Central Mindanao University

University Town, Musuan, Maramag Bukidnon

College of Nursing

PERFORMANCE CHECKLIST

FEMALE CATHETERIZATION

NAME: ________________________________ RATING: __________________

SEC/GRP:________________ DATE: ____________________

Definition:

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Purpose:
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Materials needed:

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STEPS RATIONALE REMARKS

Preparatory Phase

1 Identify the client. Discuss procedure with the

patient and assess the patient’s ability to assist
with the procedure. Discuss any allergies with
patient, especially to iodine and latex. Review
chart for any limitations in physical activity
2 Bring the catheter kit and other necessary
equipment to bedside. Obtain assistance from
another staff membrane, if necessary. Perform
hand hygiene.
3 Close curtain around bed and close door to room if
possible.

Working Phase

4 Provide for good light. Place a waste receptacle

within easy reach.

5 Raise the bed to a comfortable working height.

6 Assist client to dorsal recumbent position with

knees flexed, feet about 2 feet apart, with legs
abducted.
7 Drape. Slide waterproof pad under the patient.

8 Don gloves and perform perineal care.

9 Remove soiled gloves.

10 Place the sterile tray on one side and drape client

between thighs.

11 Don sterile gloves.

 STEPS RATIONALE REMARKS
12 Test the catheter balloon by removing protective
cap on tip of syringe and attaching syringe pre-
filled with sterile water to injection port. Inject
appropriate amount of fluid. If balloon inflates
properly, withdraw fluid and leave syringe
attached to port.
13 Attach catheter port to urinary bag.

14 Lubricate 1” to 2” of catheter tip.

15 Using the dominant hand, pick the cotton balls

soaked with betadine. Clean one labia fold, top to
bottom (from the meatus down to the rectum),
then discard. Using a new cotton ball for each
stroke, continue to clean the other labial fold, then
directly over the urinary meatus.
16 With thumb and one finger of nondominant hand,
spread labia and identify meatus. Be prepared to
maintain separation of labia with one hand until
catheter is inserted and urine is flowing well and
continuously
17 Gently insert the catheter tip into the urethra,
advance until there is urine backflow.

18 Hold the catheter securely at the meatus with

your non-dominant hand. Use your dominant
hand to inflate the catheter balloon. Inject sterile
water about 10 ml.
19 Pull gently on catheter after balloon is inflated to
feel resistance.

20 Secure the catheter with a tape.

Termination Phase

21 Remove equipment and dispose according to

facility policy.

22 Remove gloves. Secure catheter tubing between

inner thighs with tape.

23 Placed patient in comfortable position.

24 Perform hand hygiene.

25 Document any findings.

References:
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 KNOWLEDGE

PERFORMANCE Excellent Good Needs Improvement Unacceptable

SCORE
CRITERIA 5 4 3 0-2

Performed the The student is

Performed the Performed the procedure guidelines unprepared,
PREPAREDNESS procedure procedure but showed little there is an
guidelines with guidelines with unpreparedness inaccuracy,
great accuracy, minimal during the steps, with incompleteness of
completeness, and inaccuracy, some inaccuracy the performance
confidence incompleteness and incompleteness of
the performance
Performed entirely Totally performed Performed the Performed the
the procedure the procedure procedure with some procedure with
guidelines guidelines with inadequacy of steps lots of
correctly minimal inadequacy and
COMPLETENESS incompleteness incompleteness
The student is The student is The student is The student is
competent competent but less partially competent, not yet
CONSISTENCY observant, observant, not observant, competent and is
accurate, and focus accurate, and focus accurate, and focus on distracted in
in doing the steps in doing the steps doing the steps of the doing the steps of
of the procedure of the procedure procedure the procedure
ABILITY TO ASK Ask questions Ask questions with Some questions are Questions
QUESTIONS TO comprehensively mostly good points not connected to the included has
CLIENT topic little connection
to the topic

Total Score
20

SKILLS

CRITERIA VERY SATISFACTORY GOOD POOR

SATISFACTORY
5 4 3 0-2
IDEAS AND Rationale and Rationale and Rationale and Rationale and
CONTENT information are information of most information are information are
accurate and correct for steps are accurate and less accurate and often inaccurate and
all steps. correct. with some with lacking entries.
incorrect entries.
LANGUAGE AND Rationale and Rationale and Rationale and Rationale and
GRAMMAR information are clearly information are information are information
described using correct described well but not described described vaguely
and clear language. language or words used well and words using incorrect
are sometimes vague used is not words.
and inaccurate. correct or
inaccurate.
ORGANIZATION Rationale and Rationale and Organization Rationale and
information are well information are well exhibits some information lack
organized. It exhibits organized. It mostly commands of proper organization.
focus and coherent exhibits focus and focus, relatedness It does not exhibit
organization on the coherent organization of the steps and commands of focus
steps and relatedness. on the steps and organized. and relatedness of
relatedness. the steps.
Total Score
20
Remarks/Comments:
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Signature over the printed name of Student

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Signature over the printed name of Clinical Instructor

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DATE