What is the process for inserting a Foley catheter in a female patient? How can nurses ensure a successful and safe catheter insertion procedure? These questions are answered in this detailed article.

Preparing for Foley Catheter Insertion in Females

Before beginning the Foley catheter insertion procedure, it is important to gather the necessary supplies and prepare the patient. This includes:

• Peri-care supplies
• Clean gloves
• Foley catheter kit
• Extra pair of sterile gloves
• Velcro catheter securement device
• Wastebasket
• Light source (e.g., goose neck lamp or flashlight)

Nurses should also perform safety steps such as hand hygiene, checking the room for transmission-based precautions, introducing themselves and the procedure to the patient, confirming the patient’s identity using two identifiers, and assessing the patient’s ABCs. It is also important to assess for any latex/iodine allergies, history of previous catheterization difficulties, or other factors that may impact the procedure.

Positioning the Female Patient

The female patient should be positioned in a dorsal recumbent position, with the groin, legs, and feet exposed for the procedure. The patient should be draped with a bath blanket to maintain privacy. Assistance may be needed to properly position the patient and support the legs.

Creating a Sterile Field

Nurses should carefully open the Foley catheter kit and create a sterile field on the over-the-bed table. This includes:

1. Opening the outer package wrapping and positioning the sterile wrapped box with the paper label facing upward
2. Opening the kit to create and position the sterile field, touching only the outermost edges
3. Carefully removing the sterile drape from the kit and placing it under the patient, with the touched side closest to the linen
4. Washing hands and applying sterile gloves
5. Optionally placing a fenestrated drape over the patient’s perineal area to maintain sterility

Preparing the Foley Catheter

Once the sterile field is established, nurses should prepare the Foley catheter by:

• Emptying the lubricant syringe or package into the plastic tray
• Simulating the application of iodine/antimicrobial cleanser to cotton balls
• Removing the sterile urine specimen container and cap and setting them aside
• Removing the tray from the top of the box and placing it on the sterile drape
• Carefully removing the plastic catheter covering while keeping the catheter in the sterile box
• Attaching the syringe filled with sterile water to the balloon port of the catheter, keeping the catheter sterile
• Lubricating the tip of the catheter by dipping it in the lubricant and placing it in the box while maintaining sterility

Cleaning the Catheterization Area

With the patient’s labia minora gently spread and the urinary meatus visualized, the nurse should use an antiseptic swab or sterile antiseptic-soaked cotton ball to clean the labia minora, starting with the area furthest from them and using a downward stroke. This process should be repeated for the labia minora closest to the nurse.

Inserting the Foley Catheter

To insert the Foley catheter, the nurse should:

1. Grasp the lubricated catheter with their dominant hand and slowly insert it into the urethra, advancing it until urine begins to flow
2. Continue to advance the catheter until the desired length is reached, or until the drainage bag is full
3. Inflate the balloon with sterile water using the syringe, then gently pull back on the catheter to ensure proper placement
4. Secure the catheter to the patient’s leg using a Velcro catheter securement device
5. Collect any necessary urine specimen and dispose of the used supplies in the wastebasket

Providing Patient Education

Throughout the procedure, it is important for the nurse to explain each step to the patient, listen and attend to any patient cues, and ensure the patient’s privacy and dignity. After the procedure, the nurse should provide the patient with information on catheter care and any necessary follow-up.

Key Considerations

When inserting a Foley catheter in a female patient, it is crucial to follow agency policy, maintain strict sterile technique, and be attentive to the patient’s needs and comfort. Proper preparation, positioning, and technique can help ensure a successful and safe catheter insertion procedure.

21.11 Checklist for Foley Catheter Insertion (Female) – Nursing Skills

Use the checklist below to review the steps for completion of “Foley Catheter Insertion (Female).”

Steps

Disclaimer: Always review and follow agency policy regarding this specific skill.

