Female Urinary Catheter Insertion

Female catheter insertion is quite a simple procedure. There are however instances when the urinary meatus is difficult to be seen. Hence, it is important to insert the catheter straight into the meatus while making sure that the catheter tip is not contaminated. Whether you are going to insert an intermittent catheter or an indwelling catheter, the procedure is similar when it comes to insertion. A health care professional can easily perform this procedure, nonetheless, it is helpful if somebody is going to assist with the insertion procedure. If you are going to do the insertion alone, you must ensure that everything is opened and ready to use.

The catheter kit contains a sterile glove, KY jelly and povidone swabs. It will also contain a sterile towel with a hole to allow you to maintain a sterile area for the procedure.

In inserting urinary catheter on a female, you will need to perform the following steps:

1)      Ask her to lie flat on her back, bend her knees and pull it apart.

2)      Wear your gloves.

3)      Gently move her labia apart using your non-dominant hand.

4)      If you are unable to see her meatus, put your thumb for half an inch above the clitoris and gently press it in an upward or inward motion.

5)      Once you are able to view the meatus, cleans it with the povidone swabs. Each of these swabs should be used once. Wipe down the sides of the meatus and the middle.

6)      With your dominant hand, get the catheter and dip its tip onto the prepared KY jelly while your non-dominant hand is holding the patient’s labia apart.

7)      Gently insert the catheter tip onto the meatus.

8)      Try to advance the catheter until you see urine backflow.

If the catheter insertion is meant to collect a urine sample, the nurse will do so by placing the urine directly into a sterilized urine bottle. After which, the catheter will be immediately withdrawn. Nonetheless, if the procedure is done using a Foley catheter, expect that it will remain over a period of time, probably within a few days or so. The catheter will then be connected to a drain or collection bag then the nurse will inflate the bulb using sterile water to secure that it is in place.

FACTS on Catheter Associated Urinary Tract Infection (CAUTI)

Some important facts regarding Catheter Associated Urinary Tract Infection (CAUTI) include the following:

• Amongst the reported hospital acquired infections (HAIs), the most common is urinary tract infections (UTIs). An approximate of 80% of these UTIs is caused by CAUTI.
• CAUTI can cause infection on operative sites. It is linked to increased death and morbidity rates and is considered to be one of the major causes of bloodstream infections or septicemia.
• An approximate of 12 to 25% hospitalized patients are inserted with indwelling catheters, about half of these figure are inserted without appropriate reasons or indications.
• The risk for a catheterized individual to develop CAUTI increases for about 3 to 7% everyday while the indwelling catheter is left in place.
• Urinary drainage systems, including catheter use are sources of organisms that are antibiotic resistant. These organisms can cause infections that can be passed to other patients as well as on hospital staff.
• Recent and earlier studies demonstrate that patients who developed CAUTI will have a longer hospital stay. Their expenses also increase as much as $1,000 per case and even more if they develop any complication or if their CAUTI is caused by an antibiotic resistant organism.
• Studies reveal that an approximate of 40% physicians who are attending to patients with unnecessary indwelling catheters is unaware that they were still in.
• The Centers for Medicare and Medicaid Services (CMS) eliminated payment for CAUTI complications if an individual develops an infection while being hospitalized.

These facts only show that CAUTI can negatively impact the lives of individuals who develop it. More importantly it increases unnecessary cost for everybody – the healthcare providers as well as the patients.

Cystitis: Bladder Infection & Inflammation in Women

Cystitis is an infection of the bladder that is very common amongst women. The first line of treatment for cystitis includes the use of antibiotics. In some cases, this health condition improves without the need for antibacterial treatment. Additionally, it is immediately treated without significant complications.

What are the symptoms of cystitis?

Typical symptoms of cystitis in women include:

• Pain upon voiding
• Frequent passage of urine
• Pain on your lower tummy
• Fever
• Blood in your urine
• Smelly and cloudy urine

The bacteria on your anus cause most urine infections. These bacteria sometimes travel towards the direction of your urethra further going into your bladder. Other causes of cystitis include chemotherapy and certain chemicals.

Who are at risk of developing cystitis?

Women are eight times more likely to develop cystitis than men do. This is because the tube where the urine passes (urethra) is shorter and nearer to the anus in women as compared to men. Other risk factors include pregnancy, sexual engagement and diabetes mellitus.

