While sterile catheter insertion of either male or female is basically the same, because of obvious anatomical differences, I’ve created separate pages to discuss the nursing skill as well as some tips to make it easier for you.
Sometimes, just finding the urethra can be a challenge. And while the basic anatomy is usually correct, once in a blue moon, you will have a patient that doesn’t have things in the right place.
Make sure the bed is completely flat unless your patient cannot tolerate it. Having the head of the bed elevated even a little can make it difficult to visualize the urethra.
If you have a patient that cannot keep her legs apart or is extremely obese, you can have her lie on either side and insert the catheter from the posterior by having the top leg bent up towards the chest.
If you can’t find the urethra, ask the patient to cough. Sometimes you can see the urethra “wink” at you. The trick is to be looking at the area when the patient coughs, not looking at the patient’s face while you ask ;)
Then just remember exactly where that spot was, even if it isn’t obvious after the “wink”, and begin to insert the catheter. It will allow the cath to pass through if you have it located correctly.
If you accidently put the catheter in the vagina instead of the urethra, leave the first catheter where it is and use a second sterile catheter for proper placement. Leaving the first catheter in the vagina ensures that you won’t do that a second time on this particular patient. Once the second catheter is placed, you can remove the first one from the vagina.
Lighting is very important with female catheters. As a home care nurse I carried one of those flashlights that you put around your forehead. Looks like a miner’s light. People would laugh when I pulled it out. But it saved my bacon many times. Lighting in patient’s homes (and sometimes even in facilities) are not bright enough. I would tell patients, “Hey, I need to see where I’m goin’!”
I have never seen anyone clean the area in a circular motion as shown in this second video. It is always three swabs, three swipes: side, side, center and you are done.
Many times, the genital area is moist, either from vaginal discharge or due to urinary incontinence. This can make it very difficult to position your non sterile hand without slipping and keep the labia separated. Sometimes cleaning the area with wipes can remove excess moisture, making it easier to perform the female catheterization procedure.
If the patient is obese it becomes even more difficult due to the abdominal pannus pressing down against the genital area.
In spite of this difficulty, try to be a gentle as possible and be aware of just how far you are separating the labia. After all, the object is not to give the poor woman an episiotomy! Keep your fingers to the top 1/3 of the labia and you should be just fine.
BTW, I don’t use the fenestrated drape at all. I don’t know a nurse who does.
Inserted 16 Fr 5 cc balloon inflated to 10cc silastic foley catheter. Immediate return of clear light yellow urine. Obtained total of 500 cc after procedure. Secured catheter to thigh with Dale leg strap. Instructed patient to keep bag below level of bladder and off the floor. Patient verbalized understanding of instructions. Patient tolerated procedure well.