INSERTING A STRAIGHT OR INDWELLING CATHETER TO A FEMALE PATIENT

DESCRIPTION
Catheterization of the bladder involves the introduction of a sterile rubber or plastic tube
through the urethra into the bladder. The catheter allows a continuous flow of urine in clients
unable to control micturition or in those with obstruction to urinary outflow. In female clients,
the urethra is close to the anus; therefore, the risk of infections is always great and thorough
cleaning of the perineum before catheter insertion is vital. At least once each shift perineal care
must be provided.

PURPOSES
1. To relieve acute or chronic retention.

2. To provide for continuous bladder drainage and irrigation.

3. To prevent urine from contacting an incision after perineal surgery.

4. To facilitate accurate measurement of urinary output for critically ill clients whose
outputs need to be monitored hourly.
5. To instill the medications into the bladder.

ASSESSMENT
1. Assess status of patient:
1.1. when patient last voided.
1.2. level of awareness or development stage

1.3. mobility and physical limitations of patient

1.4. patient's sex and age

1.5. distended bladder
1.6. any pathological conditions and allergies
 2. Review patient's medical record, including physician's order.

PLANNING
1. Prepare necessary equipment and supplies:

1.1. sterile gloves

1.2. sterile drapes
1.3. lubricant
1.4. antiseptic cleansing solution
1.5. cotton balls
1.6. forceps
1.7. prefilled syringe with normal saline to inflate balloon of indwelling catheter

1.8. catheter of correct size and type of procedure (i.e: intermittent or indwelling)

1.9. flashlight or gooseneck lamp

1.10. bath blanket
1.11. waterproof absorbent pad
1.12. trash receptacle
1.13. disposable gloves, basin with warm water, soap, facecloth, towel

1.14. sterile drainage tubing and collection bag, tape, safety pin, elastic band

1.15. receptacle of basin

1.16. specimen container
2. Explain procedure to patient

IMPLEMENTATION
STEPS RATIONALE
1. Wash hands This reduces transmission of microorganisms.
Infection is common after catheterization.
Foley catheter systems are often colonized
with bacteria within 48 hours of
catheterization.

2. Facing patient, stand on left side of bed if Successful catheter insertion requires nurse to
right-handed. Clear bedside table and arrange assume comfortable position with all
equipment equipment easily accessible.

3. Place side rail on opposite side of the bed. This promotes client's safety.

4. Close cubicle or room curtains. This offers privacy, reduces embarrassment

and aids in relaxation during procedure.

5. Position lamp to illuminate perineal area. Good lighting is necessary to see the meatus
clearly.

6. Place waterproof pad under patient. Prevents soiling of bed linen.

7.Position client. Assist to dorsal recumbent Good visualization of the meatus is important.
position. Ask patient to relax thighs so as to Embarrassment, chilliness and feeling tense
externally rotate them can interfere with introducing catheter.

8. Drape patient. Drape with blanket. Place This avoids unnecessary exposure of body
blanket in diamond fashion over patient, one parts and maintains client's comfort.
corner at patient's neck, side corners over
each arm and side, last corner over perineum.

9. If inserting indwelling catheter, open This facilitates connection of the catheter to

package containing drainage system. Place the drainage system and provides for easy
drainage bag over edge of bottom bed frame. access.
Bring drainage tube up between side rail and
mattress.

10. Position lamp to illuminate perineal area.

11. Open catheterization kit according to Placement of equipment near the work site
direction, using aseptic technique. Place waste increases efficiency. Sterile technique protects
receptacle in accessible place. the patient and prevents the spread of
microorganisms.

