Chapter 48. Female Urinary Drainage Catheter

Introduction

Urinary catheter insertion is performed to drain urine from the bladder (Figure 48-1) in patients who are incontinent or have urinary obstruction or to frequently monitor urine output as a proxy for renal function. Long-term catheterization is associated with increased risk of urinary tract infection.

Definitions and Terms

• ▪  French (Fr): The unit of measurement used in sizing urinary catheters—where 1 French equals 1/3 of a millimeter.
• ▪  Intermittent straight catheterization: A technique used for intermittent bladder drainage wherein the catheter is inserted and removed periodically to decompress bladder.

Techniques

• ▪  Indications:
  • —Perioperative urinary drainage
  • —Urinary tract outflow obstruction
  • —Urinary volume measurement in the intensive care unit (ICU)
• ▪  Contraindications:
  • —Urethral disruption
• ▪  Method:
  • —Prior to urinary catheterization, patient consent should be obtained, the urethra and surrounding areas prepped and draped (Figure 48-2), and the universal protocol should be performed as described in Section I.
  • —Prior to catheterization, the operator should wash hands and wear sterile gloves.
  • —According to Centers for Disease Control guidelines:
    • • Catheters should only be inserted by trained personnel.
    • • Catheters should only be inserted when necessary, rather than for the convenience of patient-care personnel, and should only be left in place as long as necessary.
    • • Alternative methods of urinary drainage should be entertained (ie, condom catheter, suprapubic drain).
  • —The smallest appropriate catheter should be selected for insertion, and the balloon checked for patency.
    • • Medium catheters (16-18 Fr) are typically used in adult females.
    • • Larger catheters (20-24 Fr) may be used in patients with hematuria.
  • —The labia should be spread, the urethra identified, and the catheter should be lubricated and inserted into the urethra (Figure 48-3).
  • —After urine has drained from the catheter, the balloon should be inflated.
  • —The catheter is attached to a closed drainage system and the drainage bag is positioned below the level of the bladder to prevent urinary reflux into the bladder.
• ▪  Complications:
  • —Urethral trauma
  • —Infection

Clinical Pearls and Pitfalls

• ▪  Urethral identification may be difficult in obese patients, patients with prior surgery, following childbirth or with prolapsed of vagina and/or urethra.
• ▪  If no urine drains from the catheter after insertion to an appropriate length, the catheter may be irrigated with sterile saline—free saline return suggests that the tip is in the right location.

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