How would I know that I am suffering from cystitis?

If you are suffering from any of the abovementioned symptoms, you can seek your doctor’s advice. Your doctor may ask you to collect a urine sample that will be sent to the laboratory. Urine analysis test will help in identifying the type of bacteria that is causing your infection.

Treatment for cystitis

Treatment for cystitis includes the following:

• Antibiotics – If you are already diagnosed with cystitis, your doctor will prescribe you with antibiotic medication to be taken for three to five days. However, if you have other health condition or if you are pregnant, your doctor may not prescribe you any medication. Oftentimes, your immune system can clear mild cystitis.
• Ibuprofen or Paracetamol – Paracetamol or ibuprofen can help in relieving the pain as well as lower your temperature if you have fever.

Your doctor may also advise you to drink lots of water to “flush out” the bacteria. Nonetheless, there is no evidence that it can help. Other treatment methods also include drinking cranberry juice or any alkalinizing products such as bicarbonate or potassium citrate.

If your symptoms worsen or if you develop fever and flank pain, you should immediately consult your doctor.

Cystitis is considered a mild illness. Majority of women who develop cystitis improve within the next few days even without undergoing antibiotic therapy. Nonetheless, if your symptoms do not improve despite using antibiotics, you may need to see your doctor and use other types of antibacterial agents. You should also visit your doctor if you are experiencing recurring cystitis.

Cystitis: Bladder Infection & Inflammation in Children

The prevalence of cystitis in children is still unknown. Healthcare providers however are continuously seeing and diagnosing this health condition on younger populations. There is limited information regarding cystitis in children, hence, most of the diagnostic and treatment methods are similar to that of what is being used on adults.

Symptoms of cystitis in children

Symptoms of cystitis in children are similar to that of adults. These symptoms include:

• Abdominal or pelvic pain
• Urinary frequency
• Urinary urgency
• Muscle pains
• Allergic reactions
• Gastrointestinal problems
• Pain in the vulva

Some children also experiences bedwetting, urinary incontinence and extraordinary urinary frequency

How is cystitis diagnosed in children?

Diagnosis of cystitis in children can be challenging. Hence, it is often made through ruling out other health conditions. Several specialist visitations may be needed before properly identifying bladder infection amongst the younger population. Diagnostic steps include the following:

• Health history taking
• Physical examination
• Urinalysis
• Urine culture
• Diagnostics to rule out other health conditions

Other tests that can help in diagnosing cystitis include bladder ultrasound, cystoscopy, hydrodistention, voiding and fluid intake diary, urodynamic testing, validated symptom questionnaires and therapeutic solution testing.

Cystitis treatment in children

The mainstay conservative treatment in children diagnosed with cystitis is dietary management. Other conservative treatment methods include relaxation techniques, yoga and pelvic floor physical therapies.

Intake of low dose standard adult oral medications is also used for treating this condition in children. The dosage is dependent on the discretion of the medical team attending your child. These medications include the following:

• Hydroxyzine
• Amitriptyline
• Pentosanpolysulfate
• Cimetidine
• Gabapentin
• Opioid analgesics

Another treatment method includes bladder instillation of DMSO and therapeutic solutions such as heparin, lidocaine and bicarbonate.

Challenges of cystitis in children

Cystitis can be debilitation to you and your child. Your child may need to miss school for frequent medical specialist visits. They may need extra room breaks because of frequent urination. Additionally, cystitis can be embarrassing which may make your child subject of ridicule and teasing.

What can you do?

Despite the fact that cystitis can be quite a challenge, you can do something for your child. Here is a list of things that you can do.

• Communicate with your child’s healthcare providers, school nurse, teachers, principal, gym teacher and other people who are directly in contact with your child.
• Reassure your child that cystitis is a treatable condition.
• Educate yourself about your child’s condition as well as its treatments.
• Learn about self-help strategies that may help in easing your child’s manifestations.

Catheter Insertion in Men

Urinary catheterization is a type of procedure primarily aimed to drain urine from the bladder or to collect a sample sterile urine. Health care professionals should insert some types of male urinary catheters; nonetheless, you can do catheter self-insertion in a sterile and safe environment. The instruction given below may help in serving as your guide for self-catheterization. We recommend however that you let your primary health care provider to demonstrate the insertion process before attempting to do it yourself. Additionally, you should bear in mind that there are different varieties of male catheters requiring different insertion techniques.

