A urinary catheter is a flexible, hollow tube inserted into the bladder through the urethra to drain urine. This procedure is performed when a person cannot empty their bladder normally, such as during surgery, to manage urinary retention, or for monitoring fluid output. The insertion process requires strict adherence to aseptic technique to prevent the introduction of bacteria into the bladder. This guide outlines the proper method for inserting a female catheter and should only be performed under the guidance of a medical professional.
Essential Preparation Steps and Required Supplies
Preparation begins with assembling the necessary equipment, usually found pre-packaged in a sterile catheterization kit. The catheter size is typically 10 to 14 French (Fr) for adult females, along with a sterile drainage system if an indwelling catheter is used.
The environment must be clean, private, and well-lit for proper visualization of the anatomy. The patient should be positioned in the dorsal recumbent position, lying on their back with knees bent and hips flexed, which helps expose the perineal area.
Hand hygiene is performed before opening the sterile kit, and a sterile field is established on a clean surface near the patient.
The standard supplies include:
- Sterile gloves
- An antiseptic cleansing solution like povidone-iodine or chlorhexidine
- Sterile water-soluble lubricating jelly
- Cotton balls or pre-moistened swabs
Detailed Catheter Insertion Technique
After preparing the sterile field, thoroughly cleanse the perineal area using the antiseptic solution. Use the non-dominant hand to gently separate the labia minora to expose the urethral meatus; this hand is now contaminated and must remain in place throughout the cleansing and insertion.
Using the dominant, sterile hand, clean the area with swabs, moving from front (clitoris) to back (rectum). First, clean the labia fold farthest away, then the fold closest, and finally, clean directly down the center over the meatus.
The catheter tip is lubricated with sterile jelly to minimize friction and patient discomfort. The lubricated catheter is gently advanced into the meatus until urine flow is observed, confirming placement in the bladder. Once urine drains, advance the catheter a few more inches (2 to 4 centimeters) for indwelling catheters. This extra advancement ensures the retention balloon, when inflated, is fully within the bladder and avoids accidental inflation in the urethra, which could cause trauma.
Securing the Catheter and Post-Procedure Care
For an indwelling catheter, inflate the retention balloon using sterile water or saline from the pre-filled syringe attached to the inflation port. The injected volume (usually 5 to 10 milliliters) should match the capacity marked on the catheter.
After inflation, gently pull the catheter back until slight resistance is felt, confirming the balloon rests against the bladder neck. The catheter tube must then be secured to the patient’s inner thigh using a securement device or medical tape to prevent tension or kinking. This prevents urethral or bladder neck trauma from accidental pulling.
The drainage bag must always be positioned below the level of the bladder to ensure continuous, gravity-assisted urine flow and prevent backflow, which can introduce infection. Post-procedure care includes ensuring comfort and observing for signs of discomfort or leakage.
Recognizing and Addressing Common Insertion Difficulties
A common challenge during female catheterization is accurately locating the urethral meatus, which is small and situated just above the vaginal opening. If visualization is difficult, use a good light source and careful separation of the labia minora to fully expose the area.
If the catheter encounters resistance, never force it, as this risks creating a false passage or damaging the urethral lining. A brief pause, slight rotation of the catheter, or asking the patient to cough may help relax the urethral sphincter and allow for gentle advancement.
A frequent mistake is accidentally inserting the catheter into the vagina. This catheter is contaminated. Leave the misplaced catheter in the vagina to act as a landmark guide, and use a completely new, sterile catheter for insertion into the urethra. If the patient experiences sudden, severe pain, stop the procedure immediately and withdraw the catheter.