Helpful Hints: Female Patient Urinary Catheter Insertion

With some female patients, insertion of a urinary catheter can be difficult. The level of difficulty can be increased due to variations in anatomy, or swelling related to medical procedures or disease processes. These situations can serve to obscure visualization of the urinary meatus, thus complicating catheter placement. Nurses General Nursing Article

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Helpful Hints: Female Patient Urinary Catheter Insertion

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.

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Hellllllo Nurse

About Hellllllo Nurse, BSN, RN

RN. 15 year(s) of experience

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I'm a newbie student nurse. I will be testing on urinary catherization today in lab, although not on a human at this point. I appreciate your posting. Not sure what "winking" is, but I have an idea.

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Specializes in ER/Trauma.

I also had a urologist teach me to "intubate a bladder" by using a finger akin to the "scope" - since the urinary meatus is directly in line with the privy parts.

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Specializes in cardiac, diabetes, OB/GYN.

Let me just say that in maternity, where sometimes the vision is totally obscurred by edema, these tips are great...Thank you

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Specializes in Med-Surg., Critical Care, Cath. Lab., OR.

Great advice that is very practical. So few female patients have text book anatomy. It has been my experience that the meatus is often located in the proximal upper lady partsl wall. This is a great technique to improve on catheter insertion.

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winking totally works!

I did it in Maternity, which is crazy difficult because everything has edema and hard to get to down there, especialy when they are bigger ladies!

It's an obvious wink when you wipe it with betadine... I'm so glad that other people know this trick :wink2:

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Specializes in Emerg/Med/Surg/High Risk OB/LPN Ins.

Hi

I have also had this problem and whether due to aging or childbirth causing prolapse of the lady partsl canal, anatomical issues or disease related, it can be extermely difficult to successfully catheterize the patient.

I have had several which using the thumb to retract did not work due to the meatus being hidden farther into the lady parts. I have found positioning the patient on their side with the top leg slightly elevated by a support or an assistant works best, if the patient's condition allows. It may be too painful for a post op or back injury such as sciatica or disc. This position gives much better visualization, access and ability to insert in a downward motion rather than the elusive upward (which is where the meatus ends up so insertion is mostly blind) making it less likely to place the catheter into the lady parts.

Personally, I think all females should be catheterized this way unless their condition prevents this positioning. There would be more success with first attempts and possibly less infection and trauma

Thanks

Pattc

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I have not ever catheterized another person, but did self cath for over 17 years. Never though to leave the incorrectly placed catheter in until correctly placed. Great idea. Always had to cath in the bathroom, never thought to cath laying down, I was taught to self-cath in a sitting position. In the beginning, a mirror was a very necessary item in my kit.

Thank God for Medtonic's Interstim device for neurogenic bladders - no longer cathing! Thanks everyone for your input.

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Thanks for these hints! I had such a hard time last week with an older lady... she had a broken hip so it made moving her to an easier position for me difficult. She thought it was hilarious I had a hard time finding her urinary meatus and didn't realize there was more than one "hole", LOL... good thing she was such a good sport!

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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.

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Specializes in ED, ICU, Education.

For larger patients, I put the bed in trendelemburg and always drop the siderail so I can better position myself. Sometimes I ever have another nurse or two hold her legs up and apart. Haven't missed one in a few years.... (and I'm talking 400-500 pound patients)

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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.

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