A urinary catheter is a thin, flexible tube designed to be temporarily inserted into the bladder through the urethra to drain urine when natural voiding is not possible or incomplete. This procedure, often referred to as intermittent self-catheterization (ISC) when performed by the patient, is a common medical intervention for managing various conditions, including neurogenic bladder or urinary retention. Catheter insertion is a sterile medical procedure that should only be performed after receiving comprehensive, hands-on instruction from a qualified healthcare professional, such as a nurse or doctor. This information serves only as general guidance to support the initial training provided by your medical team.
Necessary Supplies and Hygiene
Performing self-catheterization safely requires meticulous attention to cleanliness and organization to minimize the risk of introducing bacteria into the urinary tract. The necessary supplies typically include the prescribed catheter (which may be a simple straight catheter or a pre-lubricated hydrophilic type), a water-soluble lubricant if the catheter is not pre-lubricated, and a container or toilet to collect the urine. You will also need antiseptic wipes or mild soap and water for cleansing, as well as a clean, private space to perform the procedure.
The process must begin with thorough handwashing using soap and running water, scrubbing for at least 20 seconds, and drying with a clean towel. After washing, arrange all supplies on a clean surface, like a paper towel, to ensure everything is within easy reach before you begin the sterile part of the procedure. Proper patient positioning is also important for visibility and comfort; many find it easiest to sit on the toilet with hips forward, sit in a chair with one leg raised, or lie down with knees bent and legs apart.
Maintaining a clean field is a continuous effort because the short length of the female urethra, typically around 4 centimeters, makes it easier for bacteria to reach the bladder. Careful preparation of the workspace and strict adherence to hand hygiene are the primary defenses against developing a catheter-associated urinary tract infection (CAUTI). Using sterile or clean gloves is optional, but many prefer them to maintain cleanliness.
Step-by-Step Insertion Technique
The initial step involves locating the correct anatomical structures. The urethral opening (meatus) is situated between the inner folds of tissue (labia minora), located below the clitoris and just above the vaginal opening. A small mirror may be helpful during the first few attempts to visually confirm the opening.
Use one hand to gently spread the labia to expose the urethral opening fully. Cleanse the area using the provided antiseptic wipe or a clean, soapy cloth, wiping from front to back to prevent contamination from the anal region. Keep the labia separated until the catheter is fully inserted to maintain visualization and prevent the catheter from touching surrounding skin.
If your catheter is not hydrophilic, apply a generous amount of water-soluble lubricant to the tip and the first two to three inches of the tube. Holding the catheter about an inch from the tip, gently insert the lubricated end into the urethral opening. Advance the catheter slowly and smoothly, without forcing it, until urine begins to flow, which usually happens after inserting it about two to three inches. If you encounter any resistance, try relaxing and taking a deep breath, but never push against a blockage, as this can cause injury.
After the initial flow, gently advance the catheter another half-inch to one inch to ensure the tip is securely positioned within the bladder. Hold the catheter firmly in place with one hand to prevent it from slipping out while the urine drains. If the catheter accidentally enters the vagina, leave it there as a landmark, and a new, clean catheter must be used for the correct insertion into the urethra.
Post-Insertion Management and Removal
After the catheter is successfully inserted, the bladder must be allowed to drain completely. Hold the catheter in place until the flow of urine slows to an infrequent drip or stops entirely. To encourage the final drops of urine to empty, you can gently change your position slightly or apply mild pressure to your lower abdomen.
Once drainage has ceased, the catheter can be slowly and smoothly withdrawn. Some people pinch the end of the catheter as it is being removed to prevent any residual urine inside the tube from dripping onto the surrounding area. After the catheter is fully removed, the perineal area should be wiped again with a clean wipe or tissue, always moving from front to back.
If a single-use, disposable catheter was used, discard it immediately. If the catheter is designed for reuse, clean it right away with warm, soapy water, rinse thoroughly, and allow it to air-dry on a clean surface. Store the dried catheter in a new, clean plastic bag or container. Consistent cleaning and proper storage minimize the bioburden on the catheter between uses.
Recognizing and Preventing Complications
The most frequent complication associated with catheter use is a urinary tract infection (UTI). Prevention relies on strict adherence to the hygiene and sterile technique protocols outlined for preparation and insertion. The short female urethra naturally places women at a higher risk for UTIs compared to men.
Signs that may indicate a UTI include:
- Fever.
- Pain or burning in the lower abdomen.
- Strong, foul odor from the urine.
- Cloudy urine or urine containing blood.
- Confusion, flank pain, or sudden chills.
Minor injury to the urethra can occur, typically presenting as slight bleeding during or immediately after insertion. Any inability to insert the catheter after several gentle attempts, or the presence of significant, persistent pain or heavy bleeding, requires immediate medical attention. If a blockage is suspected because the bladder feels full but no urine is draining, contact your healthcare provider without delay.