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Female urethral catheterisation animated demonstration

How to insert a urethral catheter in a female patient using sterile technique.

Equipment needed

  • Latex or silicone Foley catheter (14 French gauge for general use; sizes from 12 French to 24 French may be needed depending on the situation)

  • Sterile drape

  • Sterile paper towel (preferably fenestrated)

  • Sterile gloves

  • Plastic apron

  • Sterile pot

  • Kidney dish

  • 10 mL syringe filled with 10 mL sterile water (NOT saline)

  • Sterile lubricating gel (with or without local anaesthetic e.g., lidocaine gel) in a pre-filled 10 mL syringe

  • Swabs and saline solution (not chlorhexidine or other cleaning solutions, as these can be irritating to the skin).

Contraindications

Do not perform urethral catheterisation after pelvic trauma, especially if there is a suspicion of urethral injury that may accompany a pelvic fracture, for example. In patients with a urethral injury, there is a risk that the catheter may pass straight through the urethra and into the surrounding tissues. In these patients, arrange for further imaging of the urethra before attempting catheterisation.

If you fail to insert a urethral catheter on two or more occasions, seek a more experienced clinician for assistance. It may be necessary to use a curved coude tip catheter, a smaller or larger catheter, or a three-way irrigation catheter.

If the patient has capacity and refuses urethral catheterisation after sufficient communication and understanding, do not perform the procedure against their wishes.

Indications

  • Acute retention of urine

  • Perioperative urinary collection (e.g., patients undergoing abdominal surgery always need catheterisation as it is important that the bladder is fully emptied; if the bladder were full, there is a risk of it accidentally being cut during the operation)

  • Accurate measurement of urine output in patients who are acutely or critically unwell

  • Re-insertion of long-term urinary catheter

  • Chronic bladder obstruction and neuropathic bladder

  • Bladder irrigation or instillation.

Patients with urinary incontinence and immobility may need catheterisation but these are not clear indications. The risk of infection must be balanced against the convenience of the catheter.

Complications

  • Failure to catheterise:seek help from a more experienced clinician

  • Urinary tract infection: remove the catheter and give antibiotics as directed by local policy

  • Bleeding: minor bleeding is common and generally stops spontaneously; for more significant urethral haemorrhage seek expert advice from a more experienced clinician

  • Blocked catheter: may result from clots or other debris. Flushing the bladder with sterile normal saline may be required to remove clots, debris or mucus.[75] Irrigation with a three-way catheter for the purpose of removing clots and debris post urology surgery is normally used for short periods only and only within an acute care setting.[75]

Aftercare

Unlike catheterisation of male patients, incorrect positioning of the catheter is common in women as the urethral meatus is so close to the vaginal opening. It is very important to ensure that urine is flowing before inflating the balloon. Flowing urine is confirmation that the tip of the catheter lies within the bladder. If no urine drains do not inflate the balloon, as the tip, and therefore the balloon, may still be in the urethra. Inflating the balloon at this point could lead to urethral injury.

Documentation:

Clearly document that the patient’s consent was obtained. Also document the volume of sterile water instilled into the balloon and the residual volume of urine, as well as any complications that occurred during the procedure. It may also be sensible to document the colour and quality of the urine produced.

Catheter bag:

After successful positioning of the catheter ensure it is draining adequately and that the correct type of urine collection bag is attached.

  • An urometer may be required to measure accurate hourly urine volumes

  • Various leg-bag attachments are available for the ambulant patient.

Removal:

Once the patient no longer requires the catheter, remove it as soon as possible to prevent infection. Deflate the balloon before removing the catheter.