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How To Catheterize the Bladder in a Female Child

ByKeara N. DeCotiis, MD, Nemours/Alfred I. duPont Hospital for Children
Reviewed ByMichael SD Agus, MD, Harvard Medical School
Reviewed/Revised Modified Jul 2025
v50704395
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Urethral catheterization refers to the insertion of a flexible catheter through the urethra into the urinary bladder for diagnostic or therapeutic purposes.

Topic Resources

Several types of catheters are available. If a catheter cannot be inserted, suprapubic aspiration of the bladder may be necessary.

(See also Bladder Catheterization, How To Do Urethral Catheterization in a Female, and Urinary Tract Infection in Children.)

Indications for Bladder Catheterization: Female Child

Bladder catheterization can be done for diagnosis and/or treatment.

The main indication for inserting a bladder catheter in female children is to:

  • Obtain a sterile urine sample for testing (eg, urinalysis, urine culture) in very young children who cannot void on command

Less common reasons include:

  • Relief of acute or chronic urinary retention (obstructive uropathy)

  • Intermittent catheterization of a neurogenic bladder

  • Instillation of contrast agent for cystourethrography

  • Bladder irrigation

  • Instillation of a medication

  • Monitoring of urine output in certain patients who are hospitalized (indwelling catheter; not discussed here)

The American Academy of Pediatrics recommends bladder catheterization (or suprapubic aspiration) for obtaining urine specimens for urinalysis and culture in febrile infants aged 8 to 60 days when a urinary tract infection (UTI) is suspected because the diagnosis of urinary infection cannot be reliably established using bagged specimens (1); either procedure should be performed before initiating antimicrobial therapy.

Indications reference

  1. 1. Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management, Roberts KB. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics. 2011;128(3):595-610. doi:10.1542/peds.2011-1330

Contraindications for Bladder Catheterization: Female Child

Absolute contraindications

  • Suspected urethral disruption resulting from recent trauma

  • Significant labial adhesions and/or fusion

In children who have had traumatic injuries, lower urinary tract disruption (suggested by perineal hematoma, bleeding from the urethral meatus, or pelvic bone injury) should be excluded by vaginal examination followed by retrograde urethrography (and sometimes cystoscopy) before doing bladder catheterization.

Relative contraindications

  • Known major abnormalities of the lower urinary tract

  • History of urethral strictures

  • Prior urethral or bladder neck reconstruction

  • History of difficult catheter placement

Complications of Bladder Catheterization: Female Child

Complications include:

  • Superficial urethral trauma or bladder trauma with bleeding (common)

  • Catheter-associated UTI (common)

  • Creation of false passages in the urethra

  • Scarring and strictures

  • Bladder perforation (rare)

  • Urine leakage (particularly with inappropriately sized or located catheters)

Equipment for Bladder Catheterization: Female Child

Sometimes prepackaged kits are available; if not, equipment required typically includes:

  • Sterile drapes and gloves

  • An absorbent underpad

  • Antiseptic solution (eg, povidone-iodine, chlorhexidine) with application sticks, cotton balls, or gauze padsAntiseptic solution (eg, povidone-iodine, chlorhexidine) with application sticks, cotton balls, or gauze pads

  • Sterile water-soluble lubricant (with or without 2% lidocaine)Sterile water-soluble lubricant (with or without 2% lidocaine)

  • Sterile cup for collecting the urine specimen

  • Urethral catheter size varies with age: neonate (full term) to 6 months—5 to 6 French (Fr); infant or toddler—6 to 8 Fr; prepuberal child—10 to 12 Fr; adolescent—12 to 14 Fr

  • Washcloth for removing antiseptic solution after the procedure

Additional Considerations for Bladder Catheterization: Female Child

  • Sterile technique is necessary to prevent a lower UTI

  • Ensure the patient is not allergic to latex or povidone-iodine.Ensure the patient is not allergic to latex or povidone-iodine.

  • If doing multiple procedures, do bladder catheterization first because the child may void during the other procedures.

  • Consult urology for difficulties with catheter placement or guidance on catheter size and style in selected clinical scenarios. In cases where catheter placement is not possible, a suprapubic percutaneous aspiration may be necessary.

