Hi there! Let’s take a look at urinary catheters and catheter insertion for female patients.

A urinary catheter (also known as an ‘indwelling’ or ‘long-term’ catheter) is a hollow, flexible tube inserted through the urethra into the bladder to drain urine into an external collection bag.

Once the catheter has been inserted, a small balloon on the internal end is inflated with sterile water to keep it in situ.

Catheters are used often in healthcare settings to assist with a variety of conditions, such as both urinary incontinence and urinary retention, or by patients who may be unable to go to the toilet without assistance.

Procedure

The following demonstration is based on the Catheterisation Clinical Guidelines by the Australia and New Zealand Urological Nurses Society.

Remember to always refer first to your organisation’s internal policies and procedures when performing any procedure like this one.

• To start, gather all equipment required for the procedure.
• Discuss the procedure with the client. Consider using other educational resources such as brochures or interpreters if needed.
• Obtain the client's consent.
• Check current medications and any known allergies.
• If the client has a latex allergy, a 100% silicone catheter is needed for this procedure.
• Ensure adequate lighting.
• Maintain the client's privacy by using means such as hospital screens or bed curtains. Ensure the client is warm and not exposed.
• Have the client lie in their bed on their back.
• Ask the client to flex their hips, bend their knees and pull them apart, with their feet together.
• Place a waterproof sheet under the client's buttocks.
• Perform hand hygiene.
• Prepare and sanitise the trolley or a clean surface.
• Using an aseptic technique, open the catheterisation pack, and add sterile equipment such as the catheter.
• Pour cleansing solution onto tray.
• If a specimen is needed, open the specimen container at this time.
• Empty sterile water (which may be included in the package) into tray in preparation for balloon inflation.
• Take covering off the client.
• Perform hand hygiene, and don non-sterile gloves.
• Part the labia minora to view urethral meatus.
• If the urethral opening is not easily identifiable due to vaginal atrophy and retraction of the urethral opening, you may need to reposition the client by turning the client to the left lateral position and raising the buttocks.
• Cleanse the labia and the area surrounding the urethral opening with cleansing solution using one downward stroke each time.
• Remove non-sterile gloves, perform hand hygiene and don sterile gloves.
• Put the fenestrated drape on the client.
• Apply gel to the lower third of the catheter.
• Prepare a syringe to inflate the balloon with by drawing up sterile water into the syringe.
• Apply gel on the external urinary opening.
• Apply anaesthetic gel into the urethra and discard the gel container.
• Insert the catheter until urine flow is visualised, then advance the catheter a further 2-4 centimeters to ensure the balloon has passed the urethra.
• If resistance is felt, slightly rotate the catheter or advise the client to take a deep breath.
• If the catheter is accidentally inserted into the vagina, it may be momentarily left in to be used as a guide to help insert a new, sterile catheter into the urethra.
• Once inserted successfully, discard the first attempt’s catheter.
• Slowly inflate the balloon per manufacturer instructions.
• Do not inflate if the client complains of pain or urine is not flowing freely, as this could indicate incorrect catheter placement or bladder spasm.
• One correctly inflated, pull on the catheter slightly until resistance is felt.
• Connect the catheter to a drainage system or compatible valve.
• Secure the catheter in place using tape or a catheter strap.
• Leave some slack to ensure that the catheter does not become taut when the client moves to reduce the risk of injury.
• Ensure genital area is kept clean and dry to avoid skin irritations or infections.
• Remove gloves and perform hand hygiene.
• Check in regularly to ensure the client is comfortable.
• Dispose of used equipment and gloves in a biohazard bag, and clinical waste bag in an appropriate waste system.
• Remember to maintain hand hygiene and complete any relevant documentation.