12. Organize supplies on sterile field: It is necessary to open all supplies and
a. Open sterile package containing catheter, prepare for the procedure while both hands
pour sterile package of antiseptic solution in are sterile. Donning gloves allows nurse to
correct compartment containing sterile cotton
balls. Don sterile gloves
b. nurse may want to ensure that inflatable
balloon of indwelling catheter is intact by
inserting syringe tip through valve of intake
lumen and injecting sterile fluid until balloon
inflates. Then aspirate all fluid out of inflated
lumen.
.13. Lubricate tip of catheter, remove
specimen container and pre-filled syringe
from collection compartment of tray and set
them aside the sterile field
14. Apply sterile drape
14.1 Allow top edge of drape to from cuff
over both hands. Place drape down on bed
between patient’s thighs. Slip cuffed edge just
under buttocks, taking care not to touch
contaminated surface with gloves.
14.2 Pick-up fenestrated sterile drape and
allow it to unfold without touching any
unsterile object. Apply drape over the
perineum, exposing labia and being sure not
to touch contaminated surface.
15. Place sterile tray and contents on sterile
drape between thighs.
16. Determine that catheter tip is properly
lubricated. Female 2.5 – 5 cm (1- 2 in )
17. Cleanse urethral meatus.
a. With non- dominant hand, carefully
retract the labia to fully exposed
urethral meatus. Maintain position of
non- dominant hand throughout the
procedure.
b. With dominant hand pick up cotton
ball with forceps and clean pperineal
area, wiping from front to back from
clitoris toward anus. Use new cotton
ball for each wipe along near labial
fold, directly over meatus and along
labial fold.
18. Pick- up catheter with gloved dominant
hand 7.5 – 10 cm (3-4 in ) from catheter tip.
Hold end of catheter loosely coiled in palm of
dominant hand. Place distal end of catheter in
urine tray specimen.
handle sterile supplies without contamination.
This checks integrity of balloon. Do not use
the catheter if the balloon does not inflate or
leaks. Checking the balloon in this way may
stretch the balloon and cause increased
trauma on insertion.
This eases insertion of catheter through
urethral canal.
The drape provides a sterile field close to the
meatus. Covering the gloved hands will help
keep the gloves sterile while placing the
drape.
The drape expands the sterile field and
protects against contamination. Use of
fenestrated drape may limit visualization and
is considered optional by some practitioners.
This provides easy access to supplies during
catheter insertion.
This eases insertion of catheter through
urethral canal.
Smoothing the area immediately surrounding
the meatus helps to make it visible. Allowing
rthe labia to drop back into position may
contaminate the area around the meatus, as
well as the catheter. Your non- dominant hand
is now contaminated.
Moving from an area where there is likely to
be less contamination to an area where there
is more contamination helps prevent the
spread of organisms. Cleaning the meatus last
helps reduce the possibility of introducing
organisms into the bladder.
Hold catheter near tip because it allows easier
manipulation during insertion into urethral
meatus and prevents distal end from striking
contaminated surface.
19. Insert catheter
19.1 Ask patient to bear down as if to void Bearing down eases the passadge of the
and slowly insert catheter through meatus. catheter through rthe urethra.
19.2. Advance catheter 5- 7.5 cm (2-3 in ) in The fewmale urethra is about 3.7 – 6.2 cm (1
adult and 2.5 cm (1 in) in young child, or until ½ - 2 ½ in) long. Applying force on the
urine flows out catheter’s end. When urine catheter is likely to injure mucous
appears, advance catheter another 5 cm (2 in). membranes. The sphincter relaxes and the
Do not force against resistance. catheter can enter the bladder easily when the
patients relaxes. Advancing an indwelling
catheter and additional 1.3 – 2.5 cm (1- 1 ½
in) ensures placement in the bladder and
facilitates inflation of the balloon without
damaging the urethra
19.3. Release labia and hold catheter securely Catheter may be accidentally expelled by
with non- dominant hand. bladder or urethral contraction.
20. Collect urine specimen as need: fill This allows sterile specimen to be obtained
specimen cup to desired level (20 – 30ml) by for culture analysis.
holding end of catheter in dominant hand over
cup. With dominant hand, pinch catheter to
stop urine flow temporarily. Release catheter
to allow remaining urine in bladder to drain
into collection tray. Cover specimen cup and
set aside for labeling.
21. Allow bladder to empty full (750- Retained urine may serve as reservoir for
1000ml) unless institution policy restricts growth of microorganisms.
maximal volume of urine to drain with each
catheterization.
21.1 For straight, single use catheter, pinch This causes less discomfort to the patient.
catheter and remove slowly but smoothly
when urine cease to flow
21.2. For indwelling catheter, inflate balloon
of indwelling catheter.
21.3. While holding catheter with thumb and
little finger of non- dominant hand at meatus,
take end of catheter and place it between first
two fingers of non-dominant hand.
21.4. With free dominant hand attach syringe
to injection port at end of catheter.
21.5. Slowly inject to total amount of The balloon anchors the catheter in place in
solution. If slowly client complains of sudden the bladder. Sterile water is used to inflate the
pain, aspirate back solution and advance balloon as a precaution in case the balloon
catheter further. ruptures.
21.6. After inflating balloon fully, release Improper inflation can cause patient’s
catheter with non- dominant hand and pull discomfort and malpositioning of catheter.
gently to feel resistance. Remove fenestrated
drape.
22. Attach end of catheter to collecting tube of Closed drainage system minimizes the risk of
drainage system. Drainage bag must be below organisms being introduced into the bladder.
level of bladder. Raising bag on side rail will cause back flow
of urine into bladder.
23. Tape catheter tubing on top of thigh. Anchoring catheter to lower abdomen reduces
Allow slack in catheter so movement does not pressure on urethra, thus reducing the
create tension on catheter. possibility of tissue injury at this area.
24. Be sure that there are no obstructions or This facilitates drainage of urine and prevents
kinks in tubing. Place excess coil of tubing on the backflow of urine.
bed and fasten it to bottom sheet with clip
from drainage set or with rubber band and
safety pin.t
25. Remove gloves and dispose of equipment, It reduces transmission of microorganisms.
drapes and urine in proper receptacle.
26. Assist client to comfortable position. This maintains comfort and security.
Wash dry perineal area as needed.
27. Instruct patient on ways to lie in bed with
catheter: side-lying facing drainage system
with catheter and tubing draped over thigh
and side lying facing away from system,
catheter and tubing extended between legs.
28. Caution patient against pulling on the
catheter.
29. Wash hands This reduces the spread of microorganisms.

