Intermittent Urinary Catheterization Male

Considerations:

• Be sure to take steps to ensure student privacy when performing procedure. 
• Encourage the student to assist in the procedure as much as he is able to help student learn self-care skills. 
• Students who require urinary catheterization frequently have cloudy, foul smelling and sometimes bloody urine.  Notify parent/guardian if there is a change in urine as the health care provider should be notified. 
• The school nurse should be aware of the student’s baseline urine characteristics to identify any concerning changes that may need intervention. 
• Many students who require urinary catheterization may also have bowel issues such as constipation or stool leakage.  The student may be on a daily bowel regimen at home. 
• Discuss with the health care provider if the student uses a new catheter for each catheterization or reuses the same catheter. If the student reuses the catheter, discuss with the health care provider how long the catheter should be reused (i.e. 5 days, one week, etc.).

   

Supplies:

• Gloves
• Clean straight catheter (_____ french, per health care provider’s order) 
• Catheter storage bag or container (toothbrush holder, non-airtight plastic bag) 
• Disposable wipes or mild soap and water 
• Urinal or receptacle for urine if procedure is not performed on the toilet 
• Water based lubricant such as K-Y Jelly® or Lubafax Jelly® 
• Disposable pad to place under student if procedure is done on a cot/bed 
• Extra change of clothing 

• Student’s Individualized Health Care Plan (IHCP) and health care provider’s order 
• Parent/Guardian authorization form

Procedure:

1. Review IHCP and/or health care provider’s order 
2. Ensure proper documentation of parent/guardian authorization to perform this procedure 
3. Gather equipment and place on clean surface 
4. Explain the procedure to the student at his level of understanding 
5. Encourage the student to assist in the procedure as much as he is able to help student learn self-care skills 
6. If the student is completing procedure or assisting in procedure, have student wash hands 
7. Assist student with undressing, as needed 
8. Position the student 
9. If student is lying on a cot/bed, place a disposal pad under the student 
10. Wash hands 
11. Arrange equipment 
12. Put on gloves
13. Lubricate 1-2 inches of the catheter tip with a water-soluble lubricant and place on a clean surface
    a. Use a generous amount of lubricant since dry catheters may cause excoriations in the urethra, leading to an entry point for bacteria contamination 
14. Using your nondominant hand, grasp the sides of penis below the glans
    a. Be prepared to keep this hand in this position until the catheter is inserted and urine is flowing well and continuously
15. Gently retract foreskin if uncircumcised 
16. Wash the glans with soapy cotton ball or student specific cleaning supplies 
17. Begin at urethral opening and in a circular motion wash away from the meatus toward the base of the penis
18. Repeat procedure a total of 3 times, using a clean cotton ball each time 
19. Gently straighten the penis for ease of insertion
    a. Hold the penis with slight upward tension and perpendicular to the student’s body 
20. Have student take a deep breath and do other relaxation techniques 
21. Using your dominant hand, pick up the catheter and hold it 1-2 inches from the tip 
22. Slowly insert the catheter until urine begins to flow
23. If you meet resistance try the following (resistance in male catheterization is normal at about the level of the prostate)
    a. Rotate the catheter
    b. Have the student sit or lie in a different position
    c. If you are still unable to insert the catheter or the student experiences pain remove the catheter and follow up with parents/guardian and health care provider 
24. If resistance continues or the student experiences pain, stop insertion. Never force the catheter
25. When urine flow has stopped, pinch the catheter and remove it slowly  
26. If student is uncircumcised, pull the foreskin over the glans when finished
    a. This is extremely important as failing to do this can result in paraphimosis which is emergent situation 
27. Remove gloves 
28. Wash hands  
29. Assist student in dressing, as needed 
30. Have student wash hands 
31. Put on gloves
32. Assess urine for cloudiness and/or foul smell
    a. If present, assess student for signs of urinary tract infection:  fever, abdominal pain, blood in urine, vomiting or chills.
33. Measure urine output per health care provider’s order 
34. Discard bodily fluids and catheter per infection control procedures and school district policy 
35. Clean and store equipment as appropriate 
36. Remove gloves 
37. Wash hands 
38. Document assessment, intervention, and outcome in student’s health care record
39. Update student’s parents/guardian and health care provider, as needed 

Procedure for Cleaning the 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
a. Review health care provider’s order to determine how long the catheter can be used for 

• Catheter should be discarded if becomes too stiff or has any discoloration  

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References:

Bradley E. (2020). Achieving independence in toileting: Self-catheterization efficacy and the role of the school nurse. NASN school nurse (Print), 35(6), 314–318. https://doi.org/10.1177/1942602X20942533  

Children’s Minnesota. (2017, July). Catheterizing a boy-intermittent. Retrieved June 20, 2023, from https://www.childrensmn.org/educationmaterials/childrensmn/article/15537/catheterizing-a-boy-intermittent/   

Cincinnati Children’s. (2021, July). Intermittent catheterization-males. Retrieved June 20, 2023, from https://www.cincinnatichildrens.org/health/i/catheterize-male  

Lynn, P. (2019). Catheterizing the female urinary bladder. In Skill checklists for Taylor’s clinical nursing skills. A nursing process approach. (5th ed.). (pp. 271-273). 

Perry, A. G., Potter, P.A., Ostendorf, W., & Laplante, N. (2021). Skill 34.1 insertion of a straight or an indwelling urinary catheter. In Clinical nursing skills and techniques. (10th ed.). (pp. 997-1008). St. Louis, MO: Elsevier. 

Porter, S.M., Page, D., Engholm. H., & Somppi, C. (2019). Students supported by medical technology. In J. Selekman, Shannon, R.A., Yonkaitis, C.F. (Eds.). School nursing, a comprehensive text (3rd ed., pp. 721-740). Philadelphia PA.: F.A. Davis Co. 

Spina Bifida Association. (n.d.). Continence management in schools. Retrieved June 20, 2023, from https://www.spinabifidaassociation.org/wp-content/uploads/Beyond-Crayons-info-sheet-Continence-Management.pdf  

Tobias, N.E. (2017). Practical considerations and current best practice for pediatric clean intermittent catheterization. Pediatric nursing, 43(6), 267-273. 

Toothaker, R., & Cook, P. (2018). A review of four health procedures that school nurses may encounter. NASN school nurse (Print), 33(1), 19–22. https://doi.org/10.1177/1942602X17725885 

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Acknowledgement 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; April 22, 2024
Page last updated: April 22, 2024
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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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