OK, 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.
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.
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.