1. Gather supplies: peri-care supplies, clean gloves, Foley catheter kit, extra pair of sterile gloves, Velcro^TM catheter securement device to secure Foley catheter to leg, wastebasket, and light source (i.e., goose neck lamp or flashlight).
2. Perform safety steps:
   • Perform hand hygiene.
   • Check the room for transmission-based precautions.
   • Introduce yourself, your role, the purpose of your visit, and an estimate of the time it will take.
   • Confirm patient ID using two patient identifiers (e.g., name and date of birth).
   • Explain the process to the patient.
   • Be organized and systematic.
   • Use appropriate listening and questioning skills.
   • Listen and attend to patient cues.
   • Ensure the patient’s privacy and dignity.
   • Assess ABCs.
3. Assess for latex/iodine allergies, GYN surgeries, joint limitations for positioning, and any history of previous difficulties with catheterization.
4. Prepare the area for the procedure:
   • Place hand sanitizer for use during/after procedure on the table near the bed.
   • Place the catheter kit and peri-care supplies on the over-the-bed table.
   • Secure the wastebasket near the bed for disposal.
   • Ensure adequate lighting. Enlist assistance for positioning if needed.
   • Raise the opposite side rail. Set the bed to a comfortable height.
5. Position the female patientin a dorsal recumbent position. Uncover the patient, exposing the patient’s groin, legs, and feet for positioning and sterile field (female = dorsal recumbent; may need assistance to position patient and help support legs). Drape the patient with a bath blanket, exposing only the necessary area for patient privacy.
6. Apply nonsterile gloves and perform peri-care.
7. Remove gloves and perform hand hygiene.
8. Create a sterile field on the over-the-bed table.
9. Open the outer package wrapping. Remove the sterile wrapped box with the paper label facing upward to avoid spilling contents and place it on the bedside table or, if possible, between the patient’s legs. Place the plastic package wrapping at the end of the bed or on the side of the bed near you, with the opening facing you or facing upwards for waste.
10. Open the kit to create and position a sterile field:
    • Open the first flap away from you.
    • Open the second flap toward you.
    • Open side flaps.
    • Only touch within the outer 1” edge to position the sterile field on the table.
11. Carefully remove the sterile drape from the kit. Touching only the outermost edges of the drape, unfold and place the touched side of drape closest to linen, under the patient. Vertically position the drape between the patient’s legs to allow space for the sterile box and sterile tray.
12. Wash your hands and apply sterile gloves.
13. OPTIONAL: Place the fenestrated drape over the patient’s perineal area with gloves on inside of the drape, away from the patient’s gown, with peri-area visible through the opening. Maintain sterility.
14. Empty the lubricant syringe or package into the plastic tray. Place the empty syringe/package on the sterile outer package.
15. Simulate application of iodine/antimicrobial cleanser to cotton balls.
16. Remove the sterile urine specimen container and cap and set them aside.
17. Remove the tray from the top of the box and place it on the sterile drape.
18. Carefully remove the plastic catheter covering, while keeping the catheter in the sterile box.  Attach the syringe filled with sterile water to the balloon port of the catheter; keep the catheter sterile.
19. Lubricate the tip of the catheter by dipping it in lubricant and place it in the box while maintaining sterility.
20. If preparing the kit on the bedside table, prepare to move the items to the patient. Place the plastic tray on top of the sterile box and carry as one unit to the sterile drape between the patient’s legs, taking care not to touch your gloves to the patient’s legs or bed linens.
21. Place the plastic top tray on the sterile drape nearest to the patient.
22. Tell the patient that you are going to clean the catheterization area and they will feel a cold sensation.
23. With your nondominant hand, gently spread the labia minora and visualize the urinary meatus. Your nondominant hand will now be nonsterile. This hand must remain in place throughout the procedure.
24. With your dominant hand, use an antiseptic swab or pick up a sterile antiseptic soaked cotton ball with plastic forceps to clean the labia minora furthest from you using a downward stroke (as shown below); then discard the swab or cotton ball. Repeat for the labia minora closest to you. Use another antiseptic swab or antiseptic­ soaked cotton ball to clean the area between the labia minora. Discard the cotton ball after use into the plastic bag, not crossing the sterile field. Repeat for a total of three times using a new cotton ball each time. Discard the forceps in the plastic bag without touching the sterile gloved hand to the bag.^[1]
25. Pick up the catheter with your sterile dominant hand. Instruct the patient to take a deep breath and exhale or “bear down” as if to void, as you steadily insert the catheter maintaining sterility of the catheter until urine is noted.
26. Once urine is noted, continue inserting the catheter 2-3″ further”. Do not force the catheter.
27. With your dominant hand, inflate the retention balloon with the water-filled syringe to the level indicated on the balloon port of the catheter. With the plunger still pressed, remove the syringe and set it aside. Pull back on the catheter until resistance is met, confirming the balloon is in place.

    If the patient experiences pain during balloon inflation, deflate the balloon and insert the catheter farther into the bladder. If pain continues with the balloon inflation, remove the catheter and notify the patient’s provider.