EVALUATION
1. Palpate bladder and ask if patient remains uncomfortable.
2. Determine that there is no leaking from catheter or tubing connections.
3. Record time of procedure, characteristics and amount of urine in drainage system.
NURSING CONSIDERATIONS
1. Maintain catheter patency, place drainage tubing properly to avoid kinking or pinching.
2. Observe for signs of obstruction (e.g., Decreased urine in collection bag, voiding around
catheter, abdominal discomfort and bladder distention).
3. Irrigate catheter as necessary.
4. Ensure comfort and safety; relieve bladder spasms by administering belladonna
suppositories (if ordered); ensure adequate fluid intake and provide perineal care.
5. Prevent infection: maintain a closed drainage system and prevent backflow of urine by
keeping drainage system below level of bladder.
6. Empty collection bag at least 8 hours.
7. Promote acidification of the urine with acid ash diet and ascorbic acid.
8. Change catheter/ drainage system only when necessary.
SPECIAL CONSIDERATIONS
OLDER CLIENTS
1. Older clients may need help in holding the position.
2. Anatomical landmarks may be more difficult to visualize.
3. It is important to explain the procedure clearly and check that the client understands.
CHILDREN
1. When catheter is used with a child or adolescent, provide simple explanations.
2. Allow for privacy and respect the child’s or adolescent’s wishes regarding the presence of
a parent during catheter insertion and care.
3. Children or adolescents may be more tempted to pull or tug on the catheter. Children and
adolescents may be more active in and out of bed, so the catheter must be taped securely
to the thigh to prevent it from being pulled out.