Some women who self-catheterize often times encounter difficulties in comfortably doing so. Certain anatomical features and decreased motor skills may hinder the ability for some women to properly visualize the site of insertion, the urinary meatus.
In other cases where a clinician or caregiver is the one inserting the catheter, they may also find it difficult under certain conditions. For instance, in a supine position, the opening meatus can droop and slightly cave in to the vaginal opening, making it difficult for the person inserting the catheter to find the urinary meatus. This especially occurs as the female genitalia loses elasticity over the years.
For patients whose urinary meatus is not easily visible. The following ‘thumb technique’ has proven quite apt at adding comfortability, reducing catheterization duration and lessening pain from the insertion experience.
Collect the catheter supplies and have them at the ready for catheterization. Fold a towel several times and fold it under the patient’s back who should be in a supine position. The idea of adding the towel under the sacral region is to achieve a better angle of insertion since the hip is slightly elevated. If approved by a physician, topical lidocaine jelly can be applied to assist with mitigating pain and increasing comfortability since the invasiveness of this procedure can be quite hurtful.
Using the thumb of your hand of less dexterity, position it roughly 0.5” – 1” beneath the clitoris and gently press in and up to reveal the opening meatus. This also has the effect of tightening surrounding tissue, thus adding stability.
If the urinary meatus slips due to too much moisture, a good tip is to use a 4×4 sterile gauze with the “thumb technique” to add a bit more friction and prevent the urinary meatus from slipping as you bring it up with the weak handed thumb. Moreover, it keeps the labia minora from getting in the way of proper visualization.
When beginning insertion, grasping the catheter no more than two inches from the distal portion should be consciously practiced in order to provide stability and not allowing it to accidently move and make its way into the vaginal opening.
The “thumb technique” is also preferred over the so called ‘wink’ technique, which is when a providone iodine swab is used to wipe the area to find the urinary meatus. This is because it is much easier to locate the meatus even if it is slightly nested in the vaginal opening with the thumb technique; the ‘wink’ technique alone makes it more difficult to properly find it, should it be concealed. In any case, once the tissue is stable by using the thumb technique, you can then apply the ‘wink’ method to easily locate the opening.
If the catheter is accidently inserted into the vagina, not removing would add the benefit of providing a sort of marker so that you can properly reposition the catheter for insertion while avoiding the already discovered ‘false path’.
The thumb method has assisted many physicians and patients in overcoming the duration of insertion and the amount of pain/discomfort experienced.