How to Use a Urinary Catheter for a Female
Female catheterization may be necessary before or after surgery or childbirth, in elder care, to obtain a sterile specimen, or to relieve bladder pressure in disabled women. Catheters can be one-time, intermittent (straight) or long-term (Foley). Sterile technique is necessary to avoid introduction of bacteria into the normally sterile urinary tract.
Things You'll Need
- Sterile gloves
- Sterile drapes
- Cleansing solution, e.g. povidone-iodine
- Cotton balls
- Sterile forceps or large long tweezers
- Sterile water (usually 10 cc, for Foley)
- Urinary catheter (usually 16-18 French)
- Syringe (usually 10 cc)
- Sterile lubricant (water-based jelly)
- Collection bag and tubing (if indwelling)
- Good light or a flashlight
Instructions
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Set Up and Insert Catheter
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Wash hands. Provide privacy and assist the patient to a reclining or semi-reclining position with knees bent, feet together and knees opened wide. Pour solutions over cotton balls, unless containers are sterile, in which case they should be opened after gloving. Using sterile technique, put on gloves. Sterile technique means that the exterior gloves are not touched, so don the first glove by holding it by the inside cuff and don the second glove by holding the exterior cuff with the gloved hand. Spread a sterile drape on the bed either between the patient's knees or to one side. Drape also the pubic area; some drapes have a cutout to expose the genitals. Sterile technique applies to drapes as well; the upside should only be touched with sterile gloves, which should not touch the underside of the drapes.
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Explain to the patient that you are going to clean inside the labia and that the solution may feel cold. If packets of cleansing solution are sterile, open them and saturate cotton balls. Using forceps or tweezers to hold cotton balls, wash the pubic area and outer labia, discarding each cotton ball after use. With a gloved hand spread the top of the outer labia (majora) and the inner labia (minora). Locate the urinary meatus with the help of a flashlight. It is directly above the vagina, under the junction of the labia minora and below the clitoris. From pubic area to perineum, the landmarks are: labia majora, clitoris, labia minora, urinary meatus, vagina, perineum and anus. Wash the meatus from center to outer edge of the labia minora, using the forceps and four cotton balls, one for each side, top, and dab the meatus with the last cotton ball and wipe toward the vagina. Discard cotton balls after a single use. It is very important to wipe from the center outward in one direction only. To prevent wiping bacteria toward the meatus, do not reverse direction.
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Lubricate the end of the urinary catheter using sterile technique, i.e., do not touch containers that are not sterile and do not touch the catheter except with sterile gloves. The hand used to spread the labia is now considered contaminated and should not be moved. Pick up the lubricated catheter four or five inches from the tip and insert the lubricated tip in the urinary meatus. Tell the patient to expect pressure. Advance the catheter two or three inches if there is no resistance, asking the patient to breathe deeply and relax. If resistance is met, hold there and rotate the catheter gently until the sphincter relaxes and allows advancement. Discard any catheter that accidentally touches the labia or goes into the vagina. Watch for urine in the catheter; as soon as urine is observed, advance the catheter one or two more inches. Allow urine to drain. Use the syringe to inject sterile water into the catheter port to inflate the balloon if the catheter is to remain in place. Retract gently to seat the balloon against the neck of the bladder. Connect tubing securely to the patient's thigh with adequate slack and place collection bag below the level of the bladder. If the catheter is not designed to be indwelling, it can be removed when urine has been drained. Caution: Do not drain more than 2,000 cc from the bladder at one time and do not reuse catheters.
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Clean area and dispose of trash and gloves. Wash hands. Cover and make patient comfortable. Note any patient reactions, the size of catheter used, amount of sterile water used, and amount, clarity, color and odor of urine and document in the patient record.
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Tips & Warnings
It is helpful to have an assistant to pour cleanser and lubricant and to hold a flashlight. If insertion of the catheter is difficult or resistance persists, defer to a supervisor or someone with more experience. Do not force insertion. Placement of urinary catheters should not be painful, however, patients commonly complain of a temporary feeling of urinary urgency. Women can be taught to "self-cath" using a mirror. This should be done under the supervision of a health care professional until proficiency is demonstrated. Care of an indwelling Foley catheter includes emptying the collection bag three times a day, careful washing around the meatus and washing tubing in a single direction moving away from the body.
Ask the patient if she is allergic to povodone-iodine prior to using this cleansing solution. A doctor can order alternatives. Tissue trauma during insertion and infection are the chief complications of urinary catheters. Never place the collection bag above bladder level or rest the container on the floor.
