CATHETERIZATION RATING SCALE
Name of Student: Date:
Please check the appropriate value column:
Scale Verbal Description Rating
Performs all tasks accurately and independently; 4
Advanced well organized
Performs all tasks properly and independently; some 3
Accomplished steps were interchanged or omitted; organized
Performs most task properly; requires some 2
Developing guidance; less organized
Performs few tasks properly; requires some guidance;
Beginning 1
unorganized
PRIOR TO PROCEDURE 4 3 2 1
1 Gather the equipment needed .
2 Check Physician’s order
3
Obtain consent from the client
4
Ensure privacy throughout the procedure.
5
Explain the procedure to the patient using therapeutic
communication skills
6
Wear PPE
DURING THE PROCEDURE
4 [Link] good light
5 2. Provide privacy by closing curtains or door
6 3. (For Female) Assist patient to dorsal recumbent position with
knees flexed and feet about 2 feet apart. Drape patient. Or if
preferable, place patient in the side-lying position.
(For Male) Position patient on his back with thighs slightly apart
drape patient so that only area around penis is exposed. Clean
the penile area put on sterile gloves. Open sterile drapes and
place on patient’s thigh, place a fenestrated drape with the
opening over penis. Removed gloves and wash hands
7 4. Slide water proof drape under patient.
5. Don disposable gloves
8
9 6. (for Female) Spread the labia well with fingers and clean the
area at the vaginal orifice with a betadine using a different corner.
(For Male) Lift penis with your non-dominant hand, which is then
considered contaminated. Clean area at meatus with cotton ball
held with forceps. Use circular motion moving from the meatus
toward the base of the penis for three cleansings
7. Wipe from above the orifice downward toward sacrum (front
and back)
10 8. Removed gloves and wash hands
11 9. Prepare urine drainage setup if indwelling catheter is to be
inserted and if separate urine collection system is used
12 10. Open all supplies.
If catheter is to be indwelling test catheter balloon by attaching
syringe prefilled with sterile water or pnss about 10cc to injection
port if balloon inflates properly, withdraw fluid and leave syringe
attached to the port
13 11. Lubricate 1 to 2 inches of catheter tip with ky jelly
14 13. Pick up sterile catheter and roll the catheter to your dominant
hand. Place the drainage end of the catheter in receptacle
15 14. Insert the catheter tip into the meatus 5 to 7.5cm (2 to 3
inches) or until the urine flows. Do not force to push catheter
through the urethra into the bladder. Rotate catheter gently if
slight resistance is met as catheter reaches the external
sphincter. Once drains advance catheter another 2.5 to 5 .0
cm(1 to 2 inches
16 [Link] catheter securely with the non-dominant hand while
bladder empties
17 [Link] straight catheter slowly if straight catheter is order
18 17. Remove equipment and gloves and make patient comfortable
in bed
19 18. If the catheter is to be indwelling; inflate balloon to prevent
the catheter from sliding out of patients body
[Link] gently after balloon is inflated to feel resistance
20 [Link] catheter to drainage system if necessary
21 [Link] to upper thigh the catheter tube with tape to allow for
leg movement
22 [Link] drainage tubing is not kinked and that movement of
side rails does not interfere with catheter drainage bag
23 [Link] time of catheterization, state of catheter and balloon,
amount of urine removed, description of urine if specimen was
sent and the patients reaction to procedure in the medical record
also document the urine amount on intake and output flow sheet
Rating:
Student’s Name & Signature
Date:
Clinical Instructor’s Name & Signature