How is a catheter inserted in a female

Urinary catheterisation is the process of collecting and draining urine by inserting a thin tube into the bladder through the urethra. The tube is called a urinary catheter, through which urine can flow into an attached drainage bag. Depending on the type of catheter used and the reason for using it, the catheter may remain temporarily or permanently in the patient.

In most cases, a urinary catheter is used in people who are unable to pass urine naturally because of an illness or injury. Common medical conditions requiring for urinary catheterisation include: 

• Urinary incontinence: difficulty controlling when to urinate or leakage of urine, caused by bladder weakness or a medical condition, including multiple sclerosis or an injury in the spinal cord. To learn more about urinary incontinence, causes and treatment, check out our dedicated article here. 
• Urinary retention: difficulty emptying the bladder when urinating. This can happen as a result of another medical condition such as benign prostatic hyperplasia (BPH), prostatitis (inflammation of the prostate gland), a kidney stone obstructing the urinary tract, damage to the nerve after a stroke, or a complication from diabetes called diabetic peripheral neuropathy. Some medications can also cause the side effects of urinary retention.
• Before or after a surgery, most often surgery of the prostate or genitals.

In some instances, urinary catheters are used when conducting diagnostic tests.

There are three primary types of urinary catheters: indwelling, external, and intermittent catheters. A doctor or nurse would assess and recommend the type of urinary catheter, as well as the size, based on the patient’s medical condition, weight, age, and gender. 

1. Indwelling catheter, commonly referred to as Foley catheter – this type of catheter remains in place for an extended period that could range from days to up to 12 weeks. It is held in place with a water-filled balloon inside the patient’s bladder. Foley catheter is typically inserted through the urethra. In some cases, it is inserted through a hole in the abdomen, and referred to as a suprapubic catheter.
2. Intermittent catheter, also called short term catheter, or in and out catheter – it is used temporarily to empty the bladder once, then removed. Intermittent catheterisation needs to be done several times a day, at a designated interval or when there is a need to pass urine. Traditional intermittent catheters can be washed and reused. Disposable intermittent catheters are designed for one time use and discarded.
3. External catheter – this type of catheter is often used for male patients with urinary incontinence rather than urinary retention.

Types of urinary catheter

Urinary catheterisation process differs for different types of catheters. Indwelling or Foley catheters are usually inserted by healthcare professionals, such as nurses in clinics and hospitals. Daily care can be done at home by caregivers. Patients who use urinary catheters permanently will also need professional help to remove and replace catheters at least once every 2 months. 

Intermittent urinary catheterisation however can be done at home by a caregiver or self-administered by the patient. As complex as it sounds, most patients and caregivers report being able to carry out intermittent catheterisation with ease and without discomfort after a few times. 

Below is a general description of the catheterisation process.

For an indwelling or Foley catheter, the healthcare professional typically will:

1. Perform hand hygiene
2. If possible, place the patient on their back with knees bent and hips flexed.
3. Use sterile gloves and other sterile materials to expose the urethra and insert the lubricated catheter into the urethral opening until urine begins to flow.
4. Inject sterile water to inflate the catheter inside the bladder.
5. Attach the other end of the catheter tube to a drainage bag.

For intermittent catheterisation, a nurse often instructs the caregiver or the patient to carry out the process. If the patients are able to administer the catheter themselves, the procedure is known as self-catheterisation or clean intermittent catheterisation. 

1. Hand hygiene: Wash hands thoroughly before the procedure and do not touch anything but the catheter. You can use clean gloves.
2. Positioning: Have the patient lie on their back with knees bent and hips flexed, or get in a comfortable sitting or standing position and use a mirror to guide yourself for self-catheterisation. Special mirrors that can be attached to the leg are available for this purpose, allowing patients to conduct self-catheterisation without having to hold on to the mirror. 
3. Insertion: Apply firm but gentle pressure to insert the lubricated end of the catheter into the urethra. Then carefully guide the catheter up into the urethra until it gets to the bladder and urine begins to flow out.
4. Urine collection and removal: Insert another two inches and allow the urine to flow out into a collection container then carefully and slowly remove the catheter. 

Urinary catheter care at home

Using long-term urinary catheters increases risks of UTIs as well as other possible complications. In order to avoid these, caregivers need to perform daily catheter care strictly as instructed and with caution. An essential part of the routine is practicing good hygiene. Caregivers, and patients themselves in the case of self-catheterisation, should always wash hands with soap and water before and after the procedure. Below are important nursing care tips when performing urinary catheter care at home.

4.1. Cleaning the genitals

The genital areas should first be cleansed with mild soap and water. For men, retract the foreskin of the penis and clean away from the tip of the penis. For women, separate the labia and always clean from front to back. Remember to dry genitals gently using aseptic cloths.

4.2. Cleaning the catheter

While cleaning the catheter, hold it firmly at the point it enters the urethra so that it will not get pulled out. Start cleaning the catheter from the same point and move down the tube in the direction that is away from the body. Rinse the catheter with soap and water and dry it with a separate cloth. The catheter is attached to the body using either tape or cath-secure. Replace with new adhesive tape or cath-secure once the old one is removed.

4.3. Changing drainage bag

A drainage bag is used to collect the urine. It is an extension of the catheter which can be removed and replaced by the caregiver. When changing the drainage bag, place an aseptic cloth or gauze piece under the connection point of the catheter. Tightly press on the catheter with your fingers and slowly disconnect the drainage bag.

Clean the tip of the catheter and connector with separate alcohol pads. Connect the new bag to the catheter and then release your fingers. Dispose the used drainage bag. Make sure that there are no kinks or twists in the catheter and drainage bag.

4.4. Other precautions for care of catheter

• Always wash your hands before and after caring for the patient and catheter
• Make sure that there are no blockages or leakages in the tube
• Keep the drainage bag below the bladder level without touching the floor
• Maintain genital hygiene for the patient
• Patient should be kept well hydrated
• Keep a record of water intake and urine output so urine can be drained as frequently as needed

Precautions for care of catheter

5. Common problems and complications when using urinary catheter

Complications can arise from catheter use, especially with long term use. These include:

• Urinary tract infections (UTI), which can cause the person to experience pain or burning sensation while having frequent urination, blood in the urine, cramping in the groin, and the constant urge to urinate although the bladder is empty. Learn how to spot the signs and symptoms of UTI in our article here.
• Allergic reactions to latex may cause rash and swelling. The patient may need to change to a catheter with a different coating or insertion method.  
• Urine leakage around the catheter, which indicates that the catheter needs to be checked by a professional
• Blood in the urine, which may be caused by injury to the urethra. Medical attention should be sought immediately.
• Blood infection caused by untreated UTI, typically accompanied by high fever, chills, weakness, sweating.

Patients and/or caregivers should inform a healthcare professional as soon as they notice any of the above problems for intervention.

6. When to call for medical help

Below is a quick summary of situations when immediate medical help is recommended. Keep these handy if you are caring for a loved one with a urinary catheter, so problems can be tended to and addressed quickly. 

• When the catheter comes out
• When you notice blood, or any blood clots in urine
• When patient complains of abdominal pain
• When urine smells bad or changes colour
• When there is a reduction of urine output
• When there is a rise in patient’s body temperature (>37.5°C)
• When you notice redness or swelling in patient’s genital area
• When there is a large amount of urine leakage

Ninkatec provides quality home care solutions for a variety of conditions, such as dementia, cancer, stroke recovery, transitional care after surgery and long-term elderly care. From monitoring patients remotely to visiting them at home, we offer different home care plans based on your needs. With a team of medical experts and experienced nurses, you can trust us with the well-being of your loved ones. Check out Ninkatec’s Nursing Care services for details of the nursing procedures we carry out for patients in the comfort of their homes including changing and insertion of catheter.

*The above guide is provided for informational purposes only, and does not substitute for professional medical instructions. Patients and caregivers are recommended to seek and follow guidance from their healthcare professionals for their personal case. 

Is female catheter insertion painful?

Where is a catheter placed in a female?