Female Catheterization

__________________________________________

A Written Report
Presented to the
Faculty of School of Nursing and Health Sciences
Biliran Province State University
Naval, Biliran
_________________________________________

In Partial Fulfillment of the Requirements in

NCM 109: Maternal and Child Health Nursing Skills Laboratory
Of Bachelor of Science in Nursing
________________________________________
Aragon, Gemma Lyn
Gervacio, Keannu Ardem
Legaspi, Caryl Hanica
Macanas, Zyrriane Mae
Merabueno, Wendilyn
Panis, Annel Jane
Pinano, Daryl
Publico, Ezra Mae
Queipo, Franxine

Jhon Aerolf B. Rambano RN

Clinical Instructors
March 2023

TABLE OF CONTENTS
Contents Page
TITLE PAGE …………………………………………………………….. i
TABLE OF CONTENTS ……………………………………………….. ii
LIST OF FIGURES……………………………………………………… iii
ACKNOWLEDGMENT ……………………………………………….... iv
PART 1 - Introduction ………………………………………………… 1
Objectives ……………………………………………………. 2
PART 2 - Definition of Terms ………………………………………... 3
Purpose of Urinary Catheterization ……………………... 4
Anatomy and Physiology of the Urinary System ……… 5
Characteristics of a Normal Urine ……………………….... 6
Types of Catheters …………………………………………... 7
Indications and Contraindications ……………………….. 8
Part 3 - Guidelines & Nursing Responsibilities …………………... 9
Care of a Patient with Indwelling Catheter ……………… 10
Part 4 - Procedure Checklist on Female Catheterization ………. 10
Part 5 - References…………………………………………………….. 12

LIST OF FIGURES
Figures Page
1. Anatomy of Female Urinary Tract …………………………. 5
2. Anatomy of Female External Genitalia …………………… 5
3. Urine Sample ………………………………………………….. 6
4. Two-way Foley Catheter …………………………………….. 7
5. Three-way Foley Catheter …………………………………... 8
6. Elbow Catheter ……………………………………………….. 8
7. Suprapubic Catheter ………………………………………… 8

ACKNOWLEDGMENT
 In doing this report, we needed the assistance and direction of a few
reputable people; they are deserving of our deepest gratitude.
We would like to express our special thanks and gratitude to our clinical
instructors, Dr. Willard Riveral and Miss Divina Lantajo, RN, for their guidance and
support in completing our group report. We, reporters also appreciate their efforts in
extending their time and knowledge despite of their busy schedule. We highly valued
this report and gained a lot about this topic.
We also want to express our sincere gratitude to everyone who helped us with
this report, both directly and indirectly. Numerous people – particularly students and
the group itself – have offered insightful comments and suggestions regarding this
report.
 INTRODUCTION
Urinary catheterization is the introduction of a catheter into the urinary
bladder. This is usually performed only, when necessary, because the danger exists
of introducing microorganisms into the bladder. The most frequent health care–
associated infection is a UTI, and indwelling urethral catheters cause 80% of these
UTIs (Institute for Healthcare Improvement [IHI], 2011). A catheter-associated
urinary tract infection (CAUTI) is a “urinary tract infection that occurs while an
indwelling catheter is in place or within 48 hours of its removal” (Seckel, 2013, p. 63).
Clients with a CAUTI remain in the hospital longer and need to be placed on
antibiotic therapy, which increases health care costs. The high incidence and high
costs related to CAUTI, in addition to the fact that most are preventable, resulted in
the Centers for Medicare and Medicaid Services (CMS) not reimbursing hospitals
unless the CAUTI was documented as present on admission (Magers, 2013). It is
well documented that the risk to the client of developing a CAUTI correlates to the
duration of the catheter being in place. According to the Centers for Disease Control
and Prevention, the risk of infection increases by 5% for each day that a catheter
remains in place (Lee & Carter, 2013, p. 53). Oman et al. (2012) reported that
urinary catheters are often “retained for days because of convenience,
misunderstanding of their necessity/appropriateness, or lack of clear orders for
removal” (p. 548). Best practice is to remove a urinary catheter that is not necessary.
Another hazard is trauma with urethral catheterization, particularly in the male
client, whose urethra is longer and more tortuous. It is important to insert a catheter
along the normal contour of the urethra. Damage to the urethra can occur if the
catheter is forced through strictures or at an incorrect angle. In males, the urethra is
normally curved, but it can be straightened by elevating the penis to a position
perpendicular to the body.

