Catheter Care Checklist Form
Document routine catheter care and observations using this comprehensive checklist.
Patient Identifier (e.g., initials or patient code)
*
Date of Care
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Catheter Type
*
Please Select
Foley
Suprapubic
External (Condom)
Other
Care Performed (Check all that apply)
*
Hand hygiene before/after procedure
Catheter site cleaned
Tubing checked for kinks
Drainage bag emptied
Securement device checked
Other
Insertion Site Condition
*
Please Select
Normal/Intact
Redness
Swelling
Discharge
Bleeding
Other
Drainage/Output Observation
*
Please Select
Clear
Cloudy
Bloody
Foul odor
Other
Signs of Infection or Complication
*
Fever
Chills
Pain at site
Discharge
No signs observed
Other
Supplies Used
Sterile gloves
Antiseptic solution
Dressing supplies
Securement device
Other
Caregiver Name
*
Additional Notes or Follow-Up Action
Submit Checklist
Should be Empty: