Urinary Catheterization for Females

Things required:

• Septanol and tissue (to clean the trolley)
• IMR/ doctor's orders
• Sterile gloves 
• Apron
• Catheterization kit
• 2-way urinary catheter (usually French 10/12)
• KY jelly/ aqua jelly
• Urine bag
• Chlorhexidine solution
• Syringe
• H₂O for injection
• Blue sheet/ incontinence sheet
• Micropore and scissors
• Torchlight (if there is someone there to help you and where applicable)

Always check the items for expiry date and clarity (where applicable).

1. Verify order and patient's need for this procedure. Perform hand rub.

2. Clean trolley. Wear apron.

3. Approach and identify patient with 2 patient identifiers: patient’s name and IC again by asking patient and verifying it with his wrist tag. (Catheterization is usually ordered when patient is unable to void and there is a large volume of residual urine in the patient). Perform perineal care if needed.

4. Prepare the environment like switching on the lights, switching off the fans, screening the curtains and ensuring the correct working height. Stand on the patient's right side if you are right-handed.

5. Perform hand rub. Open the sterile urinary catheterization pack without touching anything inside. Arrange the items inside by maneuvering them from the outside of the catheterization pack.

6. Open items 6-11 into the catheterization pack. Remember to throw the first "non-sterile" part of the KY jelly and chlorhexidine solution away.

7. Assist patient to lie in the dorsal position with slightly-abducted legs, bent at the knees. Assist to remove patient's pants fully before covering them with a blanket. Place a blue sheet underneath the patient.

8. Perform surgical handwash. Dry with the tissue paper provided in the catheterization pack, picking it up by taking only its corner.

9. Don sterile gloves.

10. Test the catheter by filling its balloon up with the stated amount of water and observe for any leakage. Lubricate 3-5cm of the catheter tip with the KY jelly.

11. Close the urine bag drainage port.

12. Soak all cotton balls with chlorhexidine and squeeze out excess water, either with sterile gloves or using forceps.

13. Ask patient to remove the blanket and drape the perineum area to create a sterile field, exposing only the genitalia.

14. Take the plastic bag out and place it on the drape.

15. Place the two catheter trays on the sterile drape between the patient's legs. (The smaller tray should contain the cotton balls and a forceps while the other larger tray should contain the catheter and another forceps.)

16. With your dominant hand, use a forceps and the cotton balls to cleanse the genitalia in the following order: the labia majora, labia minora and lastly the urinary meatus. Use only one cotton ball at a time and one swipe per cotton ball. Use your non-dominant hand to separate the labia minora and expose the urethra until after insertion. Throw the forceps and the used cotton balls away.

17. Insert the urinary catheter into the urethra with another sterile forceps until urine first flows out of the catheter. Further advance the catheter around 2cm more and collect all the residual urine in the larger catheter tray by gently squeezing/ pushing down on the perineal area. The amount of residual urine should approximate the amount of residual urine shown by a bladder scan (which by right, would have been performed at least twice, depending on hospital policy, before catheterzation is ordered.)

18. Inflate the balloon with the recommended amount of water (the amount would be stated on the catheter packaging.) Gently tug the catheter to assure that it would not be displaced/ to ensure placement. When there is resistance (ie. the catheter can no longer be tugged out), push the catheter in by about 2cm.

19. Attach the urinary bag to the catheter and after tearing the drape, tape the catheter to the patient's thighs.

20. Place the urinary bag below the level of the patient's bladder to ensure there is no backflow of urine, without it touching the floor. Label "date changed" and "IDC-indwelling cathether" on the urinary bag.

21. Explain to patient that the procedure has been completed and ask if patient has any questions for you. Ensure patient’s safety and comfort levels and that the call bell is within reach before leaving the patient.

22. Discard gloves and soiled requisites. Clean the trolley and wash hands.

23. Record the procedure in the relevant documents like the nursing notes and I/O-intake/output chart (COCA-colour, odour, consistency and amount of urine). Report any abnormalities like heavily blood stained urine or other abnormal discharges present in the urine.

24. Empty the urinary bag and measure the urine at least once during every shift or when full and record COCA in the I/O chart as per order.

Note: Observe the patient throughout the whole procedure. Ask patient to take in deep breaths and relax while you insert the catheter.If patient seems uncomfortable or in pain, stop for a while to allow patient to collect and prepare herself.

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