How To Do Urethral Catheterization in a Female

• Relief of acute or chronic urinary retention, such as due to urethral obstruction (obstructive uropathy) or neurogenic bladder

• Treatment of urinary incontinence

• Monitoring of urine output

• Measurement of postvoid residual urine volume

• Collection of sterile urine for culture

• Diagnostic studies of the lower genitourinary tract

• Bladder irrigation or instillation of medication

Absolute contraindications

• None

Relative contraindications

• History of urethral strictures

• Current urinary tract infection (UTI)

• Prior urethral reconstruction

• Suspected urethral injury*

• Recent urologic surgery

• History of difficult catheter placement

*Urethral injury may be suspected following blunt trauma if patients have blood at the urethral meatus (most important sign), inability to void, or perineal or labial ecchymosis, and/or edema. In such cases, urethral disruption should be ruled out with imaging (eg, by retrograde urethrography and sometimes also cystoscopy) before doing urethral catheterization.

Complications include

• Urethral or bladder trauma with bleeding or microscopic hematuria (common)

• UTI (common)

• Creation of false passages

• Scarring and strictures

Prepackaged kits are typically used but the individual items needed include

• Sterile drapes and gloves

• Povidone iodine

• Applicator swabs, sterile gauze, or cotton balls

• Water-soluble lubricant

• Urethral catheter (size 16 French Foley catheter is appropriate for most adult women)*

• 10-mL syringe with water (for catheter balloon inflation)

• Sterile collection device with tubing

* A closed catheter system minimizes catheter-associated UTI.

• Sterile technique is necessary to prevent a UTI.

• The female urethral meatus appears as an anterior-posterior slit located anterior to the vaginal opening and about 2.5 cm posterior to the glans clitoris. If the meatus recedes superiorly into the vagina, as can happen in older women, it can often be palpated in the midline as a soft mound surrounded by a firm ring of periurethral tissue.

• To expose the vulva, position the patient supine in either lithotomy or frog position (hips and knees partially flexed, heels on the bed, hips comfortably abducted).

• Place all equipment within easy reach on an uncontaminated sterile field on a bedside tray.  You may put the box containing the catheter and the drainage system between the patient’s legs, so that it is easily accessible during the procedure.

• If not done already, attach the catheter to the collection system and do not break the seal unless a different type or size of catheter is required.

• Test the retention balloon for leaks by inflating it with water.

• Apply lubricant to the tip of the catheter.

• Saturate the applicator swabs, cotton balls or gauze with povidone iodine.

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

• Gently spread the labia and expose the urethral meatus, using your nondominant hand. This hand is now contaminated and must not be removed from the labia or touch any of the equipment during the rest of the procedure.

• Cleanse the area around the meatus with each cotton ball saturated in povidone iodine. Use a circular motion, beginning at the meatus and working your way outward. Discard or set aside the newly contaminated gauze or cotton balls.

• Hold the lubricated catheter and gently pass it through the urethra, using your free hand. Urine should flow freely into the collection tubing. If the catheter accidentally passes into the vagina, it should be discarded and a new catheter used.

• Inflate the balloon with the recommended volume of water, usually 10 mL. Resistance or pain may indicate that the balloon is in the urethra and not the bladder. If so, deflate the balloon, then insert it all the way before reinflation.

• Pull the balloon up snug against the bladder neck, after the balloon has been inflated, by slowly withdrawing the catheter until resistance is felt.

How To Catheterize the Urethra...

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• Remove the drapes.

• Secure the catheter to the thigh with an adhesive bandage or tape.

• Hang the bag in a dependent position, so that urine can drain via gravity.

• Be sure to maintain strict sterile technique during the procedure to avoid urinary tract infection.

• It is often helpful to have an assistant to help expose the meatus in women, especially those who are obese or have pelvic organ prolapse. Gentle retraction of the labia is helpful.