MODULE OF SKILL LABORATORIUM PRACTICE

BLOCK : GENITOURINARY SYSTEM

TOPIC : CATHETERIZATION PROCEDURE

I. GENERAL OBJECTIVE

After finishing skill practice of catheterization procedure, the student will be able to insert
urinary catheter by using appropriate technique, and remove the catheter when
appropriate.

II. SPESIFIC OBJECTIVES

At the end of skill practices, the student will be able to:

a. Demonstrate internal catheterization procedure by using sterile techniques
b. Demonstrate external catheterization procedure with appropriate technique
c. Demonstrate procedure of removing an indwelling catheter

III. SYLLABUS DESCRIPTION

3.1 Sub Model Objective

After finishing skill practice of catheterization procedure, student will be able to
insert both Foley, nelaton and condom catheter by using proper technique, and
remove the catheter.

3.2 Expected Competencies

a. Students demonstrate procedure of Foley and nelaton catheter insertion
b. Students demonstrate procedure of applying condom catheter
c. Students demonstrate procedure of removing indwelling catheter

3.3 Topics
a. Catheterization Procedure
b. Procedure for removing indwelling catheter

3.4 Methods
a. Presentation
b. Demonstration
c. Coaching
d. Self practices on anatomic models

3.5 Laboratory Facilities

a. Skills Laboratory
b. Trainers
c. Anatomic Model for Catheterization Procedure
d. Student Learning guide
e. Trainers guide
f. References
g. Catheterization sets
3.6 Venue
Skills Laboratory

3.7 Organizer
Block of genitourinary system of Clinical Skills Program, Medical School
Padjadjaran University, Hasan Sadikin Hospital.

3.8 Evaluation
a. Skill demonstration in model unit
b. Point nodal evaluation
c. OSCE
 COURSE STUDY GUIDE : CATHETERIZATION PROCEDURE

N Topic Sub Topic Learning R.P Media Instructo Compe Method Time
o Objectives r -tency Refference
Level
1. Cathet 1.1 Brief 1.1 Student will be DR. 1. Anatomic C4 Presentation 25 1.
erizatio Description able to identify Suwandi Models minutes Roshdal, Caroline
n of patient S., dr., 2.Cathet B, Textbook
Proced Catheteriza condition to SpB., erization of Basic
ure tion select SpU. sets Nursing, 7th
Procedu re appropriate H. Edition
3. LCD
catheter using Mumuh Philadelphia,
pojectors
method ME, dr., Lippincott,
SpB., 2000; 1290-
Student will be SpU. 1326
able to: Bambang 20
1.2 Inserting S., dr., P5 1. Demonstration minutes 2.
Catheter 1.2.1 Insert SpB,SpU. 2. Discussion Berger, Karen J,
Procedu re Foley 1.Catheteriza Fundamental
Tjahjodja
catheter by ti of Nursing,
ti SpB.,
using on Collaboratin
SpU.
sterile Procedure g for
Ferry S.
technique Learning Optimal
dr., SpU. 1. Demonstration Health, 2nd
Guide
Tuti P., 2. Discussion 15 Edition,
2. Anatomy
SKp, minutes Stamford,
Model
1.2.2 insert Mkes. Appleton-
3.Catheteriza
nelaton Yanny T. tion sets Lange, 1999,
catheter by SKp, MN. 982-997
using Sari
sterile Fatimah, 3.
technique SKp, 1. Demonstration Smith D.,
Mkes 2. Discussion 15 General
Hana R., minutes Urology,
1.2.3 apply SKp Prentice
condom Hall, 2000.
catheter by
proper
technique
1.3 Removing 1.3.1 identify 1. Learning P5 1. Discussion 15
Procedure whether Guide of 2. minutes
for an patient Removin Demonstration
Indwelling need g
Catheter discontino Procedur
us urinary e for an
catheter Indwellin
g
Catheter
1.3.2 remove 2. Anatomic
urinary Model
catheter 3.Cathet
when erizatio
appropriat n sets
e
P5 105
1.4 Student 1. Coaching minutes
Practice 1.4.1 demonstr 2. Self practice @ 15
ate minutes
1. Learning
catheteri- for each
Guide of
zation student
Catheteri
procedure
zation
Procedur
e
2. Anatomy
Model
3.
Catheteri
zation
Equipme
nt
CATHETERIZATION SETS ARRANGEMENT

