Need help w/ cathing female peds

Pediatric Critical Care Columnist · Sep 1, 2006

Are you talking about teeny tiny wee little girls or older ones? Not that it really matters. (It's a good idea to have a helper who can hold a flashlight for you.) Put a folded towel or facecloth under the patient's bum so the area is more accessible. Wash everything down there well with water before you clean with the povidine. You might have to use gauze to hold the labia open because they do get slippery. When you make your centre swipe with the povidine, watch closely for the little puddle that forms at the base of the urethral meatus, which otherwise is virtually invisible, or looks like a slit. Remember where you saw it, but don't rinse the povidone off. Lubricate the catheter well, but try not to have a big glob of lubricant at the tip. Aim the catheter slightly downward. You don't have to go in very far to get urine, if there is any. If you're putting in a Foley and you're not sure you're in the urethra, keep advancing the catheter until you feel a little resistance then try to inflate the balloon. If the balloon inflates and the catheter doesn't come out when you put a little traction on it, then you're in. Once you're sure you've got what you need, then you can wash off the povidone.

tm2400 · Sep 2, 2006

Thanks JANFRN for posting!

I'm talking about 1month to 24 months old. :confused: They are so tiny in the peri area and meatus is not visible. How do tou know exactly where to enter w/ catheter? I've attempted several times this past week but missed every time. I can not visualize the meatus. I feel like I'm doing a blind needle stick especially w/ the kits we have---they are pediatric cath kits (in & out) used for cultures. These kits have a test tube looking collecting device w/ cathter in them that is stiff clear plastic which is alredy inserted in the coll. tube. I hate these kits--I'm afraid I'm going to puncture the children. ANYONE, PLEASE PLEASE help me. My docs are getting very upset w/ me about this.

Thanks so much

Trauma Columnist · Sep 2, 2006

Jan's trick with the betadine is what I have used too with good success. As you are cleaning, note where the puddle is when it hits the meatus (it will be very small) but if you clean front to back fairly slowly, it is usually visible. A trained helper is the key to success I have found. Plus, it gives you someone to blame if you can't get it - lol. Seriously, the holder is key!

Good luck...as with many skills, practice is the key to success.

Pediatric Critical Care Columnist · Sep 2, 2006

If the povidone trick doesn't work for you, try very gently guiding the tip of the catheter along the tissue just below your little one's privy parts, which will be readily obvious, in line with perineum. As it slides along, you should be able to feel the change in surface when the meatus is reached. As long as your catheter is no bigger than an 8Fr you should be able to pass it. As traumaRUs says, having a good helper really is a good thing. (S)he can often see things a little better from a different angle and can sometimes guide you to where your'e going.

I'm not familiar with the kit you described. We pretty much don't use anything that comes prepackaged as a kit in our state-of-the-art, world class centre of excellence... :smackingf We have to assemble all the pieces parts we might need to do a task and hope that we've got everything. Our technique for measuring intrabdominal pressure for instance... we use about $100 worth of supplies that we then have to discard when we're done because there's no way to keep it sterile. Sheesh. Spend a few bucks and get the real deal people!!!

tm2400 · Sep 3, 2006

Thanks so much to both of you and I'll try these tips next time. Keep advice coming please.

Pediatric Critical Care Columnist · Sep 3, 2006

Hey, let me know how these tips work for you! Feedback about the effectiveness of teaching is important to the teacher... or at least this teacher!

TwN.two.n64 · Sep 5, 2006

I have found it easier to use at least two or more helpers, so I can stay sterile. In addition, I take a sterile q-tip and access the urethra by gently swabbing downward. The urinary meatus is difficult to visualize on a squirming baby or toddler. Always find the lady partsl opening and look straight up. It appears lower and deeper in the infant and appears to "move up" as the child develops. The privy parts can be easily mistaken for the opening. Good luck!

Trauma Columnist · Sep 5, 2006

Jan - you don't use kits?? In our ER, we had pre-packaged peds cath kits which included the sterile gloves, sterile draps, betadine, lube, and catheter already connected to the specimen bottle. Very easy and also easy to ensure you got at least 6cc which was the minimum amount to do a UA.

tm2400 · Sep 5, 2006

TwN.two.n64

Thanks for the advice. That is one of the problems is the squirming of the infants as I only have one helper and the parent who is usually not any help at all. What do you think about using papoose boards? I've never tried w/ caths-just wondering.

tm2400 · Sep 5, 2006

Hi traumaRus, thanks for the advice on cathing female infants. Have you ever used a papoose board? I only have one assistance and the parent who is no help.

Pedi-ER-RN, RN · Sep 6, 2006

We don't papoose. We have the parents stand at the head of the bed and hold the childs hands (and love on the kid) and another person holds the legs. It goes pretty well this way. Holding the legs in a lithotomy position works best for little girls. Hope this helps.