Elimination
Considerations:
• Be sure to take steps to ensure patient privacy when performing procedure
• Encourage the student to assist in the procedure as much as he/she is able to help student learn self-care skills
• There may be a small amount of urine leakage through the artificial opening
• There may be some resistance when attempting to catheterize the artificial opening because the channel goes through abdominal muscle wall. The student or parent/guardian may be able to provide some suggestions on how best to pass the catheter and access the bladder
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Supplies:
• Gloves
• Clean or sterile straight catheter
• Catheter storage bag
• Disposable wipes or soap and water
• Urinal or receptacle for urine if procedure is not performed on the toilet
• Water based lubricant
• Disposable pad to place under student if procedure is done on a cot/bed
• Student’s Individualized Health Plan (IHP) and/or healthcare provider’s order
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Procedure:
1. Review IHP and/or healthcare provider’s order
2. Gather equipment and place on clean surface
3. Explain the procedure to the student at his/her level of understanding
4. Encourage the student to assist in the procedure as much as he/she is able to help student learn self-care skills
5. If the student is completing procedure or assisting in procedure, have student wash hands
6. Assist student with undressing, as needed
7. Position the student
8. If student is lying on a cot/bed, place a disposal pad under the student
9. Wash hands
10. Arrange equipment
11. Put on gloves
12. Lubricate the tip of the catheter with a water soluble lubricant and place on a clean surface
13. Wash the stoma with soapy cotton ball, cleansing wipe, or student specific cleaning supplies in a circular motion, moving from the opening out
14. Repeat procedure a total of 3 times
15. Slowly insert the catheter into stoma until urine begins to flow
16. Insert the catheter 1-2 inches further
17. Having the student contract their abdominal muscles or crede bladder may assist in removing all the urine from the bladder
18. When urine flow has stopped, slowly pull catheter out. You may notice more urine starting to flow into the container as you pull it out. Continue to drain the bladder and completely remove catheter
19. Remove gloves
20. Wash hands
21. Reapply bandage or gauze on stoma if present
22. Assist student in dressing, as needed
23. Have student wash hands
24. Put on gloves
25. Assess urine for cloudiness and/or foul smell
• If present, assess student for signs of urinary tract infection:
• fever
• abdominal pain
• blood in urine
• vomiting
• chills
26. Measure urine per student’s order
27. Discard bodily fluids and catheter per infection control procedures and school district policy
28. Wash the used catheters with warm soapy water
29. Rinse them thoroughly with water
30. Let them air dry on a clean surface
• Catheters should be discarded if they:
• can no longer be thoroughly cleaned
• smell bad
• become too stiff (brittle)
31. Remove gloves
32. Wash hands
33. Document assessment, intervention and outcome in student’s healthcare record
34. Update student’s parents/guardian and healthcare provider, as needed
Cleaning for catheter that will be used again during the school day:
1. Put on clean gloves
2. Clean catheter with mild soap and warm water
3. Forcefully rinse the catheter lumen with tap water
4. Place catheter on clean surface and allow to air dry
5. Remove gloves
6. After equipment is dry, store as appropriate
• Catheter can be used for up to a month
• Should be discarded if becomes too stiff or has any discoloration
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References:
Bowden, V. R., & Greenberg, C. S. (2012). Pediatric nursing procedures (Third Edition). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Connecticut State Department of Education. (2012). Clinical Procedure Guidelines for Connecticut School Nurses. Available at:
http://www.sde.ct.gov/sde/lib/sde/pdf/publications/clinical_guidelines/clinical_guidelines.pdf
National Institute for Health and Clinical Excellence (NICE). (2012). Infection. Prevention and control of healthcare-associated infections in primary and community care. Available at:
http://www.nice.org.uk/nicemedia/live/13684/58656/58656.pdf
National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). (2010). Urostomy and Continent Urinary Diversion. Available at: http://kidney.niddk.nih.gov/kudiseases/pubs/urostomy/#urostomy
Porter, S., Haynie M.D., Bierle, T., Caldwell, T. & Palfrey, J. (1997). Children and Youth Assisted by Medical Technology in Educational Settings. Guidelines for Care. Second Edition. Paul H. Brookes Publishing Co., P.O. Box 10624, Baltimore, MD 21285-0624
United Ostomy Association of America. (2009). Continent Urostomy Guide. Available at:
http://www.ostomy.org/ostomy_info/pubs/ContinentUrostomyGuide.pdf
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Acknowledgment of Reviewers:
Angie Bulmahn, MSN, RN, NCSN
School Nurse Specialist
Missouri Department of Health and Senior Services
Marjorie Cole, MSN, RN, FASHA
State School Nurse Consultant
Missouri Department of Health and Senior Services
Renee Falkner, BSN, RN
School Nurse Supervision Specialist | Therapylog
Debra Funk, BSN, RN
Director of Practice
Missouri State Board of Nursing
Katherine Park, DNP, RN, NCSN
Nationally Certified School Nurse, Pierremont Elementary
Adjunct Professor, Maryville University School of Nursing
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Page last reviewed: June 28, 2021
Page last updated: June 28, 2021; February 14, 2024/no video
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The information and materials presented in this Website are intended for informational purposes only and are not designed to diagnose or treat a health problem or disease, or assist in diagnosis or treatment of the same. The information is not intended to substitute for, supplement or replace clinical judgment. If there are any concerns or questions about or relating to a nursing or medical procedure, contact the individual’s healthcare provider. The information provided on this Website is not intended to be a substitute for medical orders and persons without the proper education, training, supervision and/or licensure should not perform the procedures.
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