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How To Do Urethral Catheterization in a Female

By

Paul H. Chung

, MD, Sidney Kimmel Medical College, Thomas Jefferson University

Last full review/revision Sep 2020| Content last modified Sep 2020
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Topic Resources

Urethral catheterization is the standard method of accessing the urinary bladder. A flexible catheter is passed retrograde through the urethra into the bladder. Several types of catheters are available. If the urethra is impassable, suprapubic catheterization of the bladder will be necessary.

Indications

Contraindications

Absolute contraindications

  • None

Relative contraindications

*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) before doing urethral catheterization.

Complications

Complications include

  • Urethral or bladder trauma with bleeding or microscopic hematuria (common)

  • UTI (common)

  • Creation of false passages

  • Scarring and strictures

Equipment

Prepackaged kits are typically used but the individual items needed include

  • 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 women)*

  • 10-mL syringe with water (for catheter balloon inflation)

  • Sterile collection device with tubing

* A closed catheter system minimizes catheter-associated UTI.

Additional Considerations

  • Sterile technique is necessary to prevent a UTI.

Relevant Anatomy

  • 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

  • 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 Procedure

  • 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

  • Remove the drapes.

  • Secure the catheter to the thigh with an adhesive bandage or tape.

  • Hang the bag on the bed rails, so that urine can drain via gravity.

Warnings and Common Errors

Tips and Tricks

  • It is often helpful to have an assistant to expose the meatus in women, especially those who are obese or have pelvic organ prolapse.

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