how to catheterize a female.
By impactEDnurse • Jan 13th, 2008 • Category: Features, clinical skillsOK, now pay attention, because we are about demystify the most tricky art of female catheterization.
Remember this is a most invasive procedure, so contrary to my explanation, proceed with equal parts professionalism and asepsis.
Now, before you read any further:
Check out this.
And look at this.
preparation and positioning:
Preparation is the key.
Obtain consent from your patient and inform her of what she should expect to experience.
If you are a male nurse always have a female nurse present during the procedure. And realize that having a strange male nurse swan diving into your privates will probably be quite traumatic for most female patients.
Position the patient by asking her to draw her knees up with ankles together, and then relax and let her knees drop to either side. The other nurse can assist with maintaining comfortable positioning. (Make sure the patient remains covered whilst you are scrubbing up to guard against this.)
Note: At times patients will be unable to co-operate or unable to comply due to injury and you will have to improvise on the best way to obtain an access trajectory.
Assemble catheterization equipment as per your hospital policy.
Remember, studies have found that Lignocaine gel substantially reduces the procedural pain of female urethral catheterization by comparison with use of a water-based lubricating gel.
Quality lighting of the area will show you what is what and where is where. Take time to position a good light source.
scrub up:
Perform a thorough hand wash and then don sterile gloves.
Most catheterization kits contain a second pair of sterile gloves to place over the first pair. You can then remove the outer pair once you have swabbed the site.
Clean along the length of each of the labia majora. Use a new swab for each pass, in a smooth front to rear action to minimize risk of contaminating your work with bowel flora. Discard used swabs into bin which you have placed close by.
Using your non dominant hand, separate the labia majora and clean the labia minora in the same way. Next, swab in a downwards motion between the clitoris and the vagina.
OK. Now cautiously remove your outer gloves and discard.
Pick up the fenestrated towel and drape the patient.
Once again with your non dominant hand separate the labia. With your dominant hand pick up the catheter. It’s showtime.
pass the catheter:
In females the urethra is relatively short (around 4cm). The urethral opening or meatus is usually located in the superior fornix of the vulva, between the clitoris and the vagina.
Sometimes it is easy to spot, looking like a small stoma or a dimple or a slit….and sometimes it looks more like a needle….in a soggy, pink, mushy, haystack. Good luck.
Once you think you have the meatus in your sights hold the catheter in your dominant hand and gently introduce it into the urethra. This may cause some discomfort to the patient so take care. At this point you can ask her to take a deep breath in and relax as if she was having a nice pee.
It is not uncommon for the catheter to slide off some mysterious bit of anatomy that was not the meatus after all, and end up in the vagina.
Never mind. Leave the catheter in situ and try again with a new one.
TIP: Difficulty locating the urethra? here is a tip from the British Journal of Urology.
The index finger of the non dominant hand is inserted into the vagina. The urethral orifice can then be palpated on the anterior vaginal wall, and the finger can be held there to both block the vagina and guide the catheter in to the correct position.
Now I have never tried this, and sticking a finger into a patients vagina is extremely invasive. But, following explanation to the patient it may prove helpful if absolutely all else fails.
When you hit a bullseye ( and try not to yell out “bullseye!”) you will get a return of urine. Advance the catheter a further 4cm just to make sure you are well within the bladder before inflating the balloon.
Inflate the balloon with sterile water (check the catheter pack for correct amount. Usually 10mls) and then apply gentle traction to bring the balloon up snug against the trigone ( the area where the urethra leaves the bladder.).
Connect the catheter to the urinary drainage bag.
Tape the catheter as per your hospital policy. Make sure that there is enough slack in the system that any movement of the patients legs does not put traction on the catheter.
Clean up the whole area, and document your procedure in the nursing notes including size and type of catheter… and don’t forget to remove that bundle of 4 or 5 *missed attempts* splaying out of her vagina. Good grief! It looks like the back of my stereo down there.
