🩺 Female Urinary Catheterisation

Female urinary catheterisation involves the insertion of a sterile drainage tube into the bladder via the urethra. It is a common procedural skill required to manage urinary retention and monitor fluid balance. The procedure requires strict adherence to aseptic non-touch technique (ANTT) and sensitive patient communication, including the presence of a chaperone. Proficiency involves navigating the female anatomy to ensure the catheter is correctly placed in the bladder rather than the vagina.

Acute or chronic urinary retention where non-invasive methods have failed or are inappropriate. Accurate monitoring of urinary output in critically ill patients, such as those with sepsis or during major surgical procedures. To facilitate bladder irrigation in cases of gross haematuria with clot retention. It may also be used for the administration of intravesical medications or to assist in healing perineal wounds in incontinent patients.

Suspected traumatic urethral injury, often indicated by blood at the meatus or a high-riding prostate (though more relevant in males, pelvic fractures in females can also involve urethral tears). Acute prostatitis is a relative contraindication in general catheterisation, but for females, current labial or urethral infections may require careful consideration. Known urethral strictures or recent reconstructive surgery of the external genitalia/urethra should prompt specialist urological input rather than a ward-based attempt.

Sterile catheterisation pack (containing gallipots, gauze, and drape), sterile gloves, 0.9% sodium chloride for cleaning, 2% lidocaine lubricant gel syringe, a sterile Foley catheter (typically 12-14 Ch for females), a pre-filled 10ml syringe of sterile water for balloon inflation, a sterile drainage bag, and clinical waste disposal facilities. Ensure a light source is available for adequate visualisation of the anatomy.

Introduce yourself, confirm patient identity, explain the procedure, and obtain informed consent with a chaperone present. Prepare a sterile field using ANTT and layout equipment; donning sterile gloves. Clean the peri-urethral area with 0.9% saline using a single downward stroke for each gauze swab. Part the labia with the non-dominant hand and introduce lidocaine gel into the urethra, allowing time for anaesthesia. Insert the catheter gently into the meatus until urine flows, then advance a further 2-3cm to ensure the balloon is in the bladder. Inflate the balloon with the manufacturer-recommended volume of sterile water (usually 10ml) and gently withdraw until resistance is felt. Attach the drainage bag and secure the catheter to the patient's thigh to prevent traction.

Successful catheterisation is confirmed by the immediate flow of urine into the tubing upon entering the bladder. The appearance of the urine should be noted; cloudy urine may suggest infection, while 'frank' haematuria suggests trauma or pathology. The residual volume should be recorded immediately if the procedure was for retention, noting that 'post-obstructive diuresis' may occur if a very large volume is drained rapidly. Persistent pain or lack of urine flow despite correct depth suggests malpositioning or a blocked catheter.

Failure to identify the urethral meatus is common, often leading to accidental vaginal insertion; if this occurs, leave the catheter in the vagina as a landmark and use a new kit. Over-inflating the balloon while it is still in the urethra rather than the bladder causes significant pain and trauma (haematuria). Forgetting to clean the labia in a 'front-to-back' motion increases the risk of introducing enteric bacteria into the urinary tract. Insufficient lubrication or lack of 'dwell time' for the anaesthetic gel can lead to unnecessary patient discomfort during insertion.

Always ask for a chaperone before starting the procedure, as this is an intimate examination. Position the patient in the supine 'frog-leg' position to best visualise the meatus. If you cannot see the meatus, ask the patient to cough, as this often causes the meatus to wink or move slightly. Ensure you state that you would wait at least 3-5 minutes for the lidocaine gel to work before inserting the catheter. Always retract the labia firmly with your non-dominant hand and do not let go until the catheter is inserted to maintain sterility.

Aligned with MLA 'Clinical Skills' (Procedural): Urinary catheterisation. Knowledge of the anatomy of the female pelvis and the importance of aseptic non-touch technique (ANTT) is essential. Students must be aware of the 'CAUTI' (Catheter-Associated Urinary Tract Infection) prevention bundles used in NHS trusts. Recognition of the short length of the female urethra compared to the male is vital for safe balloon inflation.