28. Remove the sterile draping and supplies from the bed area and place them on the bedside table. Remove the bath blanket and reposition the patient.
29. Remove your gloves and perform hand hygiene.
30. Apply new gloves. Secure the catheter with securement device, allowing room as to not pull on the catheter.
31. Place the drainage bag below the level of the bladder, attaching it to the bed frame.
32. Perform peri-care as needed; assist the patient to a comfortable position.
33. Dispose of waste and used supplies.
34. Remove gloves and perform hand hygiene.
35. Assist the patient to a comfortable position, ask if they have any questions, and thank them for their time.
36. Ensure safety measures when leaving the room:
    • CALL LIGHT: Within reach
    • BED: Low and locked (in lowest position and brakes on)
    • SIDE RAILS: Secured
    • TABLE: Within reach
    • ROOM: Risk-free for falls (scan room and clear any obstacles)
37. Perform hand hygiene.
38. Document the procedure and related assessment findings. Report any concerns according to agency policy.

1. “Clinical practice guidelines: Adult female urethral catheterization” [Online]. Accessed September 2016 via the Web at http://www.suna.org/sites/default/files/download/femaleCatheterization.pdf ↵

Clinical Guidelines (Nursing) : Indwelling urinary catheter

Introduction

Aim 

Definition of Terms

Indications

Preparation 

Catheter size

Procedure for insertion of urinary catheter 

Special precautions

Documentation

Ongoing nursing management

Troubleshooting

Removal of urinary catheter 

Complications

Discharge information

Companion documents

References

Introduction

Insertion of an indwelling urethral catheter (IDC) is an invasive procedure that should only be carried out using aseptic technique, Insertion of an indwelling urethral catheter (IDC) is an invasive procedure that should only be carried using aseptic technique, either by a nurse, or doctor if complications or difficulties with insertion are anticipated. Catheterisation of the urinary tract should only be done when there is a specific and adequate clinical indication, as it carries a risk of infection.


Aim

To ensure the insertion and care of the urinary catheter is carried out in a safe manner that minimises trauma and infection risks.
 

Definition of terms

• Indwelling Urinary Catheter (IDC): A catheter which is inserted into the bladder, via the urethra and remains in situ to drain urine.  
  
• Oliguric: a reduction in urine output.
  
• Paraphimosis: occurs when the foreskin is left in a retracted position. The pain and swelling may make it difficult to return the foreskin to the non-retracted position, this may reduce blood flow to the tip of the penis which if left untreated could lead to necrosis of the glans penis. 

Indications

• To drain the bladder prior to, during, or after surgery
  
• For investigations
• To accurately measure the urine output 
• To relieve retention of urine
  
• To relieve urinary incontinence when no other means is practical
  

Preparation

Preparation of the child and family

• Gain patient/primary care givers consent for procedure
• Families/primary care givers should be given a thorough explanation of
  the procedure. Involve the parents where possible when providing an age
  appropriate explanation of the procedure to the patient.
• Consider the need for a referral to play therapy to assist in explaining
  and preparing the patient for the procedure. Play therapists are also able to
  empower the child to identify distraction techniques, as well as provide
  support and distraction throughout the procedure.
• Nursing staff should discuss and plan procedural pain management with
  the child and family prior to the procedure. This may include non pharmalogical
  (including distraction techniques) and pharmalogical considerations including
  Nitrous Oxide or sedation if necessary. For more information regarding this
  please see the Procedural Pain Management guideline.

Preparation of Environment and Equipment

Ensure the patient’s privacy is maintained throughout the procedure and that they are kept warm. Ensure there is adequate light to perform the procedure.

Prepare the following equipment:

• Dressing trolley
  
• Catheterization pack and drapes
  
• Sterile gloves
  
• Appropriate size catheter (see
  catheter size guideline below)
  
• Sterile Lubricant and/or Xylocaine jelly syringe (plain sterile lubricant for infants)
  
• Sterile water to inflate balloon (normal saline can crystallise and render the balloon porous, causing its deflation and the risk of catheter loss)
  
• 5ml/10ml Syringe
  – as stated on catheter packaging
• Specimen jar
  
• Sterile normal saline
  
• Straps/tape to secure catheter to leg
  
• Drainage bag
• Waterproof sheet

Catheter size

Use an appropriate size catheter depending on the age of the child. Catheters that are too big or small are at risk of urethral trauma or leakage. The rational for IDC insertion should also be considered when selecting catheter, for example a patient requiring an IDC post kidney trauma may require a larger size to provide adequate drainage of potential blood clots. Consider silicone catheter if for long term use. 

Procedure for insertion of urinary catheter 

The need for an IDC should be discussed with the patients’ medical team
prior to insertion. Medical approval for IDC insertion should be ordered and/or
documented.

The following should be completed in line with the RCH Aseptic Technique Procedure. 

