Before embarking on this procedure, be sure to set up your tray with the necessary equipment and/or medication.

Attach a disposable bag to the tray for depositing your used non-sharp materials.

Check for a history of previous lower abdominal surgery (especially prostate surgery) and observe for lower abdominal scars. An ultrasound-guided insertion may be required.

Ensure that the patient has a full bladder. This minimizes the risk of injuries to other viscera.

Place the patient in the supine position.

Take universal precautions.

Use aseptic technique.

Test the balloon of the catheter by inflating it with sterile water. Check for leaks. Deflate the balloon before proceeding.

Clean the area with antiseptic solution from the base of the penis or mons pubis up to the umbilicus and extend laterally as far as the midclavicular line.

Drape the area with sterile drapes exposing an area approximately 10 X 10 cm.

Palpate the full bladder.

Locate a point in the midline, 2 fingers' breadth above the pubic symphysis and introduce the needle.

Raise a skin bleb.

Infiltrate deeper into the subcutaneous fat and the rectus sheath.

Advance the needle into the bladder and aspirate urine into the syringe.

Remove the needle noting the depth and direction it had entered the bladder. Empty the syringe so that you will be able to use it to aspirate again.

Wait for approximately 5 minutes for the anesthetic to work.

Ensure that the local anesthetic has taken effect.

Make a transverse skin incision, approximately 0.5 to 1 cm in length, where you removed the needle.

Incise through the subcutaneous fat and make a small incision into the rectus sheath.

Hold the introducer with the butt end in the palm of your hand and the index finger on the shaft. This ensures better control of the instrument.

With a twisting motion from side to side, carefully insert the introducer into the bladder. You will feel a 'give' as it passes through the sheath and as it enters the bladder.

Remove the stylet from the introducer.

Aspirate urine to ensure that the introducer has entered the bladder and replace the stylet.

Advance the introducer a further 1 to 2 cm to ensure that the cannula has entered the bladder.

Remove the introducer, leaving behind the cannula.

Pass the catheter through the cannula and into the bladder. You should see urine flow through it.

Pinch the end of the catheter to prevent urine from spilling.

Whilst holding the catheter securely, ask your assistant to peel away the cannula.

Fill the balloon with sterile water.

Connect the drainage bag.

Pull the catheter until the balloon is sitting against the anterior wall of the bladder.

Suture the catheter into place with the 2.0 silk.

Apply a sterile dressing around the catheter.

Postprocedure considerations