Cath'ing Females

[OttawaRPN]

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 lady parts. 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 lady parts.

Two strikes, you're out.

Anyone else have this problem with the big ladies?

[klone, MSN, RN]

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 lady parts. 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]

I've actually found the urethra around the corner, so to speak, and in the upper wall of the lady parts 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]

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 lady parts, just like you can have males with openings on the bottom side as opposed to the tip.

[HopeItWorksDNP]

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!

[cecilsgirl]

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]

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]

I have always aimed upward and just below the base of the privy parts( yes some have very long bases) and have never gone in the lady parts 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.

[leslie :-D]

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 lady partsl 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]

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]

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]

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.