How To Catheterize the Bladder in a Female Child

Collect a sterile urine sample for testing in very young children who cannot void on command

Relief of acute or chronic urinary retention (obstructive uropathy Obstructive Uropathy Obstructive uropathy is structural or functional hindrance of normal urine flow, sometimes leading to renal dysfunction (obstructive nephropathy). Symptoms, less likely in chronic obstruction... read more )

Intermittent catheterization of a neurogenic bladder Neurogenic Bladder Neurogenic bladder is bladder dysfunction (flaccid or spastic) caused by neurologic damage. Symptoms can include overflow incontinence, frequency, urgency, urge incontinence, and retention.... read more

Instillation of contrast agent for cystourethrography Cystourethrography Imaging tests are often used to evaluate patients with renal and urologic disorders. Abdominal x-rays without radiopaque contrast agents may be done to check for positioning of ureteral stents... read more

Bladder irrigation

Instillation of a medicine

Monitoring of urine output in certain hospitalized patients (indwelling catheter; not discussed here)

Suspected lower urinary tract disruption from recent trauma

Known major abnormalities of the lower urinary tract

History of urethral strictures Urethral Stricture Urethral stricture is scarring that obstructs the anterior urethral lumen. Urethral stricture can be Congenital Acquired Anything that damages the urethral epithelium or corpus spongiosum can... read more

Prior urethral or bladder neck reconstruction

History of difficult catheter placement

Superficial urethral Urethral Trauma Urethral injuries usually occur in men. Most major urethral injuries are due to blunt trauma. Penetrating urethral trauma is less common, occurring mainly as a result of gunshot wounds, or alternatively... read more or bladder injury Bladder Trauma External bladder injuries are caused by either blunt or penetrating trauma to the lower abdomen, pelvis, or perineum. Blunt trauma is the more common mechanism, usually by a sudden deceleration... read more with bleeding (common)

Urinary tract infection Urinary Tract Infection (UTI) in Children Urinary tract infection (UTI) is defined by ≥ 5 × 10⁴ colonies/mL in a catheterized urine specimen or, in older children, by repeated voided specimens with ≥ 10⁵ colonies/mL... read more (UTI; common)

Creation of false passages

Scarring and strictures Urethral Stricture Urethral stricture is scarring that obstructs the anterior urethral lumen. Urethral stricture can be Congenital Acquired Anything that damages the urethral epithelium or corpus spongiosum can... read more

Bladder perforation (rare)

Sterile drapes and gloves

An absorbent underpad

Antiseptic solution (eg, povidone-iodine, chlorhexidine) with application sticks, cotton balls, or gauze pads

Sterile water-soluble lubricant (with or without 2% lidocaine)

Sterile cup for collecting urine specimen

Urethral catheter size varies with age: neonate (full term) to 6 months—5 to 6 French (Fr); infant or toddler—6 to 8 Fr; prepuberal child—10 to 12 Fr; adolescent—12 to 14 Fr

Washcloth for removing antiseptic solution after the procedure

Sterile technique is necessary to prevent a lower UTI Urinary Tract Infection (UTI) in Children Urinary tract infection (UTI) is defined by ≥ 5 × 10⁴ colonies/mL in a catheterized urine specimen or, in older children, by repeated voided specimens with ≥ 10⁵ colonies/mL... read more .

Ensure the patient is not allergic to latex or povidone-iodine.

If doing multiple procedures, do bladder catheterization first, as the child may void during the other procedures.

The pediatric female anatomy is similar to the adult's, with a difference in size.

The female urethral meatus is the first opening below the clitoris and is located above the vaginal opening. It can be difficult to visualize if it appears closed. Also, young girls may have labial adhesions, which can make visualization of the meatus more difficult.

The urethra is short and straight and thus easy to catheterize.

Place the patient in a supine, frog position (hips and knees partially flexed, heels on the bed, hips comfortably abducted).

An assistant should hold the legs or knees.

Allow one or both parents or caretakers to remain present to comfort the child. Having them hold the child's hand, provide a stuffed animal for the child to play with, or engage in other distraction techniques can help. Occasionally sedation is needed.

Place all equipment within easy reach on an uncontaminated sterile field on a bedside tray.

Open the prepackaged kit, taking care not to contaminate the contents.

Place the absorbent underpad with the plastic side down beneath the buttocks.

Remove diaper if present and clean the area with a wet washcloth using soap and water. Dry the area with a dry towel. Then wash your hands with soap and water.

Put on gloves using sterile technique.

Apply the sterile lubricant to the end of the catheter and place on the sterile field.

Saturate the application sticks, cotton balls, or gauze with antiseptic solution (eg, povidone-iodine).

Place the sterile fenestrated drape over the pelvis so that the vulva is exposed.

With your nondominant hand, separate the labia to expose the meatus.

Cleanse the area around the meatus with each application stick, gauze pad, or cotton ball saturated in povidone-iodine. Swab the area with an anterior-to-posterior motion. Discard or set aside the newly contaminated application stick, gauze pad, or cotton balls. If using povidone-iodine, cleanse 3 times then allow the area to dry.

Hold the catheter in your dominant free hand. Separate the labia with your nondominant hand. If the meatus is difficult to see, gently pull the vaginal introitus mucosa downward.

Advance the catheter gently through the urethra just until urine is obtained. Do not poke repeatedly or force the catheter. Urine should flow freely.

If the catheter has entered the vagina, leave that catheter in place as a landmark and obtain another catheter.

Collect urine in the specimen container. If the volume is insufficient, gently massage the lower abdomen over the bladder (suprapubic area).

Remove the catheter by pulling out gently.

Remove all remaining povidone-iodine with a wet washcloth.

Remove the drapes.

To prevent causing a UTI Urinary Tract Infection (UTI) in Children Urinary tract infection (UTI) is defined by ≥ 5 × 10⁴ colonies/mL in a catheterized urine specimen or, in older children, by repeated voided specimens with ≥ 10⁵ colonies/mL... read more , maintain strict sterile technique during the procedure.

To prevent causing blind passages and urethral injury, do not use excessive force during insertion.

Do not proceed with continued attempts at catheter placement if significant resistance is met or if the catheter feels as if it is buckling inside and not advancing.

If the catheter appears to be in the correct position but urine does not return, lubricant may be obstructing the drainage of urine. With the catheter held in the current position, flush the catheter with normal saline to dislodge the lubricant and see if urine returns prior to proceeding with the remaining steps.

If the catheter appears to be in the correct position but urine does not return and there is the possibility of anuria due to dehydration, consider providing hydration (appropriate to the patient's clinical condition) before the procedure is attempted again.

If the catheter appears to be in the vaginal opening, leave the catheter in temporarily. Reattempt catheterization of the urethral opening with a fresh sterile catheter; the previously placed vaginal catheter will prevent you from entering the incorrect orifice. Once urethral catheterization is complete, remove the vaginal catheter.

Consult a urologist for any issues with catheter placement or guidance on catheter size and style in select clinical scenarios. In certain situations where a catheter cannot be placed, a suprapubic percutaneous aspiration may be indicated.