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 OBJECTIVES
After three (3) hours of lecture/discussion and demonstration, the Level II
students will be able to:
1. Define the following relevant terms:

a. Intermittent Catheterization j. Anuria

b. Indwelling Catheter k. Hematuria
c. Bladder Distention l. Cystitis
d. Urinary Retention m. Residual urine
e. Urethral Strictures n. Oliguria
f. Urinary Incontinence o. Specific Gravity
g. Crede’s Manuever p. Ketones
h. Dysuria q. Osmolarity
i. Polyuria r. Urinalysis

2. Cite the purposes of urinary catheterization.

3. Review the anatomy and physiology of the urinary system.
4. Discuss the characteristics of a normal urine sample.
5. Cite the different types of catheters used in urinary catheterization.
6. Identify the Indications and contraindications of urinary catheterization.
7. Explain the guidelines and nursing responsibilities in performing
catheterization.
8. Discuss the general considerations in caring a client with indwelling catheter.
9. Demonstrate beginning skills in assisting/performing female catheterization.

I. DEFINITION OF TERMS
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a. Intermittent Catheterization
Catheters that are inserted into the bladder through the urethra and
removed as soon as the bladder is drained of urine.
b. Indwelling Catheter
Catheters that are inserted into the bladder through the urethra and left in
place and continuously drain the bladder.
c. Bladder Distention
Term used to refer to urinary retention in the bladder due to its incapacity
to void normally.
d. Urinary Retention
The accumulation of urine in the bladder and inability of the bladder to
empty itself.
e. Urethral Strictures
Abnormal narrowing of the urethra, causing obstructive symptoms. they
usually result from injury to the urethral mucosa and tissues around it.
Restricts the flow of urine from the bladder and can cause a variety of
medical problems in the urinary tract, including inflammation or infection.
f. Urethral Incontinence
A temporary or permanent inability of the external sphincter muscles to
control the flow of urine from the bladder.
g. Crede’s Maneuver
Manual exertion of pressure on the bladder to force urine out.
h. Dysuria
Means voiding that is either painful or difficult.
i. Polyuria
Refers to the production of abnormally large amounts of urine.
j. Anuria
Lack of urine production.
k. Hematuria
Blood in urine. This condition happens when the kidneys or other parts of
the urinary tract let blood cells leak into urine.
l. Cystitis
Inflammation of the bladder. Cystitis happens when there's an infection
caused by bacteria.
m. Residual Urine
Urine remaining in the bladder after urination; seen in bladder outlet obstr
uction and disorders of deficient detrusor contractility.
n. Oliguria
Oliguria or hypouresis is the low output of urine specifically more than 80
ml/day but less than 400ml/day.

o. Specific Gravity

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 Urine specific gravity is a measure of urine concentration. Specific
gravity measurements are a comparison of the amount of substances
dissolved in urine compared to pure water. The normal range of urine
specific gravity is 1.005 to 1.030.
p. Ketones
Ketones are chemicals the body produces when it breaks down fat for
energy. If too many ketones accumulate in the body, they can become
toxic. This is because they make the blood more acidic.
q. Osmolarity
Urine osmolarity, or osmolality, is a measure of how concentrated or dilute
the urine is.
r. Urinalysis
An analysis that includes various tests to examine the urine contents for
any abnormalities that indicate a disease condition or infection. A
urinalysis involves checking the appearance, concentration and content of
urine.

II. IMPORTANCE & PURPOSE OF URINARY

CATHETERIZATION
IMPORTANCE OF THE PROCEDURE
Urinary catheterization reduces the risk of infection and kidney damage
by making sure that your bladder is emptied, either continuously or at regular
intervals.
PURPOSES OF THE PROCEDURE

 To relieve discomfort due to bladder distention or to provide.

gradual decompression of a distended bladder
 To assess the amount of residual urine if the bladder empties incompletely
 To obtain a sterile urine specimen
 To empty the bladder completely prior to surgery
 To facilitate accurate measurement of urinary output for critically ill clients
whose output needs to be monitored hourly.
 To provide for intermittent or continuous bladder drainage and/or irrigation.
 To prevent urine from contacting an incision after perineal surgery.

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 III. ANATOMY AND PHYSIOLOGY OF THE URINARY SYSTEM

Figure 1. Female Urinary Tract

The kidney collects chemicals and water our body doesn’t need. His is turned
into urine. Urine travels out of the kidneys through the ureters to the bladder. The
bladder holds the urine until we’re ready to release it. The urethra carries urine from
the bladder out of the body. The main sphincter muscle circles the mid-urethra. It
keeps the urethra closed. When we’re ready to urinate, our brain tells the sphincter
to relax so we can release the urine.

