Whch method of female catheterization do you teach and why?

[VickyRN, MSN, DNP, RN]

There is a mild controversy at our school of nursing concerning the correct method of cleansing the female meatus before catheterization.

Our official policy is to cleanse the meatus first (using one downward stroke), then cleanse the labia minora, then majora (inner to outer, downward stroke, using clean cotton ball saturated with antiseptic solution each time). The rationale here is that one should always cleanse from inner to outer. Also, this is the same sequence as with male catheterization, and therefore less confusing to the students. With a male, of course, cleansing at the tip and proceeding downward moves from the area of least contamination to most contamination. I'm not sure the same rationale applies to females in cleansing from inner to outer, as the textbook states that wiping "along the far labial fold, near labial fold, and directly over center of urethral meatus" is the correct method to move from "area of least contamination to that of most contamination." (In other words, the most contaminated region in females is the meatus; with males, it is not, but further down the glans.)

Most other schools of nursing, textbooks, and facilities specify that the labia majora are cleansed first (farthest side, then closest), then labia minora (again farthest side, then closest), then the last one or two swipes downward across the meatus.

Which method do you teach at your school of nursing and why? Do you know of any research backing up one method over another? (I have not been able to locate any.) Any and all comments would be most appreciated. Thank you in advance :)

[cholli]

Labia, Labia, then meatus, so it is extremely clean to stick the cath in, opposite of peri-care.

yes it is confusing, but is they can't figure that out......oh my!

[Liddle Noodnik]

There is a mild controversy at our school of nursing concerning the correct method of cleansing the female meatus before catheterization.

Our official policy is to cleanse the meatus first (using one downward stroke), then cleanse the labia minora, then majora (inner to outer, downward stroke, using clean cotton ball saturated with antiseptic solution each time).

I always understood inner to outer - otherwise you will be bringing bacteria from away (and closest to clothing and orifice) to the meatus, which is the last thing you want to do.

Same principle as with scrubbing for an operative procedure, you start swabbing from center (where incision will be) and draw in a spiral to the outer edges.

Or do they not do that anymore?

[elizabells, BSN, RN]

I graduated in 06, and we learned the meatus outward method.

[FireStarterRN, BSN, RN]

First I wash the area really well with warm washrags, visualizing the target clearly. ThenI get sterile and lube up the equipemnt, then I start at the meatus and do a really good job, and use up all the betadine and cotton, I'll work my way outwards, then do a final good one on the meatus again, with the last cotton ball soaked in betadine, as my grand finale. Then I put in the cath.

[JoMom4]

I worked in a large Urology practice for a few years. Out of 10 MD's, 8 performed catheterization and cystoscopy in the office as a "clean" technique. They used non-sterile gloves. Only 2 MD's used sterile gloves. We had patients who performed self-catheterization with a catheter that was carried in their pocket. We had men who used the same red rubber catheter for 6 months, washing it with soap and water between uses. (Medicare will pay for a new one every 30 days, but not everyone knows this.) We always taught patients "clean" not "sterile" for self-cath.

I never had an MD in that office tell me there was a correct way to cleanse. I was taught meatus then labia, and this is what I did many times in front of the Urologist. I was never corrected by them.

I realize we need to continue to teach sterile technique, but in my opinion, either way the cleansing is done will be sufficient.