(See also Bladder Catheterization Bladder Catheterization Bladder catheterization is used to do the following: Obtain urine for examination Measure residual urine volume Relieve urinary retention or incontinence Deliver radiopaque contrast agents or... read more .)
Indications for Urethral Catheterization in a Female
Relief of acute or chronic urinary retention, such as due to urethral obstruction (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 ) or 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
Monitoring of urine output
Measurement of postvoid residual urine volume
Collection of sterile urine for culture
Bladder irrigation or instillation of medication
Contraindications to Urethral Catheterization in a Female
Prior urethral reconstruction
Recent urologic surgery
History of difficult catheter placement
*Urethral injury may be suspected following blunt trauma if patients have blood at the urethral meatus (most important sign), inability to void, or perineal or labial ecchymosis, and/or edema. In such cases, urethral disruption should be ruled out with imaging (eg, by retrograde urethrography and sometimes also cystoscopy Cystoscopy Cystoscopy is insertion of a rigid or flexible fiberoptic instrument into the bladder. Indications include the following: Helping diagnose urologic disorders (eg, bladder tumors, calculi in... read more ) before doing urethral catheterization.
Complications of Urethral Catheterization in a Female
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 trauma 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 or microscopic hematuria (common)
Creation of false passages
Scarring and strictures
Equipment for Urethral Catheterization in a Female
Prepackaged kits are typically used but the individual items needed include
Sterile drapes and gloves
Applicator swabs, sterile gauze, or cotton balls
Urethral catheter (size 16 French Foley catheter is appropriate for most adult women)*
10-mL syringe with water (for catheter balloon inflation)
Sterile collection device with tubing
* A closed catheter system minimizes catheter-associated UTI Catheter-Associated Urinary Tract Infections A catheter-associated urinary tract infection (CAUTI) is a urinary tract infection (UTI) in which the positive culture was taken when an indwelling urinary catheter had been in place for >... read more .
Additional Considerations for Urethral Catheterization in a Female
Sterile technique is necessary to prevent a UTI Introduction to Urinary Tract Infections (UTIs) Urinary tract infections (UTIs) can be divided into upper tract infections, which involve the kidneys ( pyelonephritis), and lower tract infections, which involve the bladder ( cystitis), urethra... read more .
Relevant Anatomy for Urethral Catheterization in a Female
The female urethral meatus appears as an anterior-posterior slit located anterior to the vaginal opening and about 2.5 cm posterior to the glans clitoris. If the meatus recedes superiorly into the vagina, as can happen in older women, it can often be palpated in the midline as a soft mound surrounded by a firm ring of periurethral tissue.
Positioning for Urethral Catheterization in a Female
To expose the vulva, position the patient supine in either lithotomy or frog position (hips and knees partially flexed, heels on the bed, hips comfortably abducted).
Step-by-Step Description of Urethral Catheterization in a Female
Place all equipment within easy reach on an uncontaminated sterile field on a bedside tray. You may put the box containing the catheter and the drainage system between the patient’s legs, so that it is easily accessible during the procedure.
If not done already, attach the catheter to the collection system and do not break the seal unless a different type or size of catheter is required.
Test the retention balloon for leaks by inflating it with water.
Apply lubricant to the tip of the catheter.
Saturate the applicator swabs, cotton balls or gauze with povidone iodine.
Place the sterile fenestrated drape over the pelvis so that the vulva is exposed.
Gently spread the labia and expose the urethral meatus, using your nondominant hand. This hand is now contaminated and must not be removed from the labia or touch any of the equipment during the rest of the procedure.
Cleanse the area around the meatus with each cotton ball saturated in povidone iodine. Use a circular motion, beginning at the meatus and working your way outward. Discard or set aside the newly contaminated gauze or cotton balls.
Hold the lubricated catheter and gently pass it through the urethra, using your free hand. Urine should flow freely into the collection tubing. If the catheter accidentally passes into the vagina, it should be discarded and a new catheter used.
Inflate the balloon with the recommended volume of water, usually 10 mL. Resistance or pain may indicate that the balloon is in the urethra and not the bladder. If so, deflate the balloon, then insert it all the way before reinflation.
Pull the balloon up snug against the bladder neck, after the balloon has been inflated, by slowly withdrawing the catheter until resistance is felt.
Aftercare for Urethral Catheterization in a Female
Remove the drapes.
Secure the catheter to the thigh with an adhesive bandage or tape.
Hang the bag in a dependent position, so that urine can drain via gravity.
Warnings and Common Errors for Urethral Catheterization in a Female
Be sure to maintain strict sterile technique during the procedure to avoid urinary tract infection Introduction to Urinary Tract Infections (UTIs) Urinary tract infections (UTIs) can be divided into upper tract infections, which involve the kidneys ( pyelonephritis), and lower tract infections, which involve the bladder ( cystitis), urethra... read more .
Tips and Tricks for Urethral Catheterization in a Female
It is often helpful to have an assistant to help expose the meatus in women, especially those who are obese or have pelvic organ prolapse. Gentle retraction of the labia is helpful.