How To Do 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

Treatment of urinary incontinence Urinary Incontinence in Adults Urinary incontinence is involuntary loss of urine; some experts consider it present only when a patient thinks it is a problem. The disorder is greatly underrecognized and underreported. Many... read more

Monitoring of urine output

Measurement of postvoid residual urine volume

Collection of sterile urine for culture

Diagnostic studies of the lower genitourinary tract Genitourinary Imaging Tests 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 or instillation of medication

None

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

Current 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 (UTI)

Prior urethral reconstruction

Suspected urethral injury 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 *

Recent urologic surgery

History of difficult catheter placement

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)

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 (common)

Creation of false passages

Scarring and strictures

Sterile drapes and gloves

Povidone iodine

Applicator swabs, sterile gauze, or cotton balls

Water-soluble lubricant

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

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 .

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.

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).

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.

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.

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 .

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.