Christ the King College

College of Nursing
Calbayog City

Name of Student Clinical Area

Inclusive Date of Experience Grade

PERFORMANCE EVALUATION CHECKLIST

Catheterization

BEHAVIOR/COMPETENCY WEIGHT SCORE REMARKS

1. Prepare the equipment:
 Sterile catheter of appropriate size
 Syringe prefilled with sterile water
 Urinary bag
 Tape
 1-2 pairs of sterile gloves 3
 Antiseptic solution
 Lubricant
 Specimen container
 Waterproof drape
 2% Xylocaine gel (if agency permits)
2. Explain the procedure 2
MALE
1. Assist client to supine position with thighs and legs
slightly apart. To allow you to see and access the 2
urinary meatus.
2. If you are right handed, stand and work at the
patient’s right side; if you are left handed, stand 2
and work on the patient’s left side.
3. Clean the meatus
Note: The non-dominant hand is considered 1
contaminated once it touches the client’s skin.
4. Use your non-dominant hand to grasp the penis
just below the glans. If necessary, retract the
2
foreskin. Hold the penis firmly upright, with slight
tension. Remove your gloves.
5. Open catheterization kit. Place a waterproof drape
without contaminating the center of the drape with 2
your hands.
6. Apply sterile gloves. 1
7. Attach the prefilled syringe to the indwelling
3
catheter inflation hub, and test the balloon.
8. Lubricate the catheter. 1
9. Grasp the catheter firmly 2-3 inches from the tip.
Ask the patient to take a slow deep breath, and 2
insert the catheter as the client exhales.
10. Hold the catheter with the non-dominant hand. In
males, lay the penis down onto the drape, being 2
careful that the catheter does not pull out.
11. Inflate the retention balloon with designated
volume. Without releasing the catheter, hold the
inflation valve between two fingers of your non-
dominant hand and inflate with your dominant
5
hand. If the client complains of discomfort,
immediately withdraw the instilled fluid, advance
the catheter further, and attempt to inflate the
balloon again.
12. Pull gently on the catheter until resistance is felt to
insure that the balloon has inflated and to place it 2
in the trigone of the bladder
13. Collect specimen if needed. 1
14. Wipe the perineal area of any remaining antiseptic
or lubricant. Replace foreskin if retracted earlier. 2
Return the client in the comfortable position.
15. Discard all used supplies in appropriate receptacles
3
and perform hand hygiene.
16. Document the catheterization procedure including
2
catheter size and results.
FEMALE
1. Prepare the client. Explain the procedure. 2
2. Assist client to supine position with knees flexed,
with feet 2 feet apart. To allow you to see and 2
access the urinary meatus.
3. If you are right handed, stand and work at the
patient’s right side; if you are left handed, stand 2
and work on the patient’s left side.
4. Perform routine perineal care to cleanse the
5
meatus from gross contamination.
5. Open catheterization kit. Place a waterproof drape
without contaminating the center of the drape with 2
your hands.
6. Apply sterile gloves. 1
7. Attach the prefilled syringe to the indwelling
3
catheter inflation hub, and test the balloon.
8. Lubricate the catheter. 1
9. Clean the meatus
Note: The non-dominant hand is considered 1
contaminated once it touches the client’s skin.
10. Use your non-dominant hand to spread the labia.
2
Establish firm but gentle position.
11. With your dominant hand, wipe one side of the
2
labia majora. Use new ball for the opposite side.
12. Repeat for the labia majora 2
13. Use the last ball to cleanse directly over the
2
meatus.
14. Grasp the catheter firmly 2-3 inches from the tip.
Ask the patient to take a slow deep breath, and 2
insert the catheter as the client exhales.
15. Advance the catheter 2 inches further after the
urine begins to flow. If the catheter accidentally
contacts the labia or slips into the vagina, it is 3
considered contaminated, and a new sterile
catherter must be used.
16. Hold the catheter with the non-dominant hand
2
being careful that the catheter does not pull out.
17. Inflate the retention balloon with designated
volume. Without releasing the catheter, hold the
inflation valve between two fingers of your non-
dominant hand and inflate with your dominant
5
hand. If the client complains of discomfort,
immediately withdraw the instilled fluid, advance
the catheter further, and attempt to inflate the
balloon again.
18. Pull gently on the catheter until resistance is felt to
insure that the balloon has inflated and to place it 2
in the trigone of the bladder
19. Collect specimen if needed. 1
20. Wipe the perineal area of any remaining antiseptic
or lubricant. Replace foreskin if retracted earlier. 2
Return the client in the comfortable position.
21. Discard all used supplies in appropriate receptacles
3
and perform hand hygiene.
22. Document the catheterization procedure including
2
catheter size and results.
Total 87

Evaluated by:

Clinical Instructor Student