Female Catheter Care
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On this page
- Definition
- Purpose
- Precautions
- Infection Control
- Description
- Preparation
- Aftercare
- Key Terms
- For More Information
Definition
Urinary catheterization is the insertion of a catheter through the urethra into the urinary bladder for withdrawal of urine. Straight catheters are used for intermittent withdrawals; indwelling (Foley) catheters are inserted and retained in the bladder for continuous drainage of urine into a closed system.
Purpose
Intermittent catheterization is used for the following reasons:� To obtain a sterile urine specimen for diagnostic evaluation; to empty bladder content when the patient is unable to void (urinate) due to urinary retention, bladder distention, and obstruction, or to measure residual urine after urination.
- To instill medication for a localized therapeutic effect and to instill contrast material (dye) into the bladder through the urethral catheter for cystourethralgraphy (x ray of the bladder and urethra).
- To empty the bladder for increased space in the pelvic cavity to protect the bladder during labor and delivery and during pelvic and abdominal surgery.
- To strictly monitor the urinary output and fluid balance of critically ill patients.
Indwelling catheterization is:
- Indicated as palliative care for terminally ill or severely impaired incontinent patients, for whom bed and clothing changes are uncomfortable, and as a way to manage skin ulceration caused or exacerbated by incontinence.
- Used to maintain a continuous out flow of urine for patients undergoing surgical procedures that cause a delay in bladder sensation, and for persons with chronic neurological disorders that cause paralysis or loss of sensation in the perineal area.
- Indicated for urologic surgery, bladder outlet obstruction, and for patients with an initial episode of acute urinary retention to allow the bladder to regain its tone.
Precautions
Because the urinary tract is normally a sterile system, catheterization presents the risk of causing a urinary tract infection (UTI). The catheterization procedure must be sterile and the catheter must be free from bacteria.
Urinary catheterization aids or replaces the body's normal ability to urinate. Intermittent use of the procedure can stimulate normal bladder function, however frequent and continuous catheterization can lead to total dependency. Catheterization is invasive and has the potential of injuring the urethra and bladder, inviting urinary tract infections. Therefore aseptic techniques should be use in all catheter management activities.
The normal flow of urine from the kidneys through the ureters, bladder, urethra prevents the movement of bacteria up through the urinary system. The antibacterial properties of the bladder wall, urethra lining, and low urine pH also serve as protective barriers to urinary tract infections. Urinary tract infections occur when bacteria invade the protective barriers of one or more urinary structures.
Infection control
Every attempt should be made to keep the urinary drainage system closed. Breaks in the system invite infections. Health care workers and patients should wash their hands before and after manipulation of the patient's catheter or collection system to control UTI. Cross-contamination is the most frequent cause of nosocomial (hospital acquired) catheter related infections. Good hand washing practices are the best prevention measure.
Frequent intermittent catheterization and long term use of indwelling catheterization predisposes the patient to UTI. Care should be taken to avoid trauma to the urinary meatus or urothelium (urinary lining) with catheters that are too large or inserted with insufficient use of lubricant. Patients with an indwelling catheter must be reassessed periodically to determine if alternative treatment will be more effective in treating the problem.
Description
The female urethral orifice is a vertical, slit-like or irregularly ovoid (egg shaped) opening, 4 or 5 mm in diameter, located between the clitoris and the vagina. The urinary meatus (opening) is concealed between the labia minora, which are the small folds of tissue that need to be separated in order to visualize the opening and insert the catheter. With proper positioning, good lighting and gloved hands, these anatomical landmarks can be identified. If necessary, provide perineal care to ensure a clean procedural environment.
Catheterization of the female patient is traditionally performed without the use of local anesthetic gel to facilitate catheter insertion. But since there are no lubricating glands in the female urethra (as found in the male urethra), the risk of trauma from a simple catheter insertion is more likely; therefore, ample supply of an anesthetic or antibacterial lubricant should be used.
Preparation
Sterile disposable catheterization sets are available in clinical settings and for home use. These sets contain most of the items needed for the procedure, such as antiseptic agent, perineal drapes, gloves, lubricant, specimen container, label, and tape. Anesthetic or antibacterial lubricant, catheter, and drainage system may need to be added. It is always wise to review the content of the pre-packaged catheterization set while assembling the materials.
Aftercare
Patients using intermittent catheterization to manage incontinence may require a period of adjustment as they try to establish a catheterization schedule that is adequate for their normal fluid intake.
Sexual activity and menopause can also compromise the sterility of the urinary tract. Irritation of the urethra during intercourse promotes the migration of perineal bacteria into the urethra and bladder, causing UTIs. Postmenopausal women may experience more UTIs than younger women. The presence of residual urine in the bladder secondary to incomplete voiding provides an ideal environment for bacterial growth.
Patient education
The patient and/or caregiver should be taught to use aseptic technique for catheter care. Nursing interventions and patient education can make a difference in the incidence of urinary tract infections in the hospital and nursing homes and home care units.
The sexuality of the patient with an indwelling catheter for continuous urinary drainage is seldom considered. If a patient is sexually active, the practitioner must explain that intercourse can take place with the catheter in place. The patient or her partner can be taught to remove the catheter before, and replace it with a new one following intercourse.
KEY TERMS
Catheterization - A procedure of inserting a catheter through the urethra into the bladder to remove urine.
Catheter - A tube for evacuating or injecting fluid.
Contaminate - To make an item unsterile or unclean by direct contact.
Foley catheter - A double channel retention catheter. One channel provides for the inflow and outflow of bladder fluid, the second (smaller) channel is used to fill a balloon that holds the catheter in the bladder.
Intermittent catheterization - Periodic catheterization to facilitate urine flow. The catheter is removed when the bladder is sufficiently empty.
Perineal area - The genital area between the vulva and anus in a woman.
Urinary incontinence - The inability to retain urine or control one's urine flow.
Urinary retention - The inability to void (urinate) to discharge urine.
Urethritis - Inflammation of the urinary bladder.
Resources
BOOKS
Nettina, Sandra M. Lippincott Manual of Nursing Practice. 7th edition. Philadelphia: Lippincott, 2001, pp.692-697.
PERIODICALS
Colley, Wendy. RGN, DNCret. FETC. "Know How." Nursing Times (July 2, 1997).
Cravens, David D., Steven Zweig. "Urinary Catheter Management." American Family Physicians 61, no. 2 (January 15, 2000): 369.
Sanyay Saint, Joann G. Elmore, Sean D. Sullivan, Scott S. Emerson, Thomas D. Koepsell, "The efficacy of silver alloy-coated urinary catheters in preventing urinary tract infection: a meta-analysis." American Journal of Medicine 105, no. 3 (September 1998): 236.
Aliene S. Linwood, B.S.N., RN, D.P.A., FACHE
"Catheterization, Female." Encyclopedia of Nursing & Allied Health. Ed. Kristine Krapp. Gale Cengage, 2002. eNotes.com. 2006. 3 Aug, 2010
For More Information
If you'd like to speak with our Catheter Specialist to help you determine the right catheter option for you or a family member, please call us at 1-866-418-9002.