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Urethral Catheterization in Women Technique

  • Author: Gil Z Shlamovitz, MD, FACEP; Chief Editor: Edward David Kim, MD, FACS  more...
 
Updated: Jan 10, 2016
 

Catheterization of Female Urethra

With the patient in position, open the catheter tray and place it on the gurney between the patient’s legs; use the sterile package as an extended sterile field. Open the preparatory solution, and pour it onto the sterile cotton balls (see the image below). Open a sterile 2% lidocaine lubricant with an applicator or a 10-mL syringe, and place these materials on the sterile field.

Preparatory solution in commercial urinary cathete Preparatory solution in commercial urinary catheterization kit.

Don the sterile gloves, and use the nondominant hand to separate the labia with the thumb and index finger. This hand is now nonsterile and is used to expose the vulva throughout the procedure.

With the sterile hand and a sterile forceps, apply preparatory solution to the urethra and the surrounding vulva in circular motions, using at least 3 different cotton balls. Without moving the nondominant hand, apply the sterile drapes that are provided with the urinary catheterization tray to create a sterile field around the vulva.

The use of a urethral anesthetic in female patients is controversial.[10] The decision to anesthetize the urethra should be made in conjunction with the patient. If the urethra is to be anesthetized, use the commercial applicator or a syringe with no needle to instill 5 mL of 2% lidocaine gel into the urethra. Place a finger on the meatus to help prevent spillage of the anesthetic lubricant. Allow 2-3 minutes for the anesthetic to take effect before proceeding with the urethral catheterization.

Hold the catheter with the sterile hand, or leave it in the sterile field. Remove the cover to expose the tip (see the image below). Apply a generous amount of either a nonanesthetic lubricant or the remaining lidocaine gel.

Urinary catheter tip. Image courtesy of Michel Riv Urinary catheter tip. Image courtesy of Michel Rivlin, MD, and G Rodney Meeks, MD.

Slowly and gently introduce the catheter into the urethra. Continue to advance the catheter either to a point several centimeters beyond where urine is first obtained or until the proximal Y-shaped ports are at the meatus (see the video below).

Urinary catheterization. Video courtesy of Michel Rivlin, MD, and G Rodney Meeks, MD.

To confirm that the distal end of the catheter is in the bladder, wait for urine to drain from the larger port. The lubricant jelly–filled distal catheter openings may delay urine return. If no spontaneous return of urine occurs, try attaching a 60-mL syringe to aspirate urine. If urine return is still not visible, withdraw the catheter and reattempt the procedure. Ultrasonography may be used at this point to verify the presence of the catheter inside the bladder.

After visualization of urine return, inflate the distal balloon by injecting 5-10 mL of 0.9% NaCl (normal saline) through the cuff inflation port. Inflation of the Foley catheter’s balloon should be aborted if the patient reports any pain as a result of the inflation; a painful inflation is probably taking place in the urethra rather than in the bladder. Inflation of the balloon inside the urethra results in severe pain, gross hematuria, and, possibly, urethral tearing.

Gently withdraw the catheter from the urethra until resistance is met. Secure the catheter to the patient’s thigh with a wide tape (see the video below). Creating a gutter with tape to elevate the catheter from the thigh may enhance the patient’s comfort.

Taping of urinary catheter. Video courtesy of Michel Rivlin, MD, and G Rodney Meeks, MD.
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Complications

Complications of urethral catheterization in women may include the following:

  • Infections, [11, 12] including urethritis, cystitis, pyelonephritis, and transient bacteremia
  • Creation of false passages
  • Urethral strictures
  • Urethral perforation
  • Bleeding
  • Altered micturition [13]

Noninfectious complications of short- and long-term catheterization include accidental removal, catheter blockage, gross hematuria, and urine leakage, and these are at least as common as clinically significant urinary tract infections in this patient population.[14]

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Contributor Information and Disclosures
Author

Gil Z Shlamovitz, MD, FACEP Associate Professor of Clinical Emergency Medicine, Keck School of Medicine of the University of Southern California; Chief Medical Information Officer, Keck Medicine of USC

Gil Z Shlamovitz, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association

Disclosure: Nothing to disclose.

Chief Editor

Edward David Kim, MD, FACS Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, Tennessee Medical Association, Sexual Medicine Society of North America, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Repros.

