cbd insertion procedureDecember 15, 2021
12. When the anaesthetic gel has taken effect, wipe away any excess, dispose of the gloves, wash and dry your hands and put on new sterile gloves.
Female-length catheters should be used routinely for female patients who are mobile. These are more discreet than standard-length catheters and are less likely to cause trauma or infections in female patients as movement in and out of the urethra is reduced (Dougherty and Lister, 2015).
A thorough risk assessment should be carried out before inserting a catheter. As with all procedures, where possible the patient’s informed consent should be obtained and documented following a discussion of the benefits and risks of catheterisation, and its effects on lifestyle and sexual relationships (Prinjha and Chapple, 2013; RCN, 2012).
Lidocaine is a topical drug and local medicines administration policy should be followed. As with any drug, it is essential to check for allergies before use (Dougherty and Lister, 2015).
This procedure should be undertaken only after approved training, supervised practice and competency assessment, and in accordance with local policies/protocols.
Source: Catherine Hollick.
21. Fully document the procedure including:
10. Hold the labia open and, with your dominant hand, clean the urethral meatus with 0.9% sterile sodium chloride (Loveday et al, 2014) in downward movements towards the anus, using single strokes (Fig 1c). This reduces the risk of CAUTI.
4. Help the patient remove relevant clothing (that is, underwear and/or pyjama bottoms) as necessary. Ensure she is not unnecessarily exposed by covering her thighs and genital area with a towel until you are ready to begin the procedure. Use a protective covering for bed linen to keep the bed dry.
Prinjha S, Chapple A (2013) Living with an indwelling urinary catheter. Nursing Times; 109: 44, 12-14.
The use of anaesthetic gels for catheterisation is well recognised in male patients but there is controversy over their use in female patients. EPIC (Loveday et al, 2014) and Royal College of Nursing (2012) guidance do not differentiate between male and female patients. Loveday et al (2014) recommend that an “appropriate lubricant from a sterile single-use container” is used for catheterisation. Many practitioners use lubricant gels with a topical anaesthetic (lidocaine 2%), but local policies should be followed.
5. Help the patient into a supine position with her legs bent and knees apart (Fig 1b).
The risk of complications means catheters should only be used after considering other continence management options, and should be removed as soon as clinically appropriate (Loveday et al, 2014).
1. Discuss the procedure with the patient, explaining any associated risks or benefits, to gain valid informed consent. Document this in the patient’s notes. Check for allergies to the lubricating or anaesthetic gel (Yates, 2015) (Box 1). Screen the bed to ensure privacy and maintain dignity.
Complications associated with catheterisation.
Catheterisation is associated with a number of complications including:
8. Wash your hands and put on sterile gloves. Place a sterile towel under the patient’s buttocks and across the thighs; this creates a sterile field (Dougherty and Lister, 2015).
Box 1. Anaesthetic and lubricating gels in female patients.
7. Open additional equipment using ANTT. Leave the urinary catheter in its inner sterile plastic protective wrapping until the time of insertion, to protect it from potential physical and environmental contamination. Remove the towel covering the patient’s genital area.
Aesthetic gels and female patients.
11. Remove the cap from the lubricating/anaesthetic gel and insert the nozzle into the urethra (Fig 1d). Squeeze the gel into the urethra, remove the nozzle and discard. If you are using an anaesthetic gel, leave it for approximately five minutes, or according to the manufacturer’s instructions, to take effect. Box 1 outlines further relevant information. If you are using a plain aqueous lubricating gel without anaesthetic you can continue with the procedure immediately.
The inflation valve on female catheters can become caught between the thighs in patients who are obese, confined to bed or wheelchair users, and this can lead to soreness (Dougherty and Lister, 2015). In these cases, a longer standard-length catheter can be used to avoid skin damage and improve patient comfort.
Health professionals should also have achieved the level of competency required by their employer before undertaking female urethral catheterisation, and should adhere to the relevant local policies and procedures, for example on continence management, catheterisation and infection prevention.
Using anaesthetic gels.
9. Using low-linting swabs, separate the labia with your non-dominant hand so you can see the urethral meatus.
3. Obtain the equipment needed to perform the female catheterisation procedure (Fig 1a), following aseptic non-touch technique (ANTT) guidance. This equipment should include:
16. Gently inflate the balloon with 10ml of sterile water or solution, according to the manufacturer’s directions (Fig 1f). For pre-filled balloons remove the clip and gently squeeze the reservoir of sterile water. Observe the patient for any signs of discomfort as inflation should be pain-free.
23. Check the patient is comfortable and give her information on the maintenance and care of the catheter and drainage system.
Note: The above indications are based primarily on expert consensus.
B. Examples of Inappropriate Uses of Indwelling Catheters.
* Please refer to Methods for implications of Category designations.
A. Examples of Appropriate Indications for Indwelling Urethral Catheter Use 1-4.
Examples of programs that have been demonstrated to be effective include: