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Cath'ing Females

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OttawaRPN OttawaRPN (Member)

Specializes in acute care med/surg, LTC, orthopedics. Has 5 years experience.

Well, I consider myself pretty skilled with most hands-on stuff but this is a procedure that causes me a great deal of trepidation.

My 50 year old patient with urinary retention had an order for an indwelling, so in I go supplies at hand with intent to complete this task in 10 mins or less. My previous experience has told me that, especially with the larger ladies who can have many, many hills and valleys down below, it's sometimes like trying to navigate through the Grand Canyon but I was having a good day so felt overly optimistic. I've seen many nurses go in blind but no... I like to visualize the urethra so after peeling back the various folds, and then more folds... you think I could find the urethra? Anatomically, I found where it should be, but when I got the catheter in and it dropped, I quickly realized I was in the vagina. So, left that Foley in to landmark what not to repeat, and started over, determined to find that darn urethra, with my face far closer than should be legal, found the same urethral wannabe, insert AND... right back in the vagina.

Two strikes, you're out.

Anyone else have this problem with the big ladies?

klone, MSN, RN

Specializes in Women's Health/OB Leadership. Has 15 years experience.

I work in OB, so I have had to cath my fair share of obese women. What I've found with an obese woman is that it REALLY helps to have a third hand in there to help out. Have a second person clean glove and just hold labia majora apart, so that you can use your non-dominant hand to hold the inner tissue folds apart.

Next piece of advice is always go slightly above where you *think* you want to be. That will help you to avoid sliding the cath into the vagina. The cath has a tendency to want to migrate south as you're trying to insert it, so by going slightly above, as it migrates south it will hopefully find its way right to where it needs to be.

roser13, ASN, RN

Specializes in Med/Surg, Ortho, ASC. Has 17 years experience.

I've actually found the urethra around the corner, so to speak, and in the upper wall of the vagina on more than one occasion. Now I know that sounds ignorant as all get-out, but it has always been on a very large woman and I have wondered if the extra adipose tissue has somehow disfigured or rearranged the basic anatomy that she was born with.At any rate, there's nothing that makes me shudder like knowing I have to do a female cath on a large patient.

nerdtonurse?, BSN, RN

Specializes in ICU, Telemetry.

Trendelenburg is your friend with "fluffy" patients, assuming they can tolerate it for other reasons. Everything shifts north, and sometimes that helps line up the internal anatomy better....and I've found my share of openings that were inside the vagina, just like you can have males with openings on the bottom side as opposed to the tip.

HopeItWorksDNP

Specializes in ER.

I've done more than my share of caths on large women during my time in the ER and have found a few things that seem to help. Like the other poster said, take help. The other nurse can help spread the labia and help spread the legs further apart. Put the patient in Trendelenburg position so the abdominal "apron" falls back towards her head and out of your way. Be aggressive with your swabs. I've found if I apply a little more pressure when cleaning, sometimes the meatus seems to react to the cold and pressure and shows itself. And lastly, don't be afraid to really get in there. I've worked with many new nurses who were very tentative about moving the tissues around. On us larger ladies, the labia get fat just like the rest of us, and the meatus can be much deeper. Don't be afraid to get your hand in there and spead til you find it. You aren't going to hurt her. And lastly, PRAY!

I learned once from a good instuctor, look for the "wink" when you put the betadine on, ( meatus may re-act by opening up a bit-) and look for the "dimple" in the chin (look).. so to speak. all above posts -wonderful advise!!

lilaclover

Specializes in Acute Spine, Neuro, Thoracic's, LTC. Has 3 years experience.

One thing I do that allows me to get it on the first try nearly everytime:

I have a second person hold a flashlight in there. I know it sounds ridiculous but it makes everything sooooo much easier. I pull the labia apart, get my helper to shine the flashlight in and then have my pt. cough. You can see the meatus wink at you every time ;)

enchantmentdis, BSN, RN

Specializes in Hospice, ONC, Tele, Med Surg, Endo/Output.