Relevant Anatomy for Bladder Catheterization: Female Child

  • The pediatric female anatomy is similar to the adult. The primary distinction is size.

  • The female urethral meatus is the first opening below the clitoris and is located above the vaginal opening. It can be difficult to visualize if it appears closed. Also, young girls may have labial adhesions, which can make visualization of the meatus more difficult.

  • In females, the urethra is short and straight.

Female Genital Organs

Positioning for Bladder Catheterization: Female Child

  • Place the patient in a supine, frog position (hips and knees partially flexed, heels on the bed, hips adequately abducted to allow access).

  • An assistant should hold the legs or knees.

Step-by-Step Description of Bladder Catheterization: Female Child

The in-and-out insertion of a catheter is described here:

  • Allow one or both parents or caretakers to remain present to comfort the child. Having them hold the child's hand, provide a stuffed animal for the child to play with, or engage in other distraction techniques can help. Occasionally, sedation may be needed.

  • Place all equipment within easy reach on an uncontaminated sterile field on a bedside tray.

  • Open the prepackaged kit, taking care to keep the contents sterile.

  • Place the absorbent underpad with the plastic side down beneath the buttocks.

  • Remove diaper, if present, and clean the area with a wet washcloth using soap and water. Dry the area with a dry towel. Then wash your hands with soap and water.

  • Put on gloves using sterile technique (ensuring hands are clean, opening the glove package without contamination, and donning the gloves without touching the outer surfaces).

  • Apply the sterile lubricant to the end of the catheter and place the catheter on the sterile field.

  • Saturate the application sticks, cotton balls, or gauze with antiseptic solution (eg, povidone-iodine).Saturate the application sticks, cotton balls, or gauze with antiseptic solution (eg, povidone-iodine).

  • Place the sterile fenestrated drape over the pelvis so that the vulva is exposed.

  • With your nondominant hand, separate the labia to expose the urethral meatus.

  • Cleanse the area around the meatus with each application stick, gauze pad, or cotton ball saturated in povidone-iodine. Swab the area with an anterior-to-posterior motion. Discard or set aside the now contaminated application stick, gauze pad, or cotton ball. If using povidone-iodine, cleanse 3 times and allow the area to dry. This hand is now nonsterile and must not be removed from the labia or touch any of the equipment during the rest of the procedure.

  • Hold the catheter in your dominant free hand. Separate the labia with your nondominant hand. If the meatus is difficult to see, gently pull the vaginal introitus mucosa downward.

  • Advance the catheter gently through the urethra until urine is obtained. Do not poke repeatedly or force the catheter. Urine should flow freely.

  • If the catheter has entered the vagina, leave that catheter in place as a landmark and obtain another catheter and attempt to insert.

  • Collect urine in the specimen container. If the volume of obtained urine is insufficient, gently massage the lower abdomen over the bladder (suprapubic area).

  • Remove the catheter by pulling out gently.

  • Remove all remaining povidone-iodine with a wet washcloth.

Aftercare for Bladder Catheterization: Female Child

  • Remove the drapes.

Warnings and Common Errors for Bladder Catheterization: Female Child

  • To prevent causing a UTI, maintain strict sterile technique during the procedure.

  • To prevent causing false passages and urethral injury, do not use excessive force during insertion.

Tips and Tricks for Bladder Catheterization: Female Child

  • Do not make continued attempts at catheter placement if significant resistance is met or if the catheter feels as if it is buckling inside and not advancing.

  • If the catheter appears to be in the correct position but urine does not return, lubricant may be obstructing the drainage of urine. With the catheter held in the current position, flush the catheter with normal saline to dislodge the lubricant and ensure urine returns before proceeding with the remaining steps.

  • If the catheter appears to be in the correct position but urine does not return and anuria due to dehydration is suspected, consider providing hydration (appropriate to the patient's clinical condition) before the procedure is reattempted.

  • If the catheter appears to be in the vaginal opening, leave the catheter in temporarily. Reattempt catheterization of the urethral opening with a fresh sterile catheter; the previously placed vaginal catheter will serve as a landmark and prevent re-entry of the incorrect orifice. Once urethral catheterization is complete, remove the vaginal catheter.

Drugs Mentioned In This Article

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