Female child

• Perform hand hygiene
  
• Place child in supine position with knees bent and hips flexed
  
• If soiling evident, clean genital area with soap and water first
• Perform hand hygiene
• Open dressing pack (aseptic field) and prepare equipment needed using
  aseptic technique
• Pour sterile normal saline onto tray
• Perform aseptic hand wash and don sterile gloves
• Apply sterile drapes/towel
• Separate labia with one hand and expose urethral opening. In neonates,
  the urethral meatus is immediately above the hymeneal fringes.
• Using swabs held in forceps in the other hand clean the labial folds and
  the urethral opening. Move swab from above the urethral opening down towards
  the rectum. Discard swab after each urethral stroke into waste bag or
  designated waste area.
• Remove catheter wire if a 6Fr catheter is used
• Lubricate catheter
• Insert catheter into the urethral opening, upward at approximately 30
  degree angle until urine begins to flow.
• 
  Inflate the balloon slowly using sterile water to the volume recommended
  on the catheter. Check that child feels no pain. If there is pain, it could
  indicate the catheter is not in the bladder. Deflate the balloon and insert the
  catheter further into the bladder. ALWAYS ensure urine is
  flowing before inflating the balloon. Note that in a child under 6 months a
  balloon is not typically used. In this case be especially mindful that
  strapping is secure.
• Withdraw the catheter slightly until resistance is felt and attach to
  drainage system
• Remove gloves and perform hand hygiene
• Secure the catheter to the thigh with either a catheter securement
  device or tape
• Clean trolley and dispose of used articles into yellow biohazard bag
• Perform hand hygiene 

Male child

• Perform hand hygiene
  
• Place child in supine position
• If soiling evident, clean genital area with soap and water first
• Perform hand hygiene
• Open catheter pack (aseptic field) and prepare equipment needed using
  aseptic technique
• Pour sterile saline onto tray
• Perform aseptic hand wash and don sterile gloves
• Lift the penis and retract the foreskin if non-circumcised. Do not force
  the foreskin back, especially in infants. A sterile gauze swab can be used to
  hold the penis. 
• Using other hand, clean the urethral opening with swabs held in forceps.
  Use a circular motion from the urethral opening to the base of the penis.
   Discard swab into waste bag or designated waste area. 
• For boys older than 3 years insert the Xylocaine gel into the urethra.
  Gently hold the urethra opening closed and wait 2 – 3 minutes to give the gel
  time to work. For infants apply sterile lubricant to catheter before insertion.
  Post urology surgery consider using two syringes of xylocaine gel to increase
  lubrication of the urethra and decrease risk of trauma.
• Remove the wire if using a 6Fr catheter
• Hold the penis with slight upward tension and perpendicular to the
  child’s body. Insert the catheter.
• When the first sphincter is reached (at level of pelvic floor muscles)
  gently bring the penis down to face the child’s toes, apply constant gentle
  pressure. If resistance is felt the following strategies should be considered:
  • Remove the catheter and utilise a 2nd tube of lubricant
  • Increase traction on penis and apply gentle pressure on the catheter
  • Ask the child to take a deep breath
  • Ask the child to cough and bear down e.g. try to pass urine
  • Gently rotate the catheter.

If unable to pass the catheter seek assistance from treating medical team or Urology registrar. DO NOT use force as you may damage the urethra.

• Advance the catheter and gently insert it completely into the urethra
  until the connection portion.
  
• ALWAYS ensure urine is flowing before
  inflating the balloon.
  
• Inflate the balloon slowly using sterile water to the volume recommended
  on the catheter. Check that child feels no pain. If there is pain, it could
  indicate the catheter is not in the bladder. Deflate the balloon and insert the
  catheter further into the bladder. Note that in a child under 6 months a
  balloon is not typically used. In this case be especially mindful that strapping
  is secure.
• Withdraw the catheter slightly till resistance is felt and attach to
  drainage system
• Reposition the foreskin if applicable
• Remove gloves and perform hand hygiene
• Secure the catheter to the thigh with either catheter securement device
  or tape
• Clean trolley and dispose of used articles into yellow biohazard bag
• Perform hand hygiene 

Special precautions

Rapid drainage of large volumes of urine from the bladder may result in hypotension and/or haemorrhage. If concerned clamp catheter if the volume seems excessive. Release clamp after 20 minutes to allow more urine to drain. A medical review of the child should be requested.

For post obstructive diuresis IV replacement of fluid and electrolytes may be required. This should be discussed with the treating medical team.

Documentation

Insertion of the IDC should be documented in the LDA activity. 

