Female catheterisation occasionally shows up as an OSCE station. It’s often feared because of the relatively large number of steps and pieces of equipment involved. That’s why it’s more important than ever to practice this station until you can do it in your sleep (although your room mates probably wouldn’t thank you for this). There’s often a significant number of marks available for communication skills when explaining the procedure to the patient, gaining consent and maintaining dignity, so don’t overlook the importance of these aspects of the station.
Gather Equipment
Male catheter - 12/14 french – male catheters are used for both male & females to avoid confusion
Catheter bag
Catheter pack:
- Small pot
- Cotton wool balls
- Sterile drapes
- Sterile gloves
- Sterile gauze
- Kidney dish or absorbent pad
- Tweezers
Saline (0.9%) - 10mls
Water filled syringe - 10mls – for inflation of catheter balloon
Lidocaine gel (1%) 5mls - for insertion into urethra for anaesthesia / lubrication
Trolley - to place your sterile field & other equipment onto
Apron
Introduction
Introduce yourself - state your name & role
Check patient details - name / DOB
Wash hands - using the appropriate 7 stage technique
Don Apron
Ensure a chaperone is present
Explain procedure:
“I need to insert a catheter to allow us to monitor your urine output“
“This will involve inserting a thin flexible tube into the bladder”
“The procedure will feel a little uncomfortable, but shouldn’t be painful”
“I’ll insert some local anaesthetic into the urethra to make the procedure as comfortable as possible”
“One of the nursing staff will be present and acting as a chaperone throughout the procedure”
Gain consent - “Do you understand everything I’ve said?” ”Are you happy to go ahead with the procedure?”
Setting up
1. Set up your sterile field:
- Lay out the sterile field across the trolley
- Empty the various pieces of equipment from their packaging onto the field aseptically
- Pour the 0.9% saline over the cotton balls located within the small plastic pot
2. Position the patient:
- Ensure the bed is at an appropriate height for you to comfortably carry out the procedure
- Expose the patients genatalia
- Position the patient supine with knees flexed & hips abducted with their heels together
- Place the kidney dish / absorbent pad between the patients thighs to reduce spillages onto the bed
3. Wash hands again & don sterile gloves
4. Make a hole in the centre of a sterile drape & place over the patients genatalia
5. Clean the genatalia:
- Hold the labia apart with the non-dominant hand
- Pick up the wet cotton balls with your tweezers & begin to clean the genatalia
- Clean in the front to back direction - using each cotton ball only once
6. Insert the anaesthetic gel:
- Warn the patient that the anaesthetic might initially sting, but will go numb quickly
- With your dominant hand place the nozzle of the syringe of anesthetic gel into the urethral meatus
- Empty the entire 5 mls of anaesthetic gel into the urethra - at a slow steady pace
- Give the gel a few minutes to take full effect
Inserting the catheter
The catheter should be on your sterile field in a plastic wrapper
1. Remove the tear-away portion of the wrapper near the catheter tip - don’t touch the catheter!
2. Hold the labia apart with your non-dominant hand
3. Insert the exposed catheter tip into the urethral meatus - warn the patient
4. Advance the catheter slowly but firmly - slowly removing the wrapper to expose more catheter
5. If there is significant resistance or the patient is in a lot of discomfort, you should remove the catheter & consider a repeat attempt or input from urology
6. As you enter the bladder you will see urine begin to drain from the catheter
7. You should continue to advance the catheter until it is fully inserted
8. Once fully inserted, inflate the catheter balloon with your 10ml syringe of water
- Ask the patient to let you know immediately if they feel any discomfort during this!
9. Once the balloon is fully inflated withdraw the catheter until resistance is felt
- This confirms the catheter is held firmly within the bladder
10. Attach the catheter bag tubing to the end of the catheter, ensuring a tight seal
11. Hang the catheter bag on the side of the bed, below the level of the patient
12. Clean up the patient & dispose of your equipment
13. Allow the patient to get dressed
To complete the procedure…
Thank patient
Wash hands
Fill out a fluid balance form and inform nursing staff of the need to monitor urine output
Document the procedure, making sure to include:
- Your details - name / grade / GMC number
- Date / time
- Consent gained
- Chaperone present
- Reason for catheterisation
- Aseptic non-touch technique used
- Volume of water inserted into balloon - e.g. 10mls
- Size of catheter
- Any complications during the procedure
- Residual volume of urine drained
- Appearance of urine - golden / haematuria / etc
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