The use of indwelling urinary catheters in the healthcare sector can be very high. Nurses should be familiar with practice and understand the procedure of using indwelling urinary catheters. Recently, MedEduQuest organized a catheterization practice using male/female catheterization simulators.

Using a urinary catheterization simulator in training can significantly benefit nurses by improving their skills, boosting confidence, and promoting safe and effective patient care.

Why Might a Person Need A Urinary Catheter?

The catheter is used when someone cannot urinate by himself/herself or when bladder or urethra need time to heal. This may happen for a number of reasons, such as:
Relief of acute or chronic urinary retention, such as due to urethral or prostatic obstruction (obstructive uropathy) or neurogenic bladder
Treatment of urinary incontinence
Monitoring of urine output
Measurement of postvoid residual urine volume
Collection of sterile urine for culture (usually for infants and women only)
Diagnostic studies of the lower genitourinary tract
Bladder irrigation or instillation of medication

What Should be Prepared for Urinary Catheterization?

Prepackaged kits are typically used but the individual items needed include:
Male/Female catheterization simulator
Sterile drapes and gloves
Povidone iodine with application swabs, cotton balls, or gauze
Water-soluble lubricant
Urethral catheter* (size 16 French Foley catheter is appropriate for most men; in the setting of prostatic hypertrophy or urethral stricture, an alternate size or style of catheter may be required)
10-ml syringe with sterile water (for catheter balloon inflation)
Urine collection device

Step-by-Step Description of Urinary Catheterization Practice

(1) Place all equipment within easy reach on an uncontaminated sterile field on a bedside tray. You may put the box containing the catheter and the drainage system infront of the simulator, so that it is easily accessible during the procedure.
(2) If not done already, attach the catheter to the collecting system and do not break the seal unless a different type or size of catheter or irrigation of the catheter is required.
(3) Saturate the applicator swabs, cotton balls, or gauze with povidone iodine.
(4) Place the sterile fenestrated drape over the pelvis so that the penis/vulva remains exposed.
(5) For male, grasp the shaft of the penis using your nondominant hand(retract the foreskin if the patient is uncircumcised). For female ,gently spread the labia and expose the urethral meatus, using your nondominant hand. This hand is now nonsterile and must not be removed touch any of the equipment during the rest of the procedure.
(6) For male simulator, cleanse the foreskin with applicator swabs. Then cleanse the glans penis with applicator swabs, gauze, or cotton balls saturated in povidone iodine. For female simulator, Cleanse the area around the meatus. Use a circular motion, beginning at the meatus, and work your way outward.
(7) In the clinical practice of male catheterization, viscous lidocaine may be injected into the urethra depending on the actual situation. The lidocaine distends the urethra, as well as provides some anesthesia, thereby easing catheter passage.
(8) Test the retention balloon for integrity by inflating it with water, and apply lubricant to the catheter tip.
(9) Hold the catheter in your free hand. The tip of catheter should point upward, so as to track the superior urethral wall during insertion.
(10) Advance the catheter slowly through the urethra and into the urinary bladder. Continue to apply steady pressure on the catheter until it is fully advanced to the level of the side port. Urine should flow freely out of the tube to the collection device.
(11) Slowly inflate the balloon with 5 to 10 mL of water. If obvious resistance happens, deflate the balloon, withdraw the catheter slightly, and then reinsert the catheter all the way before trying to reinflate the balloon.
(12) Position the balloon at the bladder neck, after successful balloon inflation, by slowly withdrawing the catheter until you feel resistance.

Additional Considerations for Urinary Catheterization Practice

The urethra of male simulator bends acutely at the pubis. Always hold the penis straight and upright, to smooth out the curve, when passing a catheter through the urethra.
Do not continue attempts at catheter placement if significant resistance is met or if the catheter feels to be buckling inside the urethra and not advancing.
Urine will appear in the catheter before the balloon has advanced beyond the prostate. Continue advancing the catheter completely to the end of the catheter before inflating the balloon, to avoid inflating the balloon in the prostate or urethral lumen.
If the catheter appears to be in the correct position, but urine does not return, lubricant may be obstructing drainage of urine. Flush the catheter with normal saline to dislodge the lubricant and see if urine returns.
If the balloon is difficult to inflate or the balloon port distends during inflation, the proximal end of the catheter is probably not in the correct position. Deflate the balloon and advance the catheter further into the bladder.

“This training with simulator provides a safe space for us to make mistakes and learn from them without causing harm to patients. This risk-free environment allows for the identification and correction of errors before performing the procedure on real patients”, Nurse Amy said.