It is critical that you ensure sterility of your work area as well as your instruments during the whole procedure when attempting to perform self-insertion of a urinary catheter. Your bladder and urethra are sterile areas. Hence, not properly cleansing your genitals or using a contaminated catheter may introduce opportunistic bacteria that may cause urinary tract infections.

In initiating the male urinary catheterization procedure, use sterile gloves and follow the steps below.

1)      Retract the foreskin of the penis.

2)      Dilate the prepuce to expose the urethra.

3)      Cleanse the urethral with aseptic swabs.

4)      Anesthetic gel may be introduced onto the glans penis and urethra to decrease discomfort.

5)      Lubricate the catheter (about 8 inches).

6)      Straighten the urethra by grasping the penis, pulling it into an upward position.

7)      Insert the lubricated catheter into the penis whilst making sure that you are inserting it in a smooth, continuous motion.

8)      Advance the urinary catheter forward until you see urine backflow.

9)      Collect the urine specimen or drain the bladder into a container or drainage bag.

If you are inserting a male Foley or indwelling catheter, you should advance the tubing for 2 more inches after seeing urine backflow. This is to ensure that the balloon is in the bladder. You can now inflate the balloon using a sterile water to anchor the catheter in place. Connect the catheter in a drainage bag and attach or fasten it to the patient’s outer thigh. You should slightly curve the catheter tubing using a tape or hypoallergenic adhesive device.

Other types of male catheters are available. These include internal and external catheters as well as disposable and reusable ones. Internal catheters include those that can be retained in the bladder over a period of time to drain urine or those that are referred to as “in and out” catheters.

Caring for Your Suprapubic Catheter

A suprapubic catheter is a germ-free tube that drains urine out of your bladder. It is inserted through an opening on your abdomen (stoma) and into your bladder. Suprapubic means that the urinary catheter is inserted into your body above the pubic bone. Urinary catheters are used when you experience difficulties with your urination due to some health conditions.

What is a closed drainage system?

The drainage system is comprised of your sterile urine drainage bag and your suprapubic catheter that forms a pathway going from the catheter tip in your bladder towards your urine bag. This creates a closed drainage system where there are no disconnections or leaks. Normally, your urinary system is a is sterile and closed to prevent microbes from entering it.

Importance of taking care of your drainage bag and catheter

Infections from urinary catheters are very common which can lead to severe medical conditions and even death. Hence, it is critical that you take care of your urinary catheter and drainage bag. To prevent infections, you should:

• Drink at least 8 to 12 cups of liquids every day.
• Wash your hands before and after handling your catheter and drainage bag.
• Ensure that you perform proper care and cleaning on your catheter.
• Be knowledgeable on how long your catheter can stay in place.
• Keep your catheter drainage system closed all the time except when replacing it.
• Ensure that the catheter tubing is properly secured on your leg.
• Always perform proper hand hygiene.
• Position the drainage bag as well as the urine bag properly. Make sure that there are no loops or kinks on your tubing. Keep your urine bag below the waist level and off the floor.
• Empty your urine bag only as needed or at least every 3 to 6 hours or when it is half to 2/2 full.
• Clean and replace the urine bag as instructed by your doctor.

How to take care of my drainage bag

• Always perform proper hand hygiene.
• Position the drainage bag as well as the urine bag properly. Make sure that there are no loops or kinks on your tubing. Keep your urine bag below the waist level and off the floor.
• Empty your urine bag only as needed or at least every 3 to 6 hours or when it is half to 2/2 full.
• Clean and replace the urine bag as instructed by your doctor.

How to clean your stoma

To clean your stoma, you should:

• Gather the items you need including soap, warm water, sterile gauze, clean towel, gauze bandage, medical gloves, and waste bin.
• Wash your hands.
• Put on your clean gloves.
• Remove the old bandage gently.
• Assess the catheter site for redness, swelling, drainage and skin injuries. Report any unwanted changes on your healthcare provider.
• Throw away your used gloves, wash your hands and ten put on another pair of gloves,
• Hold the tip of the catheter near the insertion site.
• Wipe the catheter with sterile gauze to remove blood or any other material. Start at the area near your stoma and wipe away from it.
• Clean the skin around the stoma in a circular motion.
• Pat the area gently.
• Throw your used gloves and wash your hands.
• Apply a new bandage.
• Secure the tubing with a tape. Ensure that there are no kinks or loops on the tubing.

