshooting does not allow the
catheter to pass through the urethra, do
NOT continue to force the catheter.
• Stop
• Remove catheter
• Notify doctor
• Request Urological consult
Note: Do NOT force if firm resistance is
met. If a urinary catheter cannot be
inserted in accordance with these
guidelines after 1 attempt, the patient
should be referred to senior staff or a
urologist (if available at care facility).
Wait for urine to drain from the end of the
catheter.
The lubricant gel filled distal catheter
openings may delay urine return. If no
spontaneous return of urine occurs within a
minute of catheter insertion
1. Ensure catheter is inserted to
bifurcation
2. Ensure there is minimal catheter
recoil
3. Attach a 60 ml syringe to gently
aspirate the urine
4. The bladder scanner may be used
Date Effective
August 7, 2015
Policy No.
VII-B-100
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RATIONALE
To ease insertion and prevent urethral trauma.
To avoid inflation of the balloon in the urethra.
To relax the urethral sphincter, at which point the
catheter is passed.
Traumatic insertion can lead to the formation of a false
passage, when the catheter is pushed into tissues
alongside the urethra. This is a serious condition that
can lead to urethral strictures, bleeding, and infection.
This may require surgical intervention.
Trauma to the urethra is considered a serious
complication to be avoided.
To ensure that the distal end of the catheter is in the
bladder.
Catheter irrigation is not recommended unless
obstruction with clots or mucus is anticipated.
Catheter irrigation solution should be instilled with
gentle pressure. Vigorous irrigation and aspiration
should be avoided as this can result in damage to the
bladder mucosa.
Urinary Catheter Insertion with Lidocaine 2% Jelly - Adult
ACTION
at this point to verify the presence
of urine.
If urine return is still not visible after all the
techniques outlined above have been
utilized, withdraw the catheter and
reattempt the procedure.
If the patient’s foreskin has been
retracted return to the normal position
over the glans penis.
After visualization of urine return, inflate
the distal balloon by injecting sterile water
through the inflation port of the catheter
Date Effective
August 7, 2015
Policy No.
VII-B-100
Page 16 of
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RATIONALE
Failure to reduce the foreskin can cause
paraphimosis.
Inflation of the balloon inside of the urethra will result in
severe pain, gross hematuria and possible urethral
tear.
The balloon should inflate with little resistance when in
the correct location.
Insert the exact volume of sterile water
indicated. Check the manufacturer’s
instructions on the urinary catheter
package.
Secure the catheter to the patient’s upper
thigh using a catheter stabilization device.
Ensure there is no tension on the catheter.
An improperly filled balloon expands asymmetrically
which increases the potential for erosion of the bladder
mucosa.
Placement of the catheter stabilizing device on the
upper thigh decreases the potential for pressure
necrosis, urethral erosion at the penile-scrotal junction
and pistoning. Pistoning increases the risk of bacteria
transferring into the bladder as areas of catheter
previously outside the body travel into the urethra.
Unsecured catheters can lead to bleeding, traumas,
pressure sores, penile erosion, and bladder spasms
from pressure and inadvertent tractions.
Securement devices stabilize the catheter. Preventing
tension and drag, thus reducing trauma within the
urethra and bladder.
Following completion of procedure ensure
peri-care is completed
• Cover and reposition patient for
comfort
• Ensure drainage system is working
properly
• Dispose of used supplies
• Empty garbage
• Label/send any urine specimens to
laboratory
• Document as per site policy/
procedure (for Edmonton Acute,
Policy #V-20, Patient Chart
Documentation).
Urinary Catheter Insertion with Lidocaine 2% Jelly - Adult
Date Effective
August 7, 2015
Policy No.
VII-B-100
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Urinary Catheter Insertion with Lidocaine 2% Jelly - Adult
Date Effective
August 7, 2015
Insertion of Urinary Male Catheter Criteria Checklist
Critical Practice Elements
Confirms order for catheter insertion and application of Lidocaine
2% Jelly via the urethra prior to insertion of a urinary catheter.
Reviews policy and procedure
Two patient identifier
Hand hygiene, identifies urethra and provides peri-care
2. Gathers necessary equipment.
Is able to verbalize the procedure before entering the patient room.
Identifies risks of insertion procedure and when to abort the procedure
(i.e. unable to advance the catheter to proximal "y" shaped ports
(bifurcation) and/or resistance is met.
Explains procedure to patient and verifies understanding and
cooperation as appropriate.
Washes hands. Wears appropriate PPE.
3. Provides peri-care prior to performing procedure
4. Positions the patient for comfort and ease of access to urethral meatus.
Positions bed at level comfortable working height.
5. Apply Lidocaine Jelly 2% as outlined and allow 5 minutes for
anesthetising agent to take effect.
6. Aseptic technique is maintained throughout catheter insertion procedure.
Cleanses insertion site and lubricate catheter as outlined.
Mound of jelly applied to meatus for insertion.
7. Discontinues procedure if resistance is met when attempting to advance
urinary catheter.
8. Inserts catheter to bifurcation, absence of recoil
Waits for urine return.
9. Inflates urinary balloon with amount of sterile water specified on the
urinary catheter package.
10. Peri-care completed following procedure and patient's genitalia is
covered appropriately.
If patient is uncircumcised, the foreskin is returned to its original
position
11. Apply stabilization device to upper thigh
12. Disposes of used equipment appropriately
13. Provides patient instruction as outlined.
14. Documents in patient care record.
Met
Policy No.
VII-B-100
Not
Met
1.
N/A
□ Passed (completed/verbalized all elements above)
□ Needs to Repeat under Direct Supervision
Staff Name: ______________________________________ Unit: _______________
Validated by (print name): ___________________________ Date: ______________
Signature: ____________________________________________________________
* Staff person to keep a copy for their own records
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