Clean Intermittent Catheterization Female

<< URINARY


  • Depending on the student’s underlying health condition, their urinary anatomy may have been altered surgically so may not have the typical appearance
  • For a student who has a history of intermittent catheterization there should not be any pain associated with performing the procedure

Considerations:

  • Be sure to take steps to ensure patient privacy when performing procedure
  • Encourage the student to assist in the procedure as much as he/she is able to help student learn self-care skills
  • Students who require urinary catheterization frequently have cloudy, foul smelling and sometimes bloody urine.  If their urine is consistently cloudy, foul smelling and bloody, that is a concern and the student’s parents/guardian and health care provider should be notified
  • Depending on the student’s underlying health condition, their urinary anatomy may have been altered surgically so may not have the typical appearance
  • Many students who require urinary catheterization will also have bowel issues such as constipation or stool leakage
  • For a student who has a history of intermittent catheterization there should not be any pain associated with performing the procedure

Supplies:

  • Clean gloves
  • Clean straight catheter (_____ french, per healthcare provider’s order)
  • Catheter storage bag or container (toothbrush holder, non-airtight plastic bag)
  • Disposable wipes or mild soap and water
  • Urinal or receptacle for urine if procedure is not performed on the toilet
  • Water based lubricant such as K-Y Jelly® or Lubafax Jelly®
  • Disposable pad to place under student if procedure is done on a cot/bed
  • Mirror (for assisting student in identifying urethra)
  • Extra change of clothing
  • Student’s Individualized Health Plan (IHP) and/or healthcare provider’s order

 procedure download skill competency
female-cath
Click on the photo to access the video.
  1. Review IHP and/or healthcare provider’s orders
  2. Gather equipment and place on clean surface
  3. Explain the procedure to the student at her level of understanding
  4. Encourage the student to assist in the procedure as much as she is able to help student learn self-care skills
  5. If the student is completing procedure or assisting in procedure, have student wash hands
  6. Assist student with undressing, as needed
  7. Position the student
  8. If student is lying on a cot/bed, place a disposal pad under the student
  9. Wash hands
  10. Arrange equipment
  11. Put on clean gloves
  12. Lubricate the tip of the catheter with a water soluble lubricant and place on a clean surface
    • Use a generous amount of lubricant along the length of the catheter since dry catheters may cause excoriations in the urethra, leading to an entry point for bacteria contamination
  13. Separate the labia (vaginal lips) and hold open with fingers
  14. Wash the area with cleaning wipes, disposable wash cloth, mild soapy cotton ball or student specific cleaning supplies starting at the top of the labia moving toward the anus
  15. Repeat procedure a total of 3 times, once down each side and once down the middle, using a clean cotton ball (wipe or wash cloth) each time
  16. Locate the urinary meatus
  17. Gently insert the catheter until there is urine
    • Helpful hint: urinary meatus is located just under the clitoris above the vaginal opening.  If the catheter is inserted and there is no return of urine, leave the catheter in place and use another catheter to locate the meatus.  DO NOT reintroduce the first catheter into the urinary meatus.
  18. If you meet resistance try the following:
    • Rotate the catheter
    • Have the student sit or lie in a different position
    • If you are still unable to insert the catheter or the student experiences pain remove the catheter and follow up with parents/guardian and healthcare provider
  19. When urine begins to flow, insert the catheter one inch further
  20. When urine flow has stopped remove the catheter slowly
  21. Remove gloves
  22. Wash hands
  23. Assist student in dressing, as needed
  24. Have student wash hands
  25. Put on clean gloves
  26. Assess urine for cloudiness and/or foul smell
    • If present, assess student for signs of urinary tract infection:
      • fever
      • abdominal pain
      • blood in urine
      • vomiting
      • chills
  27. Measure urine per healthcare provider’s order
  28. Discard bodily fluids and catheter per infection control procedures and school district policy
  29. Remove gloves
  30. Wash hands
  31. Document assessment, intervention and outcome in student’s healthcare record
  32. Update student’s parents/guardian, as needed

Cleaning for catheter that will be used again during the school day:

  1. Put on clean gloves
  2. Clean catheter with mild soap and water
  3. Forcefully rinse the catheter lumen with tap water
  4. Place catheter on clean surface and allow to air dry
  5. Remove gloves
  6. After equipment is dry, store as appropriate
    • Catheter can be used for up to a month
    • Should be discarded if becomes too stiff or has any discoloration

If ordered by healthcare provider, sterilize the catheters once a day:

  1. Put on clean gloves
  2. Clean the catheter as above with soap and water.
  3. Prepare a solution of 1 teaspoon liquid bleach to 8 ounces water in a clean, tightly covered container
    • Use a pure, fragrance-free and additive-free bleach, such as Hilex® or Clorox®
    • Prepare a new solution every day.
  4. Soak catheters in bleach solution for at least 30 to 60 minutes
  5. After soaking, rinse well with water and air dry on a clean towel

References:

Bowden, V. R., & Greenberg, C. S. (2012). Pediatric nursing procedures (Third Edition). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Bray. L., & Sanders, C. (2007). Teaching Children and Young People Intermittent Self-Catheterization. Urologic Nursing, 27(3), 203-09.

Children’s Hospitals and Clinics of Minnesota. (2013). Catheterizing a girl (intermittent). Available at: http://www.childrensmn.org/manuals/pfs/homecare/018324.pdf

Children’s Hospital of Wisconsin. (2013). Clean Intermittent Self-Catheterization: Female.

Connecticut State Department of Education. (2012). Clinical Procedure Guidelines for Connecticut School Nurses. Available at:
http://www.sde.ct.gov/sde/lib/sde/pdf/publications/clinical_guidelines/clinical_guidelines.pdf

Gould, C.V., Umscheid, C.A., Agarwal, R.K., Kuntz, G., Pegues, D.A. (2009). Healthcare Infection Control Practices Advisory Committee (HICPAC). Guideline for prevention of catheter-associated urinary tract infections 2009. Atlanta (GA): Centers for Disease Control and Prevention (CDC), 67, 281. Available at: http://guideline.gov/content.aspx?id=15519&search=urinary

Katrancha, E.D. (2008). Clean Intermittent Catheterization in the School Setting. The Journal of School Nursing, 24: 197-204.

National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). (2010). Urostomy and Continent Urinary Diversion.

Newman, D.K. & Willson, M.M. (2011). Review of Intermittent Catheterization and Current Best Practices. Urological Nursing, 31(1), 12-48.

Porter, S., Haynie M.D., Bierle, T., Caldwell, T. & Palfrey, J. (1997). Children and Youth Assisted by Medical Technology in Educational Settings. Guidelines for Care. Second Edition. Paul H. Brookes Publishing Co., P.O. Box 10624, Baltimore, MD 21285-0624


Acknowledgment of Reviewers:

Katie Kressin, RN, MSN, CPNP
Nurse Practitioner
Pediatric Urology
Children’s Hospital of Wisconsin

Mary Kay Logemann, RN, BSN, Med
School Nurse
Platteville Public Schools

Kerri Schmidt, BSN, RN, NCSN
School Nurse
Rhinelander School District

Heidi Vanderpool, RN, MSN, CPNP
Nurse Practitioner
Pediatric Urology
Children’s Hospital of Wisconsin


Page last reviewed: November 18, 2015
Page last updated: April 6, 2015