Helpful Hints: Female Patient Urinary Catheter Insertion

[Hellllllo Nurse]

Additionally, when a woman is supine for the catheter insertion procedure, it can cause the urinary meatus sink down, just inside the lady partsl opening, resulting in the clinician being unable to visualize it.

The following "thumb method" of catheter insertion has worked well for me when I have had a female patient whose urinary meatus is not immediately visible.

Gather your supplies; include an extra catheter. Set up your supplies and prep the patient. Placing a folded towel under the patient's lower back at the sacrum can aide in optimum positioning of the patient. If appropriate, a physician's order for sterile topical lidocaine jelly can be obtained. Using this jelly in the place of KY Jelly can promote comfort and prevent pain from manipulation of the tissues in this invasive procedure. This is especially important with patients who may be sensitive due to trauma to the tissues, or disease processes.

With your non-dominant hand, use your thumb and place it approximately one half to one inch below the privy parts, pushing slightly in and upward at the same time. This will cause the urinary meatus to be visible, and places tension on the tissue, stabilizing it. If the tissue is wet due to bleeding or drainage, you can wrap your gloved thumb in a sterile 4X4 to prevent slippage. In this way, the meatus does not get pushed inward or "roll" when you insert the catheter. Additionally, positioning your thumb in this way holds the labia minora in a retracted position, keeping it out of the way.

When you are ready to insert the catheter, be sure to grasp it no more than approximately one and a half to two inches from the distal end. This will aide in keeping the insertion end stable, and prevent it from moving and being inadvertently placed into the lady partsl opening.

The "wink" method of locating the meatus by wiping with a providone iodine swab does not work if the meatus is just inside the lady partsl opening, and not visible. With the tissue stabilized as stated above, you can then wipe with your swab, and you will plainly see the "wink". Then, drop your swab, and pick up your catheter. With the tip pointed at a slightly upward angle, and insert.

If the catheter inadvertently goes enters the lady parts, leave it there before attempting insertion of a new catheter. The misdirected catheter will serve as a landmark, which will assist you in correct placement on your next insertion attempt. You will be able to see where not to direct the catheter on your next attempt.

Utilizing this method has served to make difficult catheter insertions more comfortable for my patients, and less time consuming for me.

[annie.rn]

#NurseB said:

Great tips! I have such a hard time with female foleys. I really want to be able to do them on my own without having to ask another nurse for help.

Don't be too hard on yourself. With some patients it is almost impossible not to have a second set of hands.

[RainMom]

GrnTea said:

There's a much better idea than leaving a misplaced cath in the lady parts. Since I learned this a hundred years ago I never, ever did a lady partsl intubation again.

When you do your prep with the cotton balls and Betadine (povidone), tuck the last one into the introitus (the entrance to the lady parts)-- not deep, but just enough to stay in place. Now if your cath attempt slides south, all it runs into is sterile prep materials, and you can re-aim without having to juggle another catheter. Remember to remove the cotton ball as you clean up after the catheter is secure.

Our kits have swabs rather than cotton balls, but I started doing the same thing a while back, leaving the last one to block lady partsl entrance. I have never missed when using this method, even on very large, zero visualization ladies.

[Nurse 1 Smiley]

Great tips; thank you so much!

[echase]

That's where the landmarking with another catheter after 'misses' really comes in handy.

You could also try with the pt in another position, as prolapses are positionally influenced.

[coprogirl1]

As a hospice nurse, I am always looking for ways to keep my patients comfortable. An African nurse showed a colleague of mine a new way (for me) to insert a straight or Foley catheter. Turn your patient on her side, in Sims' position. For me, she must be on her left side, upper leg bent at the knee. Every time I have done this, the meatus has been easy to visualize. I guess after 42 years of nursing, the old dog can still learn a new trick. SO much more comfortable for the patient. sterility maintained and no lady partsl insertions.

[BottomLineUpFront]

I'm a biologist, not a nurse, and got to this thread with a search. For me, it doesn't matter whether I'm on my back or my side, having a cystogram, cystoscope, urodynamics, or, most recently, a Foley due to blocked urethra and inability to urinate--these "tiny" instruments in the urethra are horribly painful.

These catheters are nuts. The lidocane gel does nothing, except hurt when put in the urethra.

Yes, urologists try to threaten the patient with the idea I'll self-cathing if dilation doesn't work. They may as well tell me I'm going to stick a pen in my eye. Dig out the anesthesia, Bubba, or stay away from me.