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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. There’s often a significant number of marks available for communication skills. There are generally two approaches to catheterisation, the two gloved technique and the clean hand / dirty hand technique. Please use the method taught at your medical school (this guide demonstrates the clean hand / dirty hand method). Check out the female catheterisation OSCE mark scheme here.



Introduction

Introduce yourself – state your name and role

Confirm patient details – name / DOB

Ensure a chaperone is present!

 

Explain procedure:

I need to insert a catheter to allow monitoring of 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?”


Gather equipment

Trolley – to place your sterile field and other equipment onto

Sterile gloves – 2 pairs

Apron

Male catheter – 12/14  french 

Water filled syringe – 10mls – for inflation of catheter balloon

Catheter bag

Catheter pack:

  • Small pot – “Gallipot”
  • Cotton wool balls
  • Sterile drapes
  • Sterile gauze
  • Absorbent pad

 

Saline (0.9%) – 10mls

Lidocaine gel (1%) – for insertion into urethra for anaesthesia / lubrication

Sterile receiver


Setting up

1. Clean the trolley using disinfectant wipes

2. Wash hands – with soap and water

3. Don apron

4. Set up your sterile field:

  • Remove the outer packaging from the catheter pack
  • Open catheter pack aseptically to create your sterile field
  • Empty the various pieces of equipment (catheter / sterile gloves / lidocaine) from their packaging onto the field aseptically
  • Pour the 0.9% saline over the cotton balls located within the small plastic pot
  • Clean a trolley
5. Position the patient:

  • Ensure the bed is at an appropriate height for you to comfortably carry out the procedure
  • Position the patient supine with knees flexed and hips abducted with their heels together
  • Expose the patient’s genitalia (or ask your chaperone to do this)

 

6. Wash hands again and don sterile gloves

7. Place sterile absorbent pad underneath patient’s genital area 

8. Clean the genitalia:

  • Hold the labia apart with the non-dominant hand
  • Pick up the wet cotton balls and begin to clean the genitalia
  • Clean in the front to back direction – using each cotton ball only once

9. Discard used gloves, wash hands and don a new pair of sterile gloves

10. Place sterile drape over the patient’s genital area and place sterile receiver between legs

 

11. 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 3-5 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

  • If there is significant resistance or the patient is in a lot of discomfort, you should remove the catheter and consider a repeat attempt or input from urology.

 

5. As you enter the bladder you will see urine begin to drain from the catheter

6. You should continue to advance the catheter until it is fully inserted

7. 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!

8. Once the balloon is fully inflated withdraw the catheter until resistance is felt

  • This confirms the catheter is held firmly within the bladder

9. Attach the catheter bag tubing to the end of the catheter, ensuring a tight seal

10. Hang the catheter bag on the side of the bed, below the level of the patient

11. Clean up the patient and dispose of your equipment

12. Allow the patient to get dressed


To complete the procedure…

Thank patient

Wash hands

Ask nursing staff 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
  • Use of local anaesthetic
  • 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

REVIEWED BY

Graham Bone

Senior Clinical Lecturer in Medical Education


 

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