2. Retract the labia minora.

a. Use sterile gauze sponges with nondominant hand, or

b. Have an assistant retract the labia with two cottontipped applicators (Fig. 20.2).

3. Using the free hand for the rest of the procedure,

cleanse the area between the labia minora three times

with antiseptic solution.

a. Swab in an anterior-to-posterior direction to avoid

drawing fecal material into the field.

b. Blot dry with sterile gauze.

4. Follow steps 8 through 11 of the technique for the male

infant.

5. Visualize the meatus (Fig. 20.2).

a. The most prominent structure is the vaginal introitus. The urethral meatus lies immediately anterior

(between the clitoris and the introitus).

b. The meatus may be obscured by the introital fold.

Gently push the fold down with a cotton-tipped

applicator.

c. If the meatus is not visible, the infant may have

female hypospadias (the meatus is on the roof of

the vagina, just inside the introitus). The urethra

Fig. 20.1. Anatomic drawing demonstrating bladder catheterization in the male.

Chapter 20 ■ Bladder Catheterization 117

must then be catheterized blindly, which may

require a curved-tip catheter or urologic assistance.

6. Gently insert the catheter only until urine appears in

the tube. Do not insert extra tubing.

7. Follow steps 13 through 15 of technique for the male

infant.

Female Infant in Prone Position (22)

This technique is useful in an infant who cannot be placed

supine (e.g., one with a large meningomyelocele)

1. Position the infant prone on folded blankets so that the

head and trunk are elevated about 3 inches above the

knees and lower legs. The hips should be flexed with

knees abducted (Fig. 20.3A).

2. Place a gauze pad over the anus and secure with

tape across the buttocks, to avoid contamination of

the perineum from reflex bowel evacuation (Fig.

20.3B).

3. Place sterile drapes as shown in Fig. 20.3C. Follow the

procedure for female catheterization above.

Fig. 20.2. External genitalia in the female.

Retraction of labia majora and minora with cottontipped applicators. An arrow indicates urethral meatus.

A

B C

Fig. 20.3. A: Position of infant for prone catheterization. B: Placement of gauze pad over anus.

C: Placement of drapes. (Adapted from Campbell J. Catheterizing prone female infants: how can you see

what you’re doing? Am J Matern Child Nurs. 1979;4:376, based on drawing by N. L. Gahan, with permission.)