The nurse prepares to insert an indwelling urinary catheter in a client who is disoriented to time, place, and person and cannot follow directions or commands. Which intervention is most important when inserting the urinary catheter?

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Maintaining sterility is key when inserting an indwelling urinary (Foley) catheter. Sterile technique (surgical asepsis) should be used to prevent catheter-associated urinary tract infections, the 2nd most common type of health care-associated infection. Proper placement of the kit and application of sterile gloves are important to maintaining sterility. The dominant hand should be kept sterile until the procedure is complete. Once the nondominant hand is placed on the client's genitalia (to spread the labia or grasp the penis) for cleansing, it should be kept in place until the catheter is inserted to prevent contamination. (Option A) The procedure should be explained to the client; however, this client is confused and likely will not understand. (Option C) The catheter kit may be placed between the client's legs if the client is cooperative. However, use of a clean bedside table is more effective in maintaining a sterile field when the client is confused and uncooperative. (Option D) Swabs should be disposed of in the trashcan or biohazard bin in accordance with hospital policy; however, maintaining a sterile field is a higher priority. Educational objective: Maintenance of sterile technique is a key outcome for indwelling urinary catheterization. A sterile field should be maintained during the entire procedure through proper placement of the kit and application of sterile gloves. The nondominant hand should be used for cleansing and kept in place to prevent contamination. The sterile dominant hand should be used for insertion.

The Nurse Prepares to Insert an Indwelling Urinary Catheter in a Client