Urethral Catheterization in Women Technique

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.

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. ^[9] 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.

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).

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.

Complications of urethral catheterization in women may include the following:

• Infections, ^{[10, 11]} including urethritis, cystitis, pyelonephritis, and transient bacteremia

• Creation of false passages

• Urethral strictures

• Urethral perforation

• Bleeding

• Altered micturition ^[12]

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. ^[13]  In patients who have subclinical bacteriuria, the catheter can become obstructed as a result of sediment buildup. ^[14]