Female Urethral4 Catheterization

MIN CHEN

Geriatric DepartmentZHONGNAN Hospital

LEARNING OBJECTIVES

Know indications and contraindicationsfor Urethral catheterization

Know the procedures of UrethralcatheterizationCommand the skill of insertion Urethralcatheterization

Definition- Female urethracatheterization

The insertion of a catheter through theurethra into the urinary bladder topermit drainage of urineA fundamental skill for the practicinghealth care professional

Indications

Diagnostic indications include the following:■ Collection of uncontaminated urine specimen■ Monitoring of urine output■ Imaging of the urinary tractTherapeutic indications include the following[2j:■ Acute & Chronic urinary retention■ Instilling medication■ Intermittent decompression for neurogenic bladder■ Hygienic care of bedridden patients

Contraindication

Urethral injury(most commonly result from pelvicfractures)

Equipment- urinary catheterization kit

« U 1 .1 V. CT JU

iodineSterile cotton balls

Water-soluble lubrication gelSterile drapesSterile gloves

a preconnected closed Foley systema specimen container

a 10-cc syringe filled with sterile water forballoon inflation

Urinometer connected to a collection bag

Anatomy

gin by inspecting thegenital area to identifythe urethral meatus

The female urethra is afibromuscular tube

Approximately 3.5 to 4cm longIts meatus is locatedbelow the clitoris and

above the vaginal orifice

Urethra

Vagina

Anus

Clitoris

Labiummajora

Labiumminor

Preparation-Consent

inform the patient of the reasons andnecessity for the procedure

Explain the procedure to the patientincluding possible complications

Address any specific questions orconcerns

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Positioning

With the bed flat, the patient should liesupine in a frog-legged position, withlegs apart and feet together

Procedure

i Ask the patient to clean perinaeumwith soap water or the hygienic towelettei Place the patient supinei Prepare equipmentsi Wash hands

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Six steps hands washing

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UTclh

Procedure-lst sterilizationral catheterization should be performed under

sterile conditions

Inspect the sterile catheterization kit and removeit from its outer packagingseparate labia using left hand with a plastic gloveUsing right hand to handle forceps, cleanse peri¬urethral mucosa with betadine

Cleanse the mons pubis—the left labia majora-the right labia majora—left in between of labiamajora and minor- righter in between of labiamajora and minor- - left labia minor— right labiaminor- urethral meatus , one swipe per swabdiscard swab away from sterile field.Take off the clean-glove

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Procedure -drape

■ Open the inner paperwrapping to form asterile field.

■ Put the gloves on

■ Cover the patient'sabdomen and superiorpubic region with thefenestrated drape.

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Procedure-lubricate

Check the contents of the tray orthe sterile field

lubricate the tip & distal end ofcatheter( 2-5 cm)Connect the catheter with urinecollection bag

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Procedure-2nd sterilization

Sterilize the meatus —labia minors (both sides) ~meatus againbefore its insertion into the urethra,using yournondominant hand, identify the urethra by spreading

the labia majora and minora;Dlace the thumb and index finger medial to the inner

abia

spreading the fingers slightly and with gentle tractionand pulling upward toward the head of the patient(This hand is no longer sterile and should not beremoved from this position.)

Maintain hand position until preparing to inflateballoon

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Procedure-insertion

Holding the catheter in the dominanthand, gently insert the catheter tip intothe meatus

slowly advance it through the urethrainto the bladder (6-8cm) (insert until 2to 3cm beyond where urine is noted)

If the catheter is accidentallycontaminated, discard it and obtain anew sterile catheter before proceeding.

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Procedure-evaluation

Evaluate catheter function and amount,color, odor, and quality of urineIf the flow of urine is slow or nonexistent,the catheter may be obstructed or in thewrong site, or the bladder may be empty.Flush the catheter with saline

If saline or urine freely returns, thecatheter is properly inserted.

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Procedure-inflate balloon

Inject the entire contents of the 10-cc syringe of sterile water to Inflate balloon completely

Gently pull catheter until inflationballoon is snug against bladderneck

Secure catheter to abdomen or thigh,without tension on tubing

Place drainage bag below level ofbladder

Inflated Balloon

Partially InflatedBalloon in Urethra. 18

Document

Remove gloves, dispose of equipmentappropriately, wash hands

Document size of catheter inserted,amount of water in balloon, patient'sresponse to procedure, andassessment of urine

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Complications

The main complications are tissue traumaand infection

Traumatic injury may cause strictures, narrowing,and scarring of the urethra.

After 48 hours of dwelling catheterization, mostcatheters are colonized with bacteria, thusleading to possible bacteruria and itscomplications

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Removing the Catheter

First, deflate the balloon

Re-attach the syringe as you did before,Exert a bit of suction with the syringe:be sure you have taken out as muchwater as you put in; the balloon mustbe deflated

Now slowly withdraw the catheter

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Th* NEW ENGLAND JOURNAL of MEDICINE

Female Urethral Catheterization

Rafael Ortega, M.D., Linda Ng, M.D., Pavan Sekhar, B.S,, and Michael Song, MA

N EnglJ Med 2008;358:el5.Copyright © 200$ Masiaciwsttts Medical Society

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Key point

using an aseptic technique

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Shaft of clitoris

Glans of clitoris

Opening of urethra

Opening ofna

ulbsofclitoris

Pelvic bone

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