CLINICAL SKILLS

Split into small groups. Ask each group to consider:

• Indications for catheterisation
• Risks of catheterisation

Ask students to write three indications on one post-it note and three risks on another and stick on the board. Summarise to the group and briefly cover explanation and consent.

Demonstrate

1. Clean a procedure trolley, wash hands and place sterile catheterisation pack (containing appropriate sized catheter) or individual sterile equipment on the bottom of the cleaned trolley.
2. Introduce yourself, confirm patients’ identity and explain procedure obtaining verbal consent.
3. Wash hands.
4. Using an aseptic non-touch technique (ANTT) open up sterile equipment on to the top of the procedure trolley, empty sterile saline onto cotton wool.
5. Assist patient into a comfortable supine position, ensure patient dignity is maintained.
6. Expose penis area.
7. Wash hands and put sterile gloves on.
8. Using some gauze around the base of the penis with the non-dominant hand, clean the penis away from the meatus ensure the foreskin is retracted in order to clean effectively.
9. Hold the penis in a vertical position and Insert the end of the lubrication syringe into the meatus and instill 10ml slowly.
10. Remove sterile gloves, wash hands, check patient is ok and put new sterile gloves on.
11. If the catheter is not already connected to the sterile catheter bag, connect the bag to the catheter prior to insertion.
12. Place the sterile towel over the patient, ensuring the penis is accessible.
13. Tear the end of the sterile packaging from the tip of the catheter using aseptic non-touch technique (ANTT).
14. Use gauze to hold the penis with the non-dominant hand and advance the catheter using aseptic non-touch technique (ANTT) with the dominant hand.
15. Advance until you see urine flow, then advance another 2cms to ensure the catheter is in the bladder.
16. Inflate the catheter balloon with 10 mls of sterile water by connecting the syringe to the inflation port, if there is resistance or patient experiences pain stop, deflate and advance further.
17. Once the balloon is inflated remove syringe.
18. Ensure foreskin returned to normal position to avoid para-phimosis.

Briefly discuss differences in catheterisation of a female patient. If required, demonstrate this skill, otherwise the full procedure is listed here below.

1. Clean a procedure trolley, wash hands and place sterile catheterisation pack (containing appropriate sized catheter) or individual sterile equipment on the bottom of the cleaned trolley
2. Introduce yourself, confirm patients’ identity and explain procedure obtaining verbal consent.
3. Wash hands.
4. Using an aseptic non-touch technique (ANTT) open up sterile equipment on to the top of the procedure trolley, empty sterile saline onto cotton wool.
5. Position patient in comfortable supine position and with knees flexed and heels together.
6. Wash hands and put sterile gloves on.
7. Check patient is ok and has genitalia exposed.
8. Clean the genitalia with wet cotton wool balls working in a pubis-anus direction.
9. Carefully position the nozzle of the lubricant gel inside the meatus and instill slowly.
10. Remove sterile gloves, wash hands, check patient is ok and put new sterile gloves on.
11. If the catheter is not already connected to the sterile catheter bag, connect the bag to the catheter prior to insertion.
12. Place sterile towel in front of patient and start to inset the catheter using aseptic non-touch technique (ANTT), use gauze when opening the area to aid insertion.
13. Advance until you see urine flow, then advance another 2cms to ensure the catheter is in the bladder.
14. Inflate the catheter balloon with 10mls of sterile water by connecting the syringe to the inflation port, if there is resistance or patient experiences pain stop, deflate and advance further.
15. Once the balloon is inflated remove syringe.
16. Observe the urine flow, check colour, consistency and volume and check patient is comfortable.
17. Remove sterile towel, ensure catheter bag is positioned to encourage drainage.
18. Remove sterile gloves, clear equipment away, clean trolley. Provide patient information leaflet.
19. Document the details of the catheter, (size and batch number) time and date of insertion, reasons for insertion, any complications.

Working in small groups of 2-4, allow students individual turns to practice the skill. Encourage students to observe and assess others according to the protocol above.

Tutor(s) to provide feedback on technique.

1. https://geekymedics.com/female-catheterisation-osce-guide/
2. https://geekymedics.com/penile-catheterisation-osce-guide/