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Clinical Procedures > Genitourinary Procedures
Urethral Catheterization, Women
Article Last Updated: Jul 23, 2008
AUTHOR AND EDITOR INFORMATION
Section 1 of 13  
Author: Gil Z Shlamovitz, MD, Assistant Professor of Emergency Medicine, University of Connecticut School of Medicine; Attending Physician, Emergency Department, Windham Community Memorial Hospital, Willimantic, CT; Attending Physician, Emergency Department, Hartford Hospital, Hartford, CT
Gil Z Shlamovitz is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians
Editors: Andrew K Chang, MD, Associate Professor, Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center; Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc; Luis M Lovato, MD, Assistant Clinical Professor, David Geffen School of Medicine at UCLA; Director of Critical Care, Department of Emergency Medicine, Olive View/UCLA Medical Center; Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School; Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Author and Editor Disclosure
Synonyms and related keywords:
catheterization woman, female catheterization, Foley, foley, urethral catheter, urinary catheter, urethral catheterization, catheter placement, catheter insertion, foley catheter, urine specimen, urine output, urinary tract, urethral tear
Urethral catheterization is a routine medical procedure that facilitates direct drainage of the urinary bladder.1 It may be used for diagnostic purposes (to help determine the etiology of various genitourinary conditions) or therapeutically (to relieve urinary retention, instill medication, or provide irrigation). Catheters may be inserted as an in-and-out procedure for immediate drainage, left in with a self-retaining device for short-term drainage as during surgery, or left indwelling for long-term drainage for patients with chronic urinary retention.
Patients of all ages may require urethral catheterization, but patients who are elderly or chronically ill are more likely to require indwelling catheters, which carry their own independent risks. The basic principles underlying urethral catheterization are gender-neutral, but the specific aspects important in the technique of female catheterization are described in this article.
For a procedural description for male patients, see Urethral Catheterization, Men.
For more information on urinary retention, see the Medscape CME activity Management of Urinary Retention Reviewed.
- Diagnostic
- Collection of uncontaminated urine specimen
- Monitoring of urine output
- Imaging of the urinary tract
- Therapeutic
- Commercial single-use urethral catheterization tray
Commercial urinary catheterization kit. - Povidone-iodine solution (eg, Betadine)
- Sterile cotton balls
- Water-soluble lubrication gel
- Sterile drapes
- Sterile gloves
- Urethral catheter
- Prefilled saline syringe, 10 mL
- Urinometer connected to a collection bag
- Sterile anesthetic lubricant (eg, lidocaine gel 2%) with a blunt-tipped urethral applicator or a plastic syringe (5-10 mL)
- Catheter types and sizes
- Adults - Foley catheter (16-18F)
- Children - Foley catheter (5-12F)
- Infants younger than 6 months - Feeding tube (5F) with tape
- Supine, in the frog leg position, with knees flexed
- Explain the procedure, benefits, risks, complications, and alternatives to the patient or the patient's representative.
- Position the patient supine, in bed, and uncover the genitalia.
- Open the catheter tray and place it on the gurney in between the patient's legs; use the sterile package as an extended sterile field. Open the iodine/chlorhexidine preparatory solution and pour it onto the sterile cotton balls. Open a sterile lidocaine 2% lubricant with applicator or a 10-mL syringe and sterile 2% lidocaine gel and place them on the sterile field.
Preparatory solution in a commercial urinary catheterization kit. - Wear sterile gloves and use the nondominant hand to separate the labia with the thumb and index finger. This hand is now nonsterile and is used to expose the vulva throughout the procedure.
- Use the sterile hand and sterile forceps to apply preparatory solution to the urethra and the surrounding vulva in circular motions with at least 3 different cotton balls. Without moving the nondominant hand, apply the sterile drapes that are provided with the urinary catheterization tray to create a sterile field around the vulva.
- The use of a urethral anesthetic is controversial.4 The decision to anesthetize the urethra should be made in conjunction with the patient. To anesthetize the urethra, use the commercial applicator or a syringe with no needle to instill 5 mL of lidocaine gel 2% into the urethra. Place a finger on the meatus to help prevent spillage of the anesthetic lubricant. Allow 2-3 minutes for the anesthetic to take effect before proceeding with the urethral catheterization.
- Hold the catheter with the sterile hand or leave it in the sterile field to remove the cover. Apply a generous amount of a nonanesthetic lubricant or the remaining lidocaine gel.