Figure 2. Female Genitalia  Mons pubis – a rounded mound of

fatty tissue that covers the pubic bone.
 Labia majora – are large, fleshy folds
of tissue that enclose and protect the
other external genital organs.
 Labia minora – lie just inside the labia
majora and surround the openings to
the vagina and urethra.
 Urethra – carries urine from the
bladder to the outside and where the
catheter will be inserted.

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 IV. CHARACTERISTICS OF A NORMAL URINE SAMPLE

Figure 3. Urine Sample

Color Pale yellow to deep amber

Odor Odorless
Volume 750–2000 mL/24 hour
pH 4.5–8.0
Specific gravity 1.003–1.032

Osmolarity 40–1350 mOsmol/kg

Urobilinogen 0.2–1.0 mg/100 mL

White blood cells 0–2 HPF (per high-power field
of microscope)
Leukocyte esterase None

Protein None or trace

Bilirubin <0.3 mg/100 mL
Ketones None
Nitrites None
Blood None
Glucose None

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 V. TYPES OF CATHETERS
Catheters are commonly made of rubber or plastics although they may be
made from latex, silicone, polyvinyl chloride (PVC). They are sized by the
diameter of the lumen using the French (Fr) scale: the larger the number, the
larger the lumen. Either straight catheters or retention catheters.
1. Intermittent catheters
These are catheters that are inserted into the bladder through the
urethra and removed as soon as the bladder is drained of urine.
o Straight Catheter - Is a single-lumen tube with a small eye or opening
about 1.25cm (0.5in) from the insertion tip
2. Indwelling Catheter
Are catheters that are inserted into the bladder through the urethra and
left in place continuously drain the bladder.
o Two-way Foley Catheter - Is a double-lumen catheter. The outside
end of this two-way retention catheter is bifurcated; that is, it has two
openings, one to drain the urine, the other to inflate the balloon.

Figure 4. Two-way Foley Catheter

o Three-way Foley Catheter - It has a third lumen through which
sterile irrigating fluid can flow into the bladder. The fluid then exits the
bladder through the drainage lumen, along with the urine.

Figure 5. Three-way Foley Catheter

o Coudé (Elbow) Catheter - has a curved tip and is sometimes used for men
who have hypertrophied prostate.

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 Figure 6. Elbow Catheter
3. Suprapubic Catheters
This type of catheter is inserted into the bladder through a small incision
above the pubic area. It is used for continuous drainage.

Figure 7. Suprapubic Catheter

VI. INDICATIONS AND CONTRAINDICATIONS

INDICATIONS
 Relief of acute or chronic urinary retention, such as due to urethral or prostatic
obstruction
 Patients with urinary incontinence (repeatedly wetting the bed leads to local
destruction of skin tissues)
 For patients undergoing major surgical procedure (to empty the bladder
before the surgical procedure)
 Monitoring of urine output.
 Measurement of post void residual urine volume.
 Collection of sterile urine for culture (for diagnostic purposes)
 Bladder irrigation or instillation of medication
CONTRAINDICATIONS

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  History of urethral strictures
 Current urinary tract infection
 Recent urologic surgery
 History of difficult catheter placement
 Patients with known or suspected traumatic injury to the lower urinary tract.

VII. GUIDELINES AND NURSING RESPONSIBILITIES

BEFORE:
1. Check the chart to validate the doctor’s order.
2. Ensure proper identification of the patient.
3. Explain the procedure properly.
4. Gather all the equipment needed before going to the patient’s room.
5. Perform hand hygiene
6. Install privacy curtains or screens.
7. Ask the patient if she has allergies (especially to latex or iodine)
8. Assist the patient to assume a dorsal recumbent position.
DURING:
1. Maintaining sterility all throughout the procedure.
2. Coach the patient to take deep breaths while inserting the catheter and/or
when she feels minimal pain.
3. Do not force the catheter through urethra into the bladder.
4. Maintain the separation of the labia until the catheter is inserted and urine is
flowing well and continuously.
5. Encourage the patient to talk when feeling too much pain or discomfort.
6. Perform perineal care if necessary.
7. Confirm the placement of the balloon to prevent dislodgement of the tubing.
Secure the tubing properly.
AFTER:
1. Dispose the used materials.
2. The uro bag must be hanged at the side of the bed below the level of the
bladder.
3. Place the bed in lowest possible level

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 4. Check the drainage tubing is not kinked and that movement of the side rails
does not interfere with catheter or drainage bag.
5. Ensure that the hanged uro bag is not touching the floor.
6. Observe the characteristics of the urine in the uro bag and take note of any
abnormalities.
7. Assist the patient to a comfortable position and cover the patient with linens
Perform hand hygiene.