A catheterization set contains the basic equipment needed for the

procedure. The following items are including :

A. Sterile Equipment
1. Sterile catheter.
Either a plain (straight) or an indwelling catheter (Foley catheter)
can be used,which depend on purposed. Straight catheter is use
for bladder irigation and its time measurement for temporary use
only. Indwelling catheter is use for urinary continuos flow and its
time measurement for several days. Catheter are available in
sizes 8 to 20 French. Size 8 is use for infants and young children.
Size 16 is the commonly used for adults. For patient who drain
urine around an indwelling catheter, size 18 or 20 is used.
2. Condom catheter in pack. This catheter may appropriate for man
with its size vary from S, M, L and XL.
3. Syringe (10 mL) 1 pc
4. Thumb Forceps (1 pc)
5. Urine container (1 pc)
6. Solution container (2 pcs)
7. Wrapper (1 pc)
8. Gloves (1 pair)
9. Drapes (2 pcs), plain and center hole
10. Cleasing swabs. This may cotton balls or cotton bud (as
needed)
11. Cleasing solution. Most sets contain water soluble iodine
solution,such as povidone iodine (bethadine)
12. Water-soluble lubricant (K-Y Jelly)
13. Normal saline or aquadest
14. Covered Sterile Steinless Steel Container (1 pc)
15. Hemostat forcep with its container (1 pc)

B. Non Sterile Equipment

1. Urinary bag (1 pc)
2. Soiled container
3. Urine bag hanger (1 pc)
4. Adhesive Tape (1 pack)
5. Scissors (1 pc)
6. Rubber drape (1 pc)
7. Condom catheter adhesive tape

C. Supporting Equipment
1. Penlight or stand lamp
2. Bath blanket
3. Bed Pan
LEARNING GUIDE OF PROCEDURE FOR CATHETHERIZATION

A. PROCEDURE FOR CATHETHERIZATION

No. Procedure Commen

0 1 2 t
Assessment
1. Assess the patient and check the order of
catheterization need
2. Determine whether the catheter is using for
intermittent or continuesly
3. Determine if the procedure is to be straight,
condom, or indwelling catheter
4. Assess need for perineal care and collection of
a specimen
Planning
5. Wash your hand thoroughly by using antiseptic
hand soap
6. Select specific type and size of catheter
7. Collect appropriate equipment, including
catheterization set, light source, bath blanket
or sheet for draping, and extra equipment as
individually determined
Implementation
8. Introduce yourself to the patient with using
therapeutic communication
9. Identify the patient, including: name, medical
record, and sex
10. Explain the procedure, and give detail answer
when she/he ask certain questions with simply
words
11. Draw bed curtains or door, and position and
drape the patient:
a. Pediatric patient or confused patient seek
an assistant from others
b. Male position in supine position
12. a. Arrange the lamp in order to ease when we
explore meatus urethra. If we find the
perineum is soiled then we are doing
perineal care firstly.
b. Open catheterization set and arrange sterile
field. Arrange the sterile equipments by
using sterile hemostat forceps
c. Prepare cleansing swabs on sterile basin
d. If drainage bag is in separate package, open
it and attach to bed
e. If sterile drape is on top of set, grasp drape
by side that is to be non sterile and place
under patient.
f. Open catheter by tear the pack outward with
both hand out of the pack then put it on
sterile field
g. Open sterile syringe by tear the pack
outward with both hand out of pack then put
it on sterile field
h. Open cleansing solution and pour over
swabs into solution container. Then pour
normal sterile water into solution container.
i. Open anesthetic jelly
j. Put on sterile gloves
k. Set antiseptic swabs for cleansing the
perineal or penile glans by pouring into
sterile solution
 l. Place second drape with center hole on top
perineum or penile glans

