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.
Additionally, when a woman is supine for the catheter insertion procedure, it can cause the urinary meatus sink down, just inside the vaginal 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 clitoris, 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 vaginal 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 vaginal 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 vagina, 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.Last edit by Joe V on Dec 5, '14
Hellllllo Nurse has '15' year(s) of experience. Joined Oct '02; Posts: 4,774; Likes: 815.1Aug 14, '08 by InquisitivewonThanks.
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 vaginal wall. This is a great technique to improve on catheter insertion.
carrmichael30Aug 18, '08 by CallinurseWow,
I have also had a good insertion rate so to speak. But I learned from this if I miss on try one to keep the catheter there and try again. Every few years I will miss and have never thought to leave the first one in to show me where not to go. It really does make a difference when you angle slightly upwards. Thank you for this posting.
Callinurse0Oct 21, '08 by Hulababe169winking 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 :wink2:1Sep 6, '11 by pattcHi
I have also had this problem and whether due to aging or childbirth causing prolapse of the vaginal 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 vagina. 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 vagina.
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