CATHETERIZING THE FEMALE PATIENT
Supplies:
Sterile
4X4 gauze Soap
Bath
Blanket Tape or cath holder
Basin
with warm water Extra light
1. Check physician’s order for
type and size of catheter.
2. Assess patient’s knowledge
of catheterization and use of a catheter.
3. Assess whether patient is
allergic to iodine or tape.
4. Assess female patient’s
ability to assume the dorsal recumbent position.
5. Check the patient’s
identiband, gather equipment, and prepare the working space by raising the bed
to proper height and positioning the over-bed table for use.
6. Close the door and/or
privacy curtains.
7. Explain the procedure.
8. Wash your hands and don
gloves
9. Assist to assume the dorsal
recumbent position and drape with a bath blanket or sheet
10. Open the plastic covering of
the catheter kit by tearing along the lined perforated edge. Use the plastic cover as a discard bag and
place it to the side of the field or toward the foot of the bed for a waste
disposal.
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11. Remove the paper-wrapped
catheter tray and place it on the bed between the patient’s legs, near the
perineum (8-12 inches away).
12. Fold back the corner of the
bath blanket drape to expose the perineum.
With clean hands, using sterile technique (opening away from you), open
the wrapper and use it as a sterile field.
13. Pick up the sterile
absorbent underpad by one corner, and while holding two corners turned under,
slip it under the patient’s buttocks plastic side down while asking her to lift
the buttocks. Touch only the corners and
underside of the pad. OR sterile glove first and wrap underpad around gloves to
place under patient.
14. Put on the sterile gloves
and separate the two containers in the kit, placing the tray with the cotton
balls in front of the box containing the catheter and drainage bag.
15. Place the drape with the
opening over the genital area, exposing the labia. Continue reassuring the
patient.
16. Attach the sterile
water-filled syringe to the balloon port on the catheter gently insert the
water to test the patency of the balloon.
17. After the test, draw the
water back into the syringe leaving the syringe attached to the catheter
balloon port.
18. Remove the plastic sleeve on
the catheter by tearing it down the perforated side while carefully controlling
the catheter. Place the catheter within
the sterile tray where it can be easily reached.
*Remember when discarding trash to go around sterile field and “drop” into receptacle. Always stay at least 6” from anything nonsterile!!
19. Loosen the cotton balls one
from another, open the antiseptic solution pack, and drizzle antiseptic
solution evenly over the cotton balls.
Discard the empty package. Be
careful not to splatter the solution.
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20.Open the package of lubricant, or remove the stopper from
the syringe
containing it,
and squirt it into an open area of the tray.
21. Place the sterile specimen
bottle on the side of the tray or discard it.
22.With the forefinger and thumb of the nondominant hand,
separate the
labia minora,
exposing the meatus. Pull slightly upward.
Leave this hand
in place holding
the labia open until the catheter is inserted.
23.Using the forceps, pick
up one saturated cotton ball at a time and cleanse down the labia majora side
farthest from you first and then the other, discarding each used cotton ball
after one stroke. Cleanse the farthest
side of the labia minora first and then the other. Cleanse last over the meatus with a slow
downward stroke. Do not allow the labia
to close over the meatus after cleansing.
24.
Pick up the catheter about 3 inches from the tip, lubricate it well, and
gently insert it
into the meatus while pointing the catheter slightly toward
the umbilicus. Insert it about 2 to 3 inches or until you
visualize urine
flow. There may be slight resistance as the
catheter passes the internal
urethral
sphincter. If urine does not flow,
rotate the catheter gently and
carefully insert
it another inch farther. Do not use
force. If resistance is
encountered, ask
the patient to take a deep breath, and twist and advance
the catheter as
the patient does so; this relaxes the sphincter. If the
catheter has
been inserted into the vagina by mistake, leave it there as a
marker for the
vaginal opening, rescrub, and begin the procedure again
with a sterile kit.
25. Hold the catheter in place
with the dominant hand. With nondominant hand let go and reach under dominant
hand to instill the water into the balloon.
Remove the syringe from the port (while holding the plunger all the way
down) after inflation and discard it.
Gently pull on the catheter to see if it is anchored securely, then gently push it into the bladder about ½ inch. Watch the patient’s face for an expression
of discomfort while inflating the balloon to be certain that the balloon is not
in the urethra. The balloon holds
the catheter in the bladder. If the
balloon sits at the neck of the bladder after inflation, it causes pressure and
greater urge to urinate.
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26. Cleanse the antiseptic
solution from the perineum and remove the under-drape.
27. Attach the drainage bag to
the stationary part of the bed frame along the side of the bed close to the
middle. Remove the drapes, dry the genital area, dispose of used supplies,
remove gloves and wash hands.
28. Attach the catheter to the
thigh of the female with tape or a catheter holder.
29. Coil the excess drainage
tubing on the bed so that the last portion hangs straight to the drainage bag
and secure it.
30. Restore the unit, lower the
bed, raise the rails if needed, and place the call light within reach.
31. Ask yourself if sterile
technique was maintained. Is urine draining indicating proper placement in the
bladder? Is the patient without pain
from the procedure? Is there anything
you would do differently next time?
32. Note date, time, size and
type of catheter, amount of water instilled into balloon, type of technique
used, color and characteristics of the urine.
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