The whole art of urinary catheterization is to minimize the risk of introducing a urinary tract infection; so take time to prepare and clean the area as well as developing a sound aseptic technique.
impactEDnurse is also known as Ian Miller, a nurse with over 26 years experience working in a busy emergency department in, Australia. This site in no way reflects the opinions of that hospital.
All stories (although based on actual experiences) have been changed to protect patient confidentiality.
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I spit my drink out at the stereo comment, brilliantly done.
Nice post, I’m sure it’ll come in handy for a lot of people.
[...] by Ian at ImpactED, I present his link to a very informative and well written post on how to catheterize a female. A skill I hope to never have to perfect. Preparation is the [...]
Nice article! I’m sending a link to a friend who just started nursing school.
Maybe once in my career have I ever put a catheter in a patient who was able to “draw her knees up with ankles together and let her legs fall to either side.”
Most of the time you’re sticking a catheter in on a nursing home patient who is so contracted you have to do it from behind, or a 350-pounder who is so swollen up from CHF that you need a person on either leg and one to hold her pannus up. Or a little skinny old lady who is able to draw her knees up, but has had a little uterine lift after a prolapse, and her anatomy is so distorted that her urethra is up inside her vagina.
FUN!
[...] and vagina. Its sort of like Mac and Windows. Catheterizing female patients can be exasperatingly tricky, its just all so [...]
Hi! I was here the other day before going to work. I arrived at work and the first cab of the rank was a female catheterization. I think you jinxed me!
Hi
Just wanted to point out when reffering to “male nurses”, please be politically correct!!!
We are nurses, just as a female is a nurse!! and we dont need a female with us for carrying out invasive procedures to female patients – it’s all about informed consent, therapeutic communication and building that all time favourite “nurse patient relationship”!!!
and when using words like “swan diving”, how do u think the males in the class room felt????
I have personally only catheterised a few females but always gaine dtheir consent, informing them that if they wished a female could carry out this task.
Please just remember to act as a professional practitioner when lecturing your juniors.
Some good clinical stuff though
xx
I think that you did an amazing job in explaining this. I believe that you were correct in being careful to have a female nurse present. WE live in a very complex society.
May God continue to bless you in educationg. I am sorry that the male nurse felt threathened. I don’t think that you meant it to make male nurses feel threathened.
Poor patients used to get confused (or more confused as the case may be).
Many a weekend shift at my ED
All female Drs
All male nurses
My wife and I was in a severe vehicle roll over accident on Sept 4 2008 and she severely broke her leg so she has a Folley catheter. @ Registered nurses tried to cath her to change the cath and was unsuccessful. I read this page and got her cathed without hurting her or making her bleed. The 2 RNs made her bleed and hurt her very much trying to cath her. They said to take my wife to the emergency room to have her recathed. But thanks to this article, it saved us time, energy, and money from the ER visit.
try positioning liitle oldladies on their side…visualization is good and they won’t feel like they are being assaulted
No wonder western medicine practice is held in such low esteem with morons such as yourself. If you have not already done the profession a favour and left, it may well be worth considering. 4 years of service and you still have nothing to offer but boyish ribald humour. Patients are not brain dead the use of catheterisation is questionable in 80% of all cases and is more often used for convenience rather than for sound medical practice. Commence to NURSE and question medical procedures that have remained in place since the priniting of many of the TEXT books of Nursing Practice most pre 1980.
I enjoyed the read, and thought it was well presented. I also am a male RN and midwife, but sometimes it is uncomfortable dealing with women’s private bits, regardless of the years of practice. I liked the comedic bits, they ease the tension.. Good God, don’t we need that in an otherwise crusty profession. Thank God for the small but increasing numbers of male RNs in nursing. They make the day go faster with their detoxifying honesty and freshness. This was the best article I found on the topic, and made me feel more comfortable to attempt a task I had not carried out for some time. Thanks Ian!