Helpful Hints: Female Patient Urinary Catheter Insertion

With some female patients, insertion of a urinary catheter can be difficult. The level of difficulty can increased due to variations in anatomy, or swelling related to medical procedures or disease processes. These situations can serve to obscure visualization of the urinary meatus, thus complicating catheter placement.

Additionally, when a woman is supine for the catheter insertion procedure, it can cause the urinary meatus sink down, just inside the vaginal opening, resulting in the clinician being unable to visualize it.

The following “thumb method” of catheter insertion has worked well for me when I have had a female patient whose urinary meatus is not immediately visible.

Gather your supplies; include an extra catheter. Set up your supplies and prep the patient. Placing a folded towel under the patient’s lower back at the sacrum can aide in optimum positioning of the patient. If appropriate, a physician’s order for sterile topical lidocaine jelly can be obtained. Using this jelly in the place of KY Jelly can promote comfort and prevent pain from manipulation of the tissues in this invasive procedure. This is especially important with patients who may be sensitive due to trauma to the tissues, or disease processes.

With your non-dominant hand, use your thumb and place it approximately one half to one inch below the clitoris, pushing slightly in and upward at the same time. This will cause the urinary meatus to be visible, and places tension on the tissue, stabilizing it. If the tissue is wet due to bleeding or drainage, you can wrap your gloved thumb in a sterile 4X4 to prevent slippage.In this way, the meatus does not get pushed inward or "roll" when you insert the catheter. Additionally, positioning your thumb in this way holds the labia minora in a retracted position, keeping it out of the way.

When you are ready to insert the catheter, be sure to grasp it no more than approximately one and a half to two inches from the distal end. This will aide in keeping the insertion end stable, and prevent it from moving and being inadvertently placed into the vaginal opening.

The "wink" method of locating the meatus by wiping with a providone iodine swab does not work if the meatus is just inside the vaginal opening, and not visible. With the tissue stabilized as stated above, you can then wipe with your swab, and you will plainly see the "wink". Then, drop your swab, and pick up your catheter. With the tip pointed at a slightly upward angle, and insert. If the catheter inadvertently goes enters the vagina, leave it there before attempting insertion of a new catheter. The misdirected catheter will serve as a landmark, which will assist you in correct placement on your next insertion attempt. You will be able to see where not to direct the catheter on your next attempt.

Utilizing this method has served to make difficult catheter insertions more comfortable for my patients, and less time consuming for me.