I have always aimed upward and just below the base of the clitoris( yes some have very long bases) and have never gone in the vagina because of this. Give the urine a few seconds to come out because there is usually a bit of mucous clogging the tip of the cath at first.

THE most important intervention you can do, is to ensure the labia is pulled back and taut.

that is your goal.

a woman's urethra is not always superior to the vaginal opening...

i've seen it waaaaaaay northwest (but never northeast...hmmm) to the vag meatus.

i've also seen it directly west...seriously.

and so, if you can pull back the labia to extent possible, your view will be virtually unobstructed.

(trendelenburg is helpful, but not so comfortable for pt)

leslie

DizzyLizzyNurse

Specializes in Peds Medical Floor. Has 12 years experience.

I have to straight cath obese elderly ladies a lot and I almost never miss. I usually have an assistant (someone to hold the labia and flashlight) and putting the pt in Trendelenburg. I've also found that if I hold the tip of the catheter at an angle I never miss (hard to describe - hold it straight out and bend the tip up with your nail - hope that makes sense). Also you might need another person (if you can find someone lol) to help hold their legs if they can't hold them that far apart. I had a lady who couldn't hold her legs up so I bent forward and put her leg on my back. Not the most sanitary way to do it, but I was the only one on the floor able to cath her. The things we do for our pts!!!

annacnatorn

Specializes in LTC, Home Health, Hospice. Has 16 years experience.

I had a female who was born with genital abnormalities, she was obese..many many folds. It was a difficult task, she was on Home Hospice..Luckily for me 2 of us were sent to do the cath. It took 2 of us! After many many tries and failures, we put a cool rag over the area, whammo..found it! success! We told the family and patient what we needed to do. They were ok with that. Then after we were done, the family told us.."Other Nurses always have a hard time cathing her..we wanted to see what you would do!"..nothing like being tested at 3 am!...Yes the Joys of nursing and the things we do for them and subject ourselves to!

Love my JOB!

OrionQuiltsRN

Specializes in Med-Surg. Has 3 years experience.

One piece of equipment I use when cathing females is a miner's/camper's flashlight; the one that sits on your forehead with a strap. It looks like I am going mining. I am! I can point the light exactly where I need it.

One piece of equipment I use when cathing females is a miner's/camper's flashlight; the one that sits on your forehead with a strap. It looks like I am going mining. I am! I can point the light exactly where I need it.

aw, i want one of those.:)

(loving the visuals.)

leslie

Forever Sunshine, ASN, RN

Specializes in LTC. Has 7 years experience.

I had my first successful catheterization when the patient was on her side. I found it right away.

Of course the urethra was still "open" because her catheter had just fallen out.. lol..

I still consider it a success because I did not have to use the 2nd catheter and I maintained sterility (which usually just goes out the window when catheterizing little old ladies when their urethra's are hiding in a place where one wouldn't even think it would be.)

OttawaRPN

Specializes in acute care med/surg, LTC, orthopedics. Has 5 years experience.

aw, i want one of those.:)

(loving the visuals.)

I gotta say, the visuals are making me LMAO...

miner's flashlight, leg over the back, dimples and winking....

:rotfl:

I had my first successful catheterization when the patient was on her side. I found it right away.

Of course the urethra was still "open" because her catheter had just fallen out.. lol..

I still consider it a success because I did not have to use the 2nd catheter and I maintained sterility (which usually just goes out the window when catheterizing little old ladies when their urethra's are hiding in a place where one wouldn't even think it would be.)

good job, dj.

i'll never forget how proud i felt upon cathing my first pt.

also agree that side-lying is a great position to see urethra...

don't know why we don't use it more.

i usually use it for contracted pts only.

leslie

MassED, BSN, RN

Specializes in ER. Has 15 years experience.

my god, all the time. Female anatomy is as diverse as personalities. Some easy, some not so much, some just impossible. Sometimes putting a patient so far in Trendelenburg can help, especially if they have a lot of folds.... but they will turn blue from all that pressure of being nearly upside down!

My best advise is like several people have said. Get someone to help. I've cathed large ladies and small babies. You just need a second set of hands.