Inserting an indwelling urinary catheter in a female patient

Nursing, Aug 2004 by Rushing, Jill

YOUR RESPONSIBILITIES include assessing your patient's need for catheterization, inserting the catheter using aseptic technique, and reassessing her condition after catheter insertion.

DO

* Verify the order. Explain the procedure to your patient, provide privacy, and wash your hands.

* Place your patient supine with her knees flexed and her hips externally rotated. Drape her for privacy.

* Put on clean gloves. Examine the urinary meatus and assess for abnormalities, such as exudates or inflammation. Provide perineal care, then remove your gloves and wash your hands.

* Open the sterile catheter tray on a nearby clean surface. Place the waterproof drape under her buttocks and the fenestrated drape with the opening over her perineum.

* Put on sterile gloves. Saturate the cotton tips of the swab sticks in the catheter kit with povidone-iodine. (Follow facility policy if she's allergic to povidone-iodine.) Attach the sterile water syringe to the catheter inflation hub and inspect the balloon for defects. Lubricate 1 to 2 inches (2.5 to 5 cm) of the catheter tip and leave the catheter in the sterile tray.

* Separate the labia minora with your nondominant hand and keep this hand, which is contaminated, in place.

* With your other hand, pick up the swab sticks. With one downward stroke, clean the outside then the inside of each labium, discarding each used swab stick after use so it won't contaminate other equipment. Clean the meatus last, then place the catheter tray between the patient's lower legs.

* Grasp the sterile catheter 2 to 3 inches (5 to 7.5 cm) from the tip and keep it from touching anything. Ask the patient to take a deep breath and slowly exhale while you insert the catheter tip. Advance it 2 to 3 inches until urine flow starts. Advance it another 1 to 2 inches to make sure it's in the bladder. If you meet resistance, slightly rotate the catheter or maintain pressure on it until the sphincter relaxes.

* Holding the catheter in place, inflate the balloon. Keeping the plunger down, disconnect the syringe from the port. Pull gently on the catheter until you feel resistance.

* Secure the catheter to your patient's thigh with enough slack to prevent movement from creating tension on the catheter. Secure the drainage bag on the bed frame below her bladder level.

* Provide perineal care, then remove your gloves and wash your hands.

* Document the date and time, the catheter size and type, and the patient's response. Record the amount, odor, color, and consistency of urine and whether you obtained a specimen.

DON'T

* Don't use force if you feel resistance during catheter insertion.

* Don't use the catheter if it accidentally touches the labia or enters the vagina.

SELECTED REFERENCES

Berman, A., et al. (eds): Kozier & Erb's Techniques in Clinical Nursing, 5th edition. Upper Saddle River, N.J., Pearson Education, Inc., 2002.

Cravens, D., and Zweig, S.: "Urinary Catheter Management," American Family Physician. 61(2):369-376, January 15, 2000.

BY JILL RUSHING, RN, MSN

Jill Rushing is a nursing instructor at Amarillo (Tex.) College. Richard L Pullen, Jr., RN, EdD, coordinates Clinical Do's & Don'ts, which illustrates key clinical points for a common nursing procedure. Because of space constraints, it's not comprehensive.