| Purpose and indication |
Inserting a catheter without a documented clinical indication or leaving it in place for convenience. |
Unnecessary catheterization increases exposure to catheter-associated urinary tract infection, trauma, discomfort, and reduced mobility. |
Confirm a valid indication, such as acute urinary retention, accurate urine-output monitoring in selected critically ill patients, selected perioperative use, or comfort-focused care. Reassess the need every day. |
Record the indication, insertion date and time, responsible clinician, and planned review or removal criteria. |
High |
| Patient identification |
Failing to verify the patient, procedure, allergies, or relevant medical history before insertion. |
Wrong-patient procedures and unrecognized allergies or contraindications can cause preventable harm. |
Use at least two patient identifiers, explain the procedure, obtain consent according to policy, and check allergies, bleeding risk, anatomical abnormalities, and previous catheterization difficulties. |
Document identity verification, explanation, consent status, allergies, and any relevant precautions. |
High |
| Hand hygiene and asepsis |
Touching sterile catheter parts, the prepared insertion site, or the drainage connection with contaminated hands or equipment. |
Breaks in aseptic technique can introduce microorganisms into the urinary tract or vascular system. |
Perform hand hygiene before and after the procedure, prepare a clean field, use the required personal protective equipment, and maintain aseptic non-touch technique. Use sterile technique for procedures that require it. |
Confirm that the catheter package, lubricant, antiseptic or cleansing solution, gloves, and drainage system are intact and within expiry. |
High |
| Catheter type and size |
Choosing a catheter that is unnecessarily large or selecting the wrong type for the clinical purpose. |
Larger or inappropriate catheters may increase urethral trauma, discomfort, bleeding, blockage, or difficulty with drainage. |
Select the smallest appropriate diameter that provides effective drainage. Use intermittent, indwelling, external, or vascular catheters only for their intended indications and according to patient factors. |
Document catheter type, material when clinically relevant, diameter, length, and the reason for selection. |
Moderate |
| Patient preparation and positioning |
Beginning insertion before providing privacy, positioning the patient correctly, or explaining possible sensations. |
Inadequate preparation can increase anxiety, movement, contamination, failed insertion, and accidental injury. |
Provide privacy, explain each step, position the patient safely, use adequate lighting, and have an assistant available when needed. For urinary catheterization, use appropriate positioning for the patient’s anatomy and mobility. |
Record patient tolerance, assistance required, and any barriers such as pain, limited mobility, or altered anatomy. |
Moderate |
| Lubrication and insertion |
Using insufficient lubricant, applying excessive force, or advancing the catheter despite significant resistance or pain. |
Forceful insertion may cause mucosal injury, bleeding, false passage, or urethral trauma. |
Use sterile, single-use lubricant as appropriate, advance gently, stop if marked resistance or severe pain occurs, and seek qualified assistance rather than forcing the catheter. |
Document the number of attempts, resistance, pain, bleeding, urine return, and escalation to a qualified clinician or specialist. |
High |
| Urinary catheter balloon |
Inflating the retention balloon before urine is observed and the catheter is adequately advanced into the bladder. |
Premature inflation in the urethra can cause severe pain, bleeding, tissue injury, and catheter malfunction. |
For a balloon-retained urinary catheter, confirm urine return and advance the catheter according to the approved procedure before inflating the balloon with the specified sterile fluid volume. Never inflate if placement is uncertain. |
Record urine return, balloon volume and fluid, catheter size, and patient response. |
High |
| Vascular catheter site selection |
Using an area of infection, skin damage, flexion, or a limb with relevant restrictions without assessing alternatives. |
Unsuitable sites may increase infection, infiltration, extravasation, phlebitis, dislodgement, or impaired circulation. |
Assess skin integrity, vein condition, therapy characteristics, limb restrictions, and anticipated duration. Choose a site and device appropriate for the prescribed therapy and follow local vascular-access policy. |
Document site, side, vein or anatomical location when required, device size, number of attempts, and initial site assessment. |
High |
| Securement and connections |
Leaving the catheter unsecured, creating tension, or disconnecting a closed drainage or infusion system unnecessarily. |
Movement and tension can cause tissue damage, dislodgement, leakage, contamination, or interruption of therapy. |
Secure the catheter without impairing circulation, keep connections closed and clean, avoid dependent loops where applicable, and use a sterile replacement process if a system must be disconnected. |
Check securement, dressing or fixation, patency, connection integrity, and the patient’s comfort after insertion. |
Moderate |
| Urinary drainage management |
Placing the drainage bag above bladder level, allowing the outlet to touch a contaminated surface, or permitting tubing to kink. |
These errors can promote reflux, impaired drainage, contamination, bladder distension, and infection risk. |
Keep the drainage bag below bladder level and off the floor, maintain unobstructed tubing, use a closed system, and empty the bag using a clean technique and a dedicated container. |
Assess urine flow, tubing position, bag position, urine characteristics, and any obstruction or leakage. |
High |
| Specimen collection |
Collecting a urine specimen from the drainage bag or using a non-sterile container. |
Bag urine may not represent fresh bladder urine and can produce inaccurate results or contamination. |
Collect specimens from the designated sampling port using aseptic technique and a sterile container. Do not disconnect the catheter and drainage tubing solely to obtain a specimen. |
Label the specimen correctly and document the collection time, source, and reason for testing. |
Moderate |
| Post-insertion monitoring |
Failing to reassess the patient, insertion site, drainage, pain, or signs of infection after insertion. |
Early signs of trauma, obstruction, infiltration, phlebitis, infection, or catheter malfunction may be missed. |
Reassess immediately after insertion and at clinically appropriate intervals. Monitor pain, bleeding, swelling, drainage, patency, urine output, temperature, and local or systemic infection signs. |
Record post-insertion assessment, patient education, output or infusion status, complications, and actions taken. |
High |
| Removal and daily review |
Keeping the catheter in place after the indication has resolved or removing it without checking the prescribed process. |
Prolonged use increases infection and device-related complications, while inappropriate removal can cause retention or interruption of essential therapy. |
Review continued need at least daily where applicable, remove promptly when no longer indicated, and follow the approved removal and post-removal monitoring procedure. |
Document ongoing indication, removal date and time, catheter condition, patient response, and follow-up assessment when required. |
High |
| Safety note: This table is for educational reference and does not replace institutional policy, clinical training, manufacturer instructions, or assessment by a qualified healthcare professional. Stop the procedure and seek expert assistance if there is severe pain, significant resistance, bleeding, suspected false passage, inability to confirm placement, or acute patient deterioration. |
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