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Female intermittent self catheterisation

Senior urogynaecology nurse specialist Angie Rantell explains the proceedure and considerations for intermittent self catheterisation in women.

The idea of performing intermittent self catheterisation (ISC) can be daunting for some women. They may have never examined their genitalia with a mirror and may be lacking in knowledge about their own anatomy. Patients need information on basic anatomy and should be given an opportunity to discuss their fears about the procedure, including issues related to pain or religious and cultural beliefs.

Many different female length catheters are available and it is essential to offer advice on suitable products. It is recommended that women use a size 10-12Ch catheter.

The first product that a patient tries may not always be the most comfortable or easy to use, so they should be offered several products to try at home (Royal College of Nursing, 2008; Association for Continence Advice, 2007).

Different positions can be used to perform ISC, including standing with a leg on the toilet or sitting on the floor against a wall and squatting. The position used will depend on the patient’s mobility, balance, dexterity and lifestyle. Two possible positions are illustrated.

The ISC Procedure

If patients are able to micturate they should always be encouraged to do so before using the catheter. The procedure that female patients should follow is outlined below:

  • Patients should give informed consent for the procedure;
  • The patient should wash her hands with soap and water or use an alcohol based gel. ISC is a clean procedure;
  • Ensure that the catheter is prepared for use according to
  • the manufacturer’s instructions;
  • Spread the labia apart and wash the urethral meatus from the front towards the anus;
  • Find a comfortable position and, using the index finger and middle finger of the non dominant hand, spread the labia apart and lift gently upwards to show the urethral opening (a free standing magnifying mirror is helpful);
  • Holding the catheter with the dominant hand, gently insert the catheter tip into the urethral opening and into the bladder slowly until urine starts to flow (ensure the funnel is directed into a collection bag, receptacle or toilet bowl). For some women - for example, those with a prolapse - it may be necessary to slightly angle the catheter to ease insertion;
  • Once urine has stopped or is slowing down move the catheter forward very slightly to ensure that all the urine is drained from the bladder;
  • Slowly withdraw the catheter from the urethra. Place a finger over the end of the funnel to prevent urine leaking from the catheter on removal;
  • Place the used catheter back into the packaging and dispose of according to local policy. Do not flush down the toilet (Dougherty and Lister, 2008).

The number of times a day the patient needs to catheterise will depend on the volume of urine drained from the bladder.

Discuss how to obtain supplies of catheters and provide patient information (Dougherty and Lister, 2008).

Problem solving

Women who have poor eyesight can use a “touch technique” to identify vaginal landmarks and the position and feel of the urethral meatus. Those who have reduced manual dexterity and mobility can aid ISC by using catheter handling aids, labial separators and mirrors that are attached to a leg strap.

Female length catheters should be used for all female patients but there are occasions when women who are pregnant or those who have large abdomens or large labia with deep set urethras may require a male length. These women can be taught alternative positions they can use to gain access to the urethra.

Angie Rantell, BSc, RGN, is senior urogynaecology nurse specialist, King’s College Hospital, London

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