The State Board of Nursing has established the following regulations for catheterization:
A. The student’s health file shall contain a written request from the parent(s) or guardian for the clean, intermittent catheterization of the student.
B. The student's health file shall contain signed permission from the parent(s) or guardian for the performance of the clean, intermittent catheterization procedure by the licensed or non- licensed school employee.
C. The student's health file shall contain a current written order for clean, intermittent catheterization from the student's physician and shall include written instruction for the procedure. The order shall be renewed each school year.
D. A licensed registered nurse shall develop written instructions specific for the needs of the student. These shall be made available to the non-licensed school employee and shall be updated each school year.
E. The supervision of the self-catheterizing student shall be based on the needs of the student and the skill of the non-licensed school employee.
F. A licensed registered nurse, designated by the superintendent, shall be responsible for the training of non-licensed school employees who are willing to perform clean, intermittent catheterization of the students.
G. The training of the non-licensed school employee shall include but not be limited to:
1. An initial in-service training of a length to be determined by the licensed registered nurse.
2. A current review of the instructions and procedures each school year.
3. Instruction in the anatomy, physiology and pathophysiology of the urinary system including common anomalies for the age group served by the employee.
4. Techniques common to the urinary catheterization procedure.
5. Identification and care of the required equipment.
6. Common signs and symptoms of infection and recommended procedures to prevent the development of infections.
7. Identification of the psychosocial needs of the parent/guardian and the student with emphasis on the need for privacy and confidentiality.
8. Documentation requirements.
9. Communication skills including the requirements for reporting to the registered nurse, the physician, and the parent/guardian.
10. Medications commonly prescribed for the clean, intermittent catheterization patient and their side effects.
11. Contraindications for clean, intermittent catheterization and the procedure to be followed if the non-licensed school employee is unable to catheterize the student.
12. Training in catheterization procedures specific to the student's needs.
13. Developmental growth patterns of the age group served by the employee.
14. Utilization of a teaching model to demonstrate catheterization techniques with return demonstration performed by the non-licensed school employee if a model is available.
15. The training of the non-licensed school employee shall be documented in the employee's permanent file with a copy attached to the student's health file.
Students may require diapering or help toileting due to health, physical or cognitive disabilities. These students may require diapering or toileting on a scheduled or on an “as needed” basis. These tasks should be performed with dignity and respect for the student in a private and safe setting.
- Inspect the designated changing area and make sure that all of the necessary equipment and supplies are available (i.e. gloves, wipes, water, soap, etc.)
- Prepare table/surface where student will be changed by wiping with a sanitized cloth and placing protective paper on the table surface.
- Wear appropriate personal protective equipment (PPE) – gloves (sleeves and apron, if necessary).
- Tell the student about what you are doing.
- Transfer student to changing surface. If a transfer is needed, plan the transfer with the other staff member and student.
- Remove soiled diaper and place in a waste receptable (receptacle should be emptied every 2 hours).
- Clean student using wipes.
- Dispose of soiled gloves, wash hands with soap and water while second staff member tends to the student and put on a clean pair of gloves.
- Place clean diaper on student.
- Transfer student from changing surface.
- Remove paper and clean with disinfectant spray/cloth.
- Wash hands with soap and water.
The changing of gloves and cleaning of the surface is to avoid cross-contamination of infected or contagious material and is a safe handling procedure which should be practiced. The proper removal and disposal of gloves should be included in the bloodborne pathogen training offered to each staff member.
- Escort student to restroom/changing area.
- Prepare toilet by wiping with sanitize/disinfectant wipe and/or placing protective paper.
- Put on PPE – gloves (sleeves and aprons, if necessary).
- Talk to student about what you are doing.
- Assist student with clothes.
- Transfer and/or assist student on toilet seat.
- Clean student when finished.
- Dispose of gloves and wash hands with soap and water while second staff member tends to student. Put on clean pair of gloves.
- Transfer student from toilet.
- Assist with clothes.
- Wash hands with soap and water.
Highline School District 401
Adopted by the Superintendent: April 15, 1992
Revised by the Superintendent: November 2019