- Slowly and gently introduce the catheter into the urethra. Continue to advance the catheter either several centimeters beyond where urine is first obtained or until the proximal Y-shaped ports are at the meatus.
- Wait for urine to drain from the larger port to ensure that the distal end of the catheter is in the bladder. The lubricant jelly–filled distal catheter openings may delay urine return. If no spontaneous return of urine occurs, try attaching a 60-mL syringe to aspirate urine. If urine return is still not visible, withdraw the catheter and reattempt the procedure. Ultrasonography may be used at this point to verify the presence of urine in the bladder.
- After visualization of urine return, inflate the distal balloon by injecting 5-10 mL of 0.9% NaCl (normal saline) through the cuff inflation port. Inflation of the balloon inside the urethra will result in severe pain, gross hematuria, and, possibly, urethral tear.
- Gently withdraw the catheter from the urethra until resistance is met. Secure the catheter to the patient's thigh with a wide tape. Creating a gutter with tape to elevate the catheter from the thigh may increase the patient's comfort.
- Use a larger size catheter when the indication for placement is continuous bladder irrigation due to hematuria and clots. A 3-way catheter (with an additional port) is often used in conjunction with a large-volume reservoir to create a "Murphy drip" for continuous irrigation.
- Ultrasonography may be used to verify the presence of the catheter inside the bladder if urine is not returned upon placement.
- Prophylactic antibiotics are recommended for patients with a prosthetic heart valve or an artificial urethral sphincter.
- Suspected bladder injury is not a contraindication to placement of a urethral catheter. A urethral catheter allows drainage of urine from an injured urinary bladder and provides a route for contrast administration during cystoscopy. Extraperitoneal urinary bladder injuries are usually treated conservatively with an indwelling catheter, while intraperitoneal urinary bladder injuries usually require operative repair.
- Lidocaine gel and other viscous water-based lubricants facilitate the insertion of urethral catheters. Lidocaine gel has an added benefit of providing urethral anesthesia.5, 6 The tip of the gel applicator should be inserted into the meatus and the gel pushed into the urethra prior to Foley insertion when topical anesthesia is being used.
- Inflation of the Foley catheter's balloon should be aborted if the patient reports any pain as a result of the inflation, as such an inflation is likely taking place in the urethra and not the bladder. Inflation of the balloon inside the urethra results in severe pain, gross hematuria, and, possibly, urethral tear.
The authors and editors of eMedicine gratefully acknowledge the assistance of Lars Grimm with the literature review and referencing for this article.
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Preparatory solution in a commercial urinary catheterization kit. |
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- Ortega R, Ng L, Sekhar P, Song M. Videos in clinical medicine. Female urethral catheterization. N Engl J Med. Apr 3 2008;358(14):e15. [Medline].
- Selius BA, Subedi R. Urinary retention in adults: diagnosis and initial management. Am Fam Physician. Mar 1 2008;77(5):643-50. [Medline].
- Newman DK. The indwelling urinary catheter: principles for best practice. J Wound Ostomy Continence Nurs. Nov-Dec 2007;34(6):655-61; quiz 662-3. [Medline].
- Tanabe P, Steinmann R, Anderson J, Johnson D, Metcalf S, Ring-Hurn E. Factors affecting pain scores during female urethral catheterization. Acad Emerg Med. Jun 2004;11(6):699-702. [Medline].
- Doherty W. Instillagel: an anaesthetic antiseptic gel for use in catheterization. Br J Nurs. Jan 28-Feb 10 1999;8(2):109-12. [Medline].
- Gerard LL, Cooper CS, Duethman KS, Gordley BM, Kleiber CM. Effectiveness of lidocaine lubricant for discomfort during pediatric urethral catheterization. J Urol. Aug 2003;170(2 Pt 1):564-7. [Medline].
- Kunin CM. Urinary-catheter-associated infections in the elderly. Int J Antimicrob Agents. Aug 2006;28 Suppl 1:S78-81. [Medline].
- Hart S. Urinary catheterisation. Nurs Stand. Mar 12-18 2008;22(27):44-8. [Medline].
- Reichman E, Simon RR, eds. Emergency Medicine Procedures. Columbus, OH: McGraw-Hill Medical Publishing; 2004.
Urethral Catheterization, Women excerpt Article Last Updated: Jul 23, 2008
Topic originally published: Oct 30, 2007
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