urinary cath help

Any new tips out there for cathing a difficult female? Had one today that 3 of us tried and never did obtain a spec (if she did not HAVE a UTI I bet she has one now) Tiniest little clitoris and vaginal opening I have ever seen.I never did visualize the meatus.Of course she is demented so it took 2 to hold her and she yelled and cried and we all hated it....Sheesh-we all said a prayer before we started and STILL could not get it....St Francis is the Patron St of lost objects,right? Maybe we prayed to the wrong one? I know some tips-she could not follow directions to cough to make the meatus "wink" She would not pee a little for us-I tried to tilt her hips forward on pillows-she wiggled around...I tried looking from the back with her on her side...No go.....Well-she had 2 falls over the weekend and hisortically for her it means a UTI-and she is afebrile like many of the elderly...The doc rounds in the am-I noted some discharge and inflammation(all the searching and stretching) He'll do what he wants to do-but if he wants a urine he'll have to get it :chuckle It really takes the the wind out of my sails to not get the cath-and I am usually pretty good....She was pitiful-called us all kinds of b*tches and she is ordinarily a gentle little soul...I feel like crap....

[P_RN, ADN, RN]

Try the Sims position. You may have to do it by touch but if you put a betadine cotton ball at the introitus it may show the meatus. Another tip is to hold the cath the alongside your index finger instead of in a pinching mode and "probe" the meatus may be just inside the introitus. Lots of light, lots of hands and lots of prayer and it just might work.

[dawngloves, BSN, RN]

Originally posted by ktwlpn

....St Francis is the Patron St of lost objects,right? Maybe we prayed to the wrong one?

That's the problem!Wrong saint! You should have prayed to St. Anthony!

[mcm355]

You would have been better to pray to St. Anthony. He has been great at helping me find everything from a meatus to a vein on a 400 pounder to a solution to a baaaaad day. Have to agree with the cath alongside the index finger as another option, esp. if the pt. is too large to even lift out of the recliner and you have the flashlight clamped between your teeth and she has your head clamped between her knees. Love that home health nursing but thats another story.

[ERNurse752, RN]

Gently take hold of both sides of the labia majora and pull straight out. The meatus should pop right up.

[Jay-Jay, RN]

I was once having a terrible time finding the meatus. Fortunately, this lady had been cathed numerous times, with the family watching, so they were able to SHOW me where to find it...

It was near the upper end of the inside of one of the labia minora!! It was quite small, too...never would have found it without help!

And MCM....pts. in recliners....yeah, don't you LOVE it??

[canadiannurse21]

lol, with the head between the knees reference, it just reminded me of a week ago, I had to get a MSU from a lady who couldn't stand, and did NOT want to be catheterized, so, she got on the cammode, I kneeled down, with flashlight in my teeth, and pried open to get a specimen, just so I could extend the meatus towards my face, and when she did urinate, it was all over me!

OMG eh? From now on, a sterile bedpan is my choice for the immobile

:)

[LoisJean]

Just an aside: I always did good peri care on the ladies B4 doing cath....(the reference to 'head between the knees' brought back olfactory memories...whew!) ERNurse752 is correct. 99.9% of the time the urinary meatus will open up if the labia is gently pulled straight out....did I ever tell you guys about the lady who had 4 holes to choose from instead of 3? That was one to remember.

Peace,

Lois Jean

[night owl]

You don't know how happy I am to have all male residents! Believe it or not, in my 28 years of nursing, I've catheterized one female and that was in school! God bless you all. I'll say a prayer to St. Anthony for your lost little meatus. He'll help you find it the next time...

[angelbear]

Try it some time with the contractured and malformed pts. It's a trip sometime they can look like an occtopus by the time they are done. I sometimes wonder if we arent causing more UTI's than were originally there.