Intermittent Urinary Catheterization – Female

Considerations:

• Be sure to take steps to ensure student privacy when performing procedure. 
• Encourage the student to assist in the procedure as much as she is able to help the student learn self-care skills. 
• Students who require urinary catheterization frequently have cloudy, foul smelling and sometimes bloody urine. Notify parent/guardian if there is a change in urine as the health care provider should be notified. 
• The school nurse should be aware of the student’s baseline urine characteristics to identify any concerning changes that may need intervention. 
• Depending on the student’s underlying health condition, their urinary anatomy may have been altered surgically so it may not have the typical appearance. 
• Many students who require urinary catheterization may also have bowel issues such as constipation or stool leakage. The student may be on a daily bowel regimen at home. 
• Discuss with the health care provider if the student uses a new catheter for each catheterization or reuses the same catheter.

  a.

  If the student reuses the catheter, discuss with the health care provider how long the catheter should be reused (i.e. 5 days, one week, etc.). 

Supplies:

• Clean gloves
• lean catheter (_____ french, per health care provider’s order) 
• Disposable wipes or mild soap and water or hand sanitizer 
• Urinal or receptacle for urine if procedure is not performed on the toilet 
• Water based lubricant such as K-Y Jelly® or Lubafax Jelly® if catheter is not prelubricated in packaging 
• 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 Care Plan (IHCP) and health care provider’s order 

Procedure:

1. Review IHCP and/or health care provider’s orders
2. Ensure proper documentation of parent/guardian authorization to perform this procedure
3. Gather equipment and place on clean surface
4. Explain the procedure to the student at her level of understanding
5. Encourage the student to assist in the procedure as much as she is able to help student learn self-care skills
6. If the student is completing procedure or assisting in procedure, have student wash hands or use hand sanitizer
7. Assist student with undressing, as needed
8. Position the student
9. If student is lying on a cot/bed, place a disposal pad under the student
10. Wash hands
11. Arrange equipment
12. Put on clean gloves
13. Lubricate 1-2 inches of the catheter tip with a water-soluble lubricant and place on a clean surface
    a. Use a generous amount of lubricant since dry catheters may cause excoriations in the urethra, leading to an entry point for bacteria contamination 
14. Using your thumb and one finger of nondominant hand, separate the labia (vaginal lips) and hold open with fingers
    a. Be prepared to maintain separation of the labia with one hand until the catheter is inserted and the urine is flowing well and continuously 
15. Using your dominant hand, 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
16. 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 
17. Locate the urinary meatus
    a. 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. Using your dominant hand, hold the catheter 2 to 3 inches from the tip and gently insert the catheter into the urethra 
19. Advance the catheter until there is a return of urine 
20. If you are still unable to insert the catheter or the student experiences pain remove the catheter and follow up with parents/guardian and health care provider If you meet resistance try the following:
    a. Rotate the catheter
    b. Have the student sit or lie in a different position
    c.  If you are still unable to insert the catheter or the student experiences pain remove the catheter and follow up with parents/guardian and health care provider
21. When urine flow has stopped remove the catheter slowly  
22. Remove gloves 
23. Wash hands  
24. Assist student in dressing, as needed 
25. Have student wash hands 
26. Put on clean gloves 
27. Assess urine for cloudiness and/or foul smell
    a. If present, assess student for signs of urinary tract infection:
    * fever 
    * abdominal pain
    * blood in urine
    * vomiting
    * chills
28. Measure urine output per health care provider’s order/IHP
29. Discard bodily fluids and catheter per infection control procedures and school district policy 
30. Remove gloves 
31. Wash hands 
32. Document assessment, intervention and outcome in student’s health care record
33. Update student’s parents/guardian, as needed

 

Procedure for Cleaning the Cather (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. Wash your hands 
7. After equipment is dry, store as appropriate
   a. Review health care provider’s order to determine how long the catheter can be used for
   i. Catheter should be discarded if becomes too stiff or has any discoloration  

References:

Bradley E. (2020). Achieving independence in toileting: Self-catheterization efficacy and the role of the school nurse. NASN school nurse (Print), 35(6), 314–318. https://doi.org/10.1177/1942602X20942533 

Children’s Minnesota. (2017, July). Catheterizing a girl-intermittent. Retrieved June 20, 2023, from https://www.childrensmn.org/educationmaterials/childrensmn/article/15538/catheterizing-a-girl-intermittent/  

Cincinnati Children’s. (2021, July). Intermittent catheterization-females. Retrieved June 20, 2023, from https://www.cincinnatichildrens.org/health/i/catheterize-female  

Fortuna, S. M., Korcal, L., & Thomas, G. (2018). Bladder management in children: Intermittent catheterization education. NASN school nurse (Print), 33(3), 178–185. https://doi.org/10.1177/1942602X18756164 

Lynn, P. (2019). Catheterizing the female urinary bladder. In Skill checklists for Taylor’s clinical nursing skills. A nursing process approach. (5th ed.). (pp. 268-270). 

Perry, A. G., Potter, P.A., Ostendorf, W., & Laplante, N. (2021). Skill 34.1 insertion of a straight or an indwelling urinary catheter. In Clinical nursing skills and techniques. (10th ed.). (pp. 997-1008). St. Louis, MO: Elsevier. 

Porter, S.M., Page, D., Engholm. H., & Somppi, C. (2019). Students supported by medical technology. In J. Selekman, Shannon, R.A., Yonkaitis, C.F. (Eds.). School nursing, a comprehensive text (3rd ed., pp. 721-740). Philadelphia PA.: F.A. Davis Co. 

Spina Bifida Association. (n.d.). Continence management in schools. Retrieved June 20, 2023, from https://www.spinabifidaassociation.org/wp-content/uploads/Beyond-Crayons-info-sheet-Continence-Management.pdf  

Tobias, N.E. (2017). Practical considerations and current best practice for pediatric clean intermittent catheterization. Pediatric nursing, 43(6), 267-273. 

Toothaker, R., & Cook, P. (2018). A review of four health procedures that school nurses may encounter. NASN school nurse (Print), 33(1), 19–22. https://doi.org/10.1177/1942602X17725885  

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Acknowledgment of Reviewers:

Angie Bulmahn, MSN, RN, NCSN
School Nurse Specialist
Missouri Department of Health and Senior Services

Marjorie Cole, MSN, RN, FASHA
State School Nurse Consultant
Missouri Department of Health and Senior Services

Renee Falkner, BSN, RN
School Nurse Supervision Specialist | Therapylog

Debra Funk, BSN, RN
Director of Practice
Missouri State Board of Nursing

Katherine Park, DNP, RN, NCSN
Nationally Certified School Nurse, Pierremont Elementary
Adjunct Professor, Maryville University School of Nursing

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Page last updated: April 18, 2025
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