Acknowledgements

Andrew K Chang, MD Associate Professor, Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center

Andrew K Chang, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Luis M Lovato, MD Associate Clinical Professor, University of California, Los Angeles, David Geffen School of Medicine; Director of Critical Care, Department of Emergency Medicine, Olive View-UCLA Medical Center

Luis M Lovato, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of Medscape Reference gratefully acknowledge the assistance of Lars Grimm with the literature review and referencing for this article. They also thank Michel Rivlin, MD, and G Rodney Meeks, MD, for the videos and several of the images in this article.

References
  1. Ortega R, Ng L, Sekhar P, Song M. Videos in clinical medicine. Female urethral catheterization. N Engl J Med. 2008 Apr 3. 358(14):e15. [Medline].

  2. van den Broek PJ, Wille JC, van Benthem BH, Perenboom RJ, van den Akker-van Marle ME, Niël-Weise BS. Urethral catheters: can we reduce use?. BMC Urol. 2011 May 23. 11:10. [Medline]. [Full Text].

  3. Selius BA, Subedi R. Urinary retention in adults: diagnosis and initial management. Am Fam Physician. 2008 Mar 1. 77(5):643-50. [Medline].

  4. Newman DK. The indwelling urinary catheter: principles for best practice. J Wound Ostomy Continence Nurs. 2007 Nov-Dec. 34(6):655-61; quiz 662-3. [Medline].

  5. Lam TB, Omar MI, Fisher E, Gillies K, MacLennan S. Types of indwelling urethral catheters for short-term catheterisation in hospitalised adults. Cochrane Database Syst Rev. 2014 Sep 23. 9:CD004013. [Medline].

  6. Doherty W. Instillagel: an anaesthetic antiseptic gel for use in catheterization. Br J Nurs. 1999 Jan 28-Feb 10. 8(2):109-12. [Medline].

  7. Gerard LL, Cooper CS, Duethman KS, Gordley BM, Kleiber CM. Effectiveness of lidocaine lubricant for discomfort during pediatric urethral catheterization. J Urol. 2003 Aug. 170(2 Pt 1):564-7. [Medline].

  8. Wong ES, Hooton TM. Guideline for Prevention of Catheter-associated Urinary Tract Infections. http://www.cdc.gov/ncidod/dhqp/gl_catheter_assoc.html. Centers for Disease Control and Prevention Web site. Available at http://www.cdc.gov. Accessed: July 10, 2009.

  9. Tanabe P, Steinmann R, Anderson J, Johnson D, Metcalf S, Ring-Hurn E. Factors affecting pain scores during female urethral catheterization. Acad Emerg Med. 2004 Jun. 11(6):699-702. [Medline].

  10. Kunin CM. Urinary-catheter-associated infections in the elderly. Int J Antimicrob Agents. 2006 Aug. 28 Suppl 1:S78-81. [Medline].

  11. Hart S. Urinary catheterisation. Nurs Stand. 2008 Mar 12-18. 22(27):44-8. [Medline].

  12. Suskind AM, Smith PP. Evidence of a functional effect of transient transurethral catheterization on micturition in women. Int Urogynecol J. 2012 Jan 17. [Medline].

  13. Hollingsworth JM, Rogers MA, Krein SL, Hickner A, Kuhn L, Cheng A, et al. Determining the noninfectious complications of indwelling urethral catheters: a systematic review and meta-analysis. Ann Intern Med. 2013 Sep 17. 159(6):401-10. [Medline].

 
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Commercial urinary catheterization kit.
Preparatory solution in commercial urinary catheterization kit.
Urinary catheterization kit. Image courtesy of Michel Rivlin, MD, and G Rodney Meeks, MD.
Urinary catheterization supplies. Image courtesy of Michel Rivlin, MD, and G Rodney Meeks, MD.
Urinary catheter tip. Image courtesy of Michel Rivlin, MD, and G Rodney Meeks, MD.
Urinary catheter urine collection bag. Image courtesy of Michel Rivlin, MD, and G Rodney Meeks, MD.
Urinary catheterization. Video courtesy of Michel Rivlin, MD, and G Rodney Meeks, MD.
Taping of urinary catheter. Video courtesy of Michel Rivlin, MD, and G Rodney Meeks, MD.
Female urinary organs, anterior view.
 
 
 
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