A Complete Illustrated Guide to Clean Intermittent Catheterization for Females

What is Clean Intermittent Catheterization?

Clean intermittent catheterization refers to a method of regularly emptying urine by inserting a catheter into the bladder through the urethra under clean conditions. The definition of "clean" means that all catheterization supplies are thoroughly cleaned, the perineum and urethral meatus are washed with clean water (no disinfection required), and hands are scrubbed with soap or hand sanitizer before catheter insertion. Sterile operation is not necessary.

Supplies Required for Clean Intermittent Catheterization

1. Catheter
2. Water-soluble lubricant
3. Hand sanitizer/soap
4. Disposable gloves and disposable underpad
5. Clean wet wipes (alcohol-free and fragrance-free)
6. Graduated urine container (for urine collection)
7. Mirror (for backup use)
8. Garbage bag
9. Urination record sheet

Detailed Catheterization Steps

1. Prepare supplies

Gather all required items and place them within easy reach.

2. Wash hands

Scrub hands thoroughly with soap or hand sanitizer, rinse with clean water and dry them completely.

3. Lubricate and prepare the catheter

For hydrophilic-coated catheters requiring hydration, activate the lubricating coating on the catheter surface according to the manufacturer’s instructions, then hang the catheter beside you. For pre-lubricated catheters, simply hang them in an easily accessible location.

4. Clean the perineum

Wipe the urethral meatus in a rotating motion from the inside out with clean wet wipes to prevent bacteria from entering the body and causing infection.

5. Catheter insertion for adult females

The female urethra is 3–5 cm in length. Advance the catheter 1–2 cm further once urine flows out. Due to the anatomical characteristics of the female urethra, self-visualization of the urethral meatus is not possible. Select a proper body position and use a backup mirror to help expose the urethral meatus successfully and ensure smooth catheter insertion.

6. Post-catheterization care

After urine flow stops, slowly withdraw the catheter, dry the perineum, put on clothes, wash hands again and record the details in the urination log.

Catheterization Interval

The interval between catheterizations depends on the residual urine volume, generally ranging from 4 to 6 hours per session. Based on the assessment of simple bladder capacity and pressure measurement, the volume of urine drained per catheterization should not exceed the patient’s maximum safe bladder capacity. Typically, catheterization is performed 4–6 times a day, with the specific frequency determined by physicians according to the safe capacity. As the residual urine volume decreases, the catheterization interval can be gradually extended. Catheterization may be discontinued when the residual urine volume is less than 100 ml per session.

Precautions for Intermittent Catheterization

1. Do notwait until a strong urge to urinate occurs before performing catheterization.
2. If resistance is encountered during catheter insertion, pause for 5–10 seconds, withdraw the catheter 3 cm, then reinsert it slowly.
3. The total urine volume drained per catheterization should be ≤ 400–500 ml to avoid overdistension of the bladder.
4. Insert the catheter gently; do notuse excessive force or insert it too quickly to prevent damage to the urethral mucosa.
5. For female catheterization, avoid inserting the catheter into the vagina by mistake. If accidental vaginal insertion occurs, replace the catheter with a new one for reinsertion. Never reuse a catheter to prevent infection.
6. Inspect the catheter packaging for dampness or damage before use. If any abnormality is found, stop using the catheter immediately and replace it at a hospital.
7. Although the daily frequency of catheterization is determined by the residual urine volume after urination, always follow the doctor’s guidance to decide the number of daily catheterization sessions. Even if the residual urine volume is below 50 ml, do notdiscontinue self-catheterization based on personal judgment. Consult a doctor to determine the appropriate time to stop self-catheterization. For patients without the urge to urinate, establish a scheduled catheterization routine (please discuss with your attending physician to formulate a personalized urination plan).