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Need help w/ cathing female peds

tm2400 tm2400 (New) New

Specializes in Peds, Geriatrics, Homehealth. Has 16 years experience.

If anyone has any advice on straight cathing female peds pts ,PLEASE share with me. I don't have a problem w/ boys but can't get the girls.

NotReady4PrimeTime, RN

Specializes in NICU, PICU, PCVICU and peds oncology. Has 25 years experience.

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

Specializes in Peds, Geriatrics, Homehealth. Has 16 years experience.

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

traumaRUs, MSN, APRN, CNS

Specializes in Nephrology, Cardiology, ER, ICU. Has 27 years experience.

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.

NotReady4PrimeTime, RN

Specializes in NICU, PICU, PCVICU and peds oncology. Has 25 years experience.

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 clitoris, 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

Specializes in Peds, Geriatrics, Homehealth. Has 16 years experience.

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

NotReady4PrimeTime, RN

Specializes in NICU, PICU, PCVICU and peds oncology. Has 25 years experience.

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!

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 vaginal opening and look straight up. It appears lower and deeper in the infant and appears to "move up" as the child develops. The clitoris can be easily mistaken for the opening. Good luck!

traumaRUs, MSN, APRN, CNS

Specializes in Nephrology, Cardiology, ER, ICU. Has 27 years experience.

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

Specializes in Peds, Geriatrics, Homehealth. Has 16 years experience.

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

Specializes in Peds, Geriatrics, Homehealth. Has 16 years experience.

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.

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.

tm2400

Specializes in Peds, Geriatrics, Homehealth. Has 16 years experience.

Hello to all who posted advice for me,

A GREAT BIG THANKS TO ALL TOO!!! I used the techniques you all suggested on Friday Sept 8th and it worked:monkeydance: . I was so happy with myself (have to brag a little because doc sure didn't). It was a bad day in the office Friday and everyone was rushing around and then this female pedi cath came up. I felt like finding somewhere to hide :chair: but I went in the room and remembered all the great advice I'd received from you all and cathed the baby and got my sterile specimen; I then felt much better the rest of the day!

Thanks again!!:yeah:

NotReady4PrimeTime, RN

Specializes in NICU, PICU, PCVICU and peds oncology. Has 25 years experience.

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.

no, judi, we don't use kits. as i said, we don't have kits for most things. we have a disposable cath tray, a disposable irrigation tray and disposable dressing trays and of course, csr supplies/trays. everything else is assemble-it-yourself. it's very frustrating to work in a place that fancies itself as state-of-the-art, centre-of-excellence, world-class, but is too cheap to ensure we have suction canisters on a long weekend (the whole health region has been completely out since tuesday), monitors that are reliably going to work, adequate numbers of pumps... even our pyxis kakked at 0330 today and we couldn't access anything in it. good thing we have two code carts, cuz if we'd've had a code, we would have needed the contents of both!

tm2400 congratulations!!! :smiley_aa :cheers: i'm so glad the tips we gave you worked for you!! now the confidence success has given you will make it easier next time, and the time after, and one day you'll wonder what the problem was. way to go. brag all you want! you earned it.

rnsrgr8t

Specializes in Peds Urology,primary care, hem/onc.

Congrats! tm2400! I used to work in a Pediatric office and I am now a PNP in Urology so we have to catheterize a lot! A couple of hints, we use those cath kits a lot. If it is a teeny baby, use the 5fr catheter. Second, slightly loosen the cap on the collection tube.. sometimes it creates a vacuum and the urine will not drain by gravity unless you loosen it. You need a good helper to help hold. Have the parents up by the head and gently hold the hands. Have your help hold each leg, bend them at the knee and bring them up to the chest (so their thighs are up against their stomache). You want their bottoms up just a little off the table, this helps them not to wiggle so much. When you are cleaning with the betadine, watch for the meatus to "wink" at you (as described above) it always will. It may not be exactly where you think. When you are inserting the catheter you may sometimes hit some resitance when you hit the sphincter, especially if they are crying. Hold gentle, constant pressure and you should be able to glide past. If you keep pulling back and "poking" the spincter, it will tighten up even more. Sometimes you cannot visualize the meatus because they may have labial adhesions. If you are not sure, I would ask the MD to look. In those girls, you will never be able to see it unless the adhesions are released. If you accidently go into the vagina, leave the catheter there so you know where not to go the next time. When I was first learning, I used to go in everytime someone needed to be catheterized and help hold. I used to always see if I could visualize the meatus before they were catheterized. It gave me a lot of practice and now I almost never have a problem. BTW, sometimes people use the little NG feeding tubes. That is fine to do but be careful. Once you obtain urine, stop advancing (this is true for boys and girls). We have had a couple of them get advanced way too far and then knot on themselves (b/c they are so soft) and then could not be removed. Good Luck and congrats on the great job! With practice, you will get confidence!

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