m. Put the urine container underneath

perineum or penis
n. Set up the specimen container and its cap
upside down
13. a. After meatus is identified, cleanse the area
surrounding the meatus, using swabs held
in forceps. Use circular motion on males.
Swab from anterior to posterior on females.
Use one swab for each area. Discards swabs
away from sterile field.
b. Use non dominant hand to expose the
meatus
c. In the male, retrograde injection of 10 to 15
mL of a water-soluble lubricant-anesthetic
(e.g., 2% lidocaine hydrochloride jelly) and
placement of a urethral clamp for 5 to 10
minutes to allow the anesthetic to contact
the mucosal surfaces are recommended
before any urethral instrumentation. In the
female, the lubricant-anesthetic can be
placed directly on the catheter or a cotton-
tipped applicator coated with lubricant-
anesthetic can be placed in the urethra
before catheterization.
d. Use sterile hand to move tray containing
catheter close to patient, and to pick up
catheter
e. In the male patient, the penis is placed on
stretch perpendicular to the body (pointing
slightly toward the umbilicus) without
compressing the urethra and then the
catheter is placed in the urethral meatus
by holding the catheter at the tip until the
branched of the catheter
15. If using a straight catheter, obtain a specimen
and drain the bladder
16. If using an indwelling catheter, fill the balloon
by instilling sterile water as required volume
that depend on its size
17. Pull out the catheter by gently movement due
to assure the internal fixation is right
18. Connect the bag to the catheter
19. Tape the catheter to the patient-for a to the
lower abdomen
20. Place urine bag beside bed rail by using urine
bag hanger
21. Assist patient to comfortable position
22. Gather and discard disposable equipment.
Clean non disposable equipment
23. Wash your hand thoroughly by using antiseptic
hand soap
Evaluation
24. Evaluate the following criteria:
a. Indwelling catheter draining properly or
straight catheter inserted and removed
without discomfort
b. Correct external fixation
c. Patient comfortable
Documentation
25. Document the following :
a. Date and time of catheter insertion
b. Type and size of catheter
 c. Whether a specimen was obtained
d. Amount of urine
e. Description of urine
f. Patients response to procedure
g. Name of operator

C. PROCEDURE FOR REMOVING AN INDWELLING CATHETER

No. PROCEDURE Comme

0 1 2 nt
Assessment
1. Verify the order
2. Determine whether a urine specimen is
needed
Planning
3. Wash your hand thoroughly by using antiseptic
hand soap
4. Obtain necessary equipment:
a. Paper towels
b. A syringe to remove the fluid from balloon
catheter
c. A small container to catch urine
d. Clean gloves
Implementation
5. Identify the patient
6. Explain that catheter is to be removed and
what to expect
7. Prepare patient by proper draping. Put on
clean gloves
8. Withdraw the catheter
a. Place paper towels under catheter
b. Use syringe to remove fluid from balloon
c. Pinch catheter and pull it out smoothly
d. Wrap the catheter in paper towel
e. Hold and of catheter up to allow urine to
drain from tubing
9. Assist patient to comfortable position
10. Measure urine output
11. Dispose of the equipment
12. Remove gloves and wash your hands
thoroughly with antiseptic hand soap
Evaluation
13. Evaluate using the following criteria :
a. Catheter removed without difficulty
b. Patient voiding adequate amounts
(approximately 250 ml) at regular interval
c. Patient is continuing to increase fluid intake
Documentation
14. Documentation the following :
a. Time of catheter removal
b. Urine output
c. Patients response
CRITERIA OF PERSONAL PERFORMANCE EVALUATION

SCALE COMMENT
PERFORMANCE
ACHIEVEMENT
1 If students are doing the task that only
fill less than 35% of whole items for each LOW
step precisely
2 If student are doing the task that only fill MILD
35% - 60% from whole items for each
step precisely
3 If student are doing the task that only fill MODERATE
60% - 78% from whole items for each
step precisely
4 If student are doing the task that fill at EXCELLENT
least 80% from whole items for each
step precisely

SKILL LABORATORIUM PRACTICE ARRAGEMENT

SCHEDULE OF PRACTICE

No Subject Allocated Tutor

. Time
1. Brief Description about
catheterization procedure :
a. Purpose of Procedure
b. Type of catheterization method
c. Indication for each method

2. Catheterization Procedure
Demonstration :
a. Indwelling/Straight catheter

3. Removing Indwelling Catheter

Demonstration

4. Tutorial Practice for each student