• Including catheter type, length and size 
• Amount of water instilled into balloon 
• Document all procedures and cares involving IDC cares

Ongoing nursing management

• Measure urine output as indicated 1 – 4 hourly, assessing the colour and concentration of urine output.        
• Unless otherwise specified by the treating team, normal paediatric urine output is 1-2ml/kg/hr. Report any variation from this to the treating medical team.  
  • Certain drugs will increase diuresis, such as diuretics and ACE inhibitors.
    
  • If oliguric ensure catheter is not blocked (see
    trouble shooting below).
    
  • Record fluid balance. A fluid balance which keeps the urine dilute will lessen the risk of infection. This may not be possible due to the clinical condition of the child.
    
• The IDC insertion site and securement should be assessed at least once a shift, to ensure the IDC is not pulling on the genitals and not twisted. 
  
• IDC drainage bags should be emptied once a shift at a minimum. 
  
• Position drainage bag to prevent backflow of urine or contact with the floor. Gravity is important for drainage and prevention of urine backflow. Ensure the drainage bag is below the level of the bladder, is not kinked or twisted and is secured.

Drainage system

Adherence to a sterile continuously closed method of urinary drainage has been shown to markedly reduce the risk of acquiring a catheter associated infection. Therefore breaches to the closed system should be avoided.

Consider changing the catheter tube and/or bag based on clinical indicators including infection, contamination, obstruction or if system disconnects. If the equipment is damaged or leaks, replace system and/or catheter using aseptic technique and sterile equipment.

Hygiene

• Routine hygiene should be maintained with routine bathing/showering, including daily clean IDC insertion site with warm soapy water and more frequently if build-up of secretions is evident
• Uncircumcised boys should have the foreskin gently eased down over the catheter after cleaning.
• Always check the strapping of the catheter is secure after hygiene is performed.

Infection surveillance

• Consider daily the need for the IDC to remain in situ. Remove as soon as no longer required to reduce risk of Urinary Tract Infection (UTI).
• Cloudy, offensive smelling or unexplained blood stained urine is not normal and needs further investigation.

Specimen collection

• Urine for for urinalysis or culture should be collected fresh from the needleless
  sampling port of catheter tubing (not drainage bag), this should be completed
  in line with the Aseptic Technique Procedure.
  • Clamp below the sampling point.  
  • Scrub sampling point vigorously with 70% alcohol and chlorhexidine (0.5% or 2%) soaked gauze or swabs for at least 15 seconds and allow to air dry 
  • Access port with a 10ml syringe to collect sample
  • Unclamp catheter
• Large volumes e.g. 24hr collection, can be collected from drainage bag.

Troubleshooting

• Catheter not draining/ blocked/patient oliguric
  
• Check catheter/tubing not kinked
  
• Check catheter is still secured to patient leg and that it  hasn’t migrated out of bladder
  
• Assess patient’s hydration status to ensure they are not dehydrated. Consider the need to perform a bladder scan to assess bladder volume. Escalate to medical team if concerned.
  
• The patency of a catheter can be checked via the sampling port or catheter tubing. A blocked catheter should be flushed via the catheter tubing, this is of particular importance in case of blood clots or mucus (for example after a bladder augment).  
  

The following techniques to check for patency and/or flush a catheter should be completed following the Aseptic Technique Procedure. 

Catheter leaking

• Ensure the catheter is still draining and that the urine is not overflowing around a blocked catheter. See above for tips regarding catheters not draining.
• If the catheter is a balloon catheter, make sure the balloon is still inflated. Hold the catheter tubing securely in the same position and empty the balloon to make sure the amount that has been placed initially in the balloon is still present. If not, reinflate the balloon to its initial volume with water. Deflation of the balloon happens easily with a 6Fr catheter.
• Check catheter size is correct for age/size of the child. Use of a balloon catheter in neonates should only be with consultation with the treating medical team.
• Consider the need to remove and reinsert a new catheter in consultation with the treating medical team.  

Removal of urinary catheter 

Equipment required for removal:

• Standard precaution PPE
• 5ml/10ml Syringe – as stated on catheter packaging
• Waterproof sheet
• Kidney dish / receiving container

Procedure:

• Explain procedure to child and family and gain consent.
• Check amount of water used to inflate IDC balloon.
• Gather equipment required for removal
• Ensure patient privacy and have patient in supine position. 
• Place waterproof sheet and/or kidney dish between patient legs.
• Perform hand hygiene & don gloves.
• Deflate balloon completely and remove any straps/tapes
• Gently withdraw catheter on exhale if possible, with rotation movements if necessary.
  • Bear in mind that once inflated, the balloon won’t deflate to its total initial flat state and the balloon portion of the catheter will remain larger than the catheