The catheter slips into the vagina during a straight catheterization of a female client. The nurse does which action?
A. Leaves the catheter in place and gets a new sterile catheter.
B. Leaves the catheter in place and asks another nurse to attempt the procedure.
C. Removes the catheter and redirects it to the urinary meatus.
D. Removes the catheter, wipes it with a sterile gauze, and redirects it to the urinary meatus.
Correct Answer: A. Leaves the catheter in place and gets a new sterile catheter.
The catheter in the vagina is contaminated and can’t be reused. If left in place, it may help avoid mistaking the vaginal opening for the urinary meatus. A single failure to catheterize the meatus doesn’t indicate that another nurse is needed although sometimes a second nurse can assist in visualization of the meatus. Urinary bladder catheterization is performed for both therapeutic and diagnostic purposes. Based on the dwell time, the urinary catheter can be either intermittent (short-term) or indwelling (long-term).
Option B: After exposing the urethral meatus, a lubricated catheter tip is advanced in the meatus until there is a spontaneous return of urine. The catheter balloon is then inflated as per the manufacturer’s recommendations.
Option C: In the event a catheter is inserted in the vagina, it should be left there until a new sterile catheter is successfully inserted into the meatus. Analgesia is of no proven clinical use in women. Lubrication jelly should be applied to the tip of the catheter. The application of lubricant to the urethral meatus is associated with difficulty in catheter insertion.
Option D: Urinary tract infection (UTI) is the most common complication that occurs as a result of long-term catheterization. The normal urinary flow prevents the ascension of microbes from the periurethral skin avoiding the infection. Alteration of the defensive mechanism from the catheter results in an increased risk of UTIs. Escherichia coli and Klebsiella pneumonia are the most common organisms implicated in UTIs. Recurrent UTIs are associated with increased antibiotic resistance.