VIII. CARING A CLIENT WITH INDWELLING CATHETER

Fluids
The client with a retention catheter should drink up to 3,000 mL/day if permitted.
Dietary Measures
Acidifying the urine of clients with a retention catheter may reduce the risk of UTI
and calculus formation. Foods such as eggs, cheese, meat and poultry, whole
grains, cranberries, plums and prunes, and tomatoes tend to increase the acidity
of urine.
Perineal Care
No special cleaning other than routine hygienic care is necessary for clients with
retention catheters, nor is special meatal care recommended.
Changing the Catheter and Tubing
Routine changing of catheter and tubing is not recommended. Collection of
sediment in the catheter or tubing and impaired urine drainage are indicators for
changing the catheter and drainage system.

IX. PROCEDURE CHECKLIST ON FEMALE CATHETERIZATION

PROCEDURES RATIONALE
1. Review the patient’s chart to confirm the
medical order given by the doctor.
2. Gather all the equipment needed. Obtain
assistance from another staff member, if necessary.
3. Perform hand hygiene and put on PPE,
if indicated.
4. Identify the patient.

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5. Close the curtains around the bed and close
the door of the room , if possible. Ask the
patient if she has any allergies, especially to
latex or iodine.
6. Provide good lightning. Place a trash
receptacle within reach.
7. Assemble equipment overbed table or other
surface within reach.
8. Adjust the bed to a comfortable working
height. Stand on the patient’s right side if you
are right-handed, patient’s left side if you are
left- handed.
9. Assist the patient to a dorsal recumbent
position with knees flexed, feet about 2 ft apart.
Drape the patient.
10. Put on clean gloves. Clean the perineal
using cleanser. Wipe from above orifice
downward to the sacrum.
11. Open sterile catheterization tray on a clean
and dry surface.
12. Put on sterile gloves. Grasp the upper
corners of drape and unfold drape without
touching nonsterile areas.
13. Open all the supplies. Remove cap from
the prefilled sterile syringe and attach to the
balloon inflation port on the catheter.
14. Lubricate 1 to 2 inches of the catheter tip.
15. With thumb and one finger of nondominant
hand, spread the labia and identify the meatus.
16. Use the dominant hand to clean the meatus.
17. Using dominant hand, hold the catheter 2 to
3 inches from the tip and insert slowly into the
urethra. Advance the catheter until there is a
return of urine. Once the urine drain, advance
the catheter. Ask the patient to breath dreeply,
and rotate the catheter gently.

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18. Hold the catheter securely at the meatus
with you non- dominant hand. Use your
dominant hand to inflate the balloon. Inject the
entire volume of sterile water supplied in a
prefilles syringe. Remove the syringe from the
port.
19. Pull gently on the catheter after the balloon
is inflated to feel resistance.
20. Remove equipment and dispose of it
according to facility policy. Discard syringe in
sharps container. Wash and dry the perineal
area.
21. Remove gloves. Secure the catheter tubing
to the patient’s inner thigh with a catheter-
securing device.
22. Assist the patient to a comfortable position.
Cover the patient with bed linens.
Place the bed in the lowest position.
23. Remove gloves and additional PPE, if used.
Perform hand hygiene.

X. REFERENCES:
Berman, A., Snyder, S., & Frandsen, G. (2016a). Kozier and Erb’s Fundamentals of
Nursing. Prentice Hall.

Physical Characteristics of Urine | Anatomy and Physiology II (lumenlearning.com)

https://courses.lumenlearning.com/suny-ap2/chapter/physical-characteristics-
of-urine/

McLaughin, J.E. (2023, March 15). Female External Genital Organs. MSD Manual
Consumer Version.
https://www.msdmanuals.com/home/women-s-health-issues/biology -of-the-
female-reproductive-system/female-external-genital-organs

The StayWell Company. (2022). Anatomy of the Female Urinary Tract. Fairview
Health Services. Retrieved March 24, 2023,
from https://www.fairview.org/patient-education/82968

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