How to change your catheter

You may need to change your catheter every after 4 to 6 weeks. To do this, you should:

• Wash your hands with water and soap.
• Prepare your sterile supplies – new catheter kit which includes the catheter, gel lubricant, syringe, gloves, and sterile water. You should also prepare anesthesia, bandages and tape.
• Ensure that the tip of your new catheter is already lubricated.
• Put on two pairs of gloves – one over the other.
• Clean the area around your catheter site with a sterile solution.
• Deflate the balloon with one of your prepared syringes.
• Slowly remove the old catheter.
• Remove the top pair of gloves.
• Insert the new catheter as far as the old catheter was placed.
• Wait for your urine to flow, which may take a few minutes.
• Inflate the balloon using sterile water (5 to 8 ml).
• Attach the drainage bag.

If you are having difficulties in changing your catheter, you should call your doctor immediately.

What problems may occur with changing my catheter and what should I do?

• Catheter is not coming out easily during replacing it. If this happens, you may need to use another type of catheter. You should also tell your doctor about this.
• Not able to insert the new catheter.If you are unableto insert the new catheter, immediately cover your stoma with a sterile gauze and call your doctor right away.
• Catheter balloon is in the wrong place. If it is not inserted deep enough, insert more of the catheter and fill the balloon again. If it is inserted to deep, try to pull it out slowly until you are in the right place.
• The catheter comes out accidentally. If this occurs, insert a new catheter.
• Loss of stoma.Your stoma will close after 5 to 10 minutes if there is no catheter in it. Immediately put on a new catheter, if not, immediately seek care.
• Blocked catheter.Ensure that there are no leaks or kinks. Increase the amount of your oral fluid intake.
• Tissue overgrowth around your stoma.Prevent this by moving the catheter around to reduce pressure.
• Lower abdominal pain
• Urine leakage on your urethra or around your stoma
• No urine output

What other complications may occur?

• The catheter comes out accidentally. If this occurs, insert a new catheter.
• Loss of stoma.Your stoma will close after 5 to 10 minutes if there is no catheter in it. Immediately put on a new catheter, if not, immediately seek care.
• Blocked catheter.Ensure that there are no leaks or kinks. Increase the amount of your oral fluid intake.
• Tissue overgrowth around your stoma.Prevent this by moving the catheter around to reduce pressure.

Signs and symptoms of catheter problems

• Lower abdominal pain
• Urine leakage on your urethra or around your stoma
• No urine output

When should I call my doctor?

Call your doctor when:

• You are having a fever.
• You notice changes on your urine – its smell and color.
• You notice urine leakage.
• You notice that there is skin overgrowth around your stoma.
• The closed drainage system has accidentally opened.
• Your catheter appeared blocked.
• You notice that you have less urine than usual.
• The catheter accidentally comes out and you are not able to replace it immediately.
• Your insertion site have pus, blood, pus and redness.
• You experience pain on your lower abdomen, pelvis, back or hip.

When to seek immediate help

• You notice that you have less urine than usual.
• The catheter accidentally comes out and you are not able to replace it immediately.
• Your insertion site have pus, blood, pus and redness.
• You experience pain on your lower abdomen, pelvis, back or hip.

Appropriate Uses of Indwelling Urethral Catheter

Catheter use is needed for individuals who are suffering from problems on urination. It is also indicated for:

• People who are suffering from bladder blockage.
• People who are suffering from acute urinary retention.
• Critically ill individuals who requires accurate measurement of urinary output.
• People who will undergo certain surgeries including those who:

–          Will undergo surgery of the urinary tract

–          Will undergo surgery that will last for a prolonged time (in such cases, indwelling urinary catheter should be removed once the individual is transferred to the recovery room)

–          Will undergo surgery whilst receive large volume of fluids or is expected to excrete large amount of urine

–          Needs their urinary output monitored closely before and after a surgical procedure

• People with wound on their genital area and are currently suffering from urinary incontinence
• People who needs to be immobilized particularly those who sustained traumatic injuries and
• Dying individuals for end of life care

Use of indwelling catheters is recommended for the above mentioned cases. You should not attempt to perform indwelling catheter insertion if it’s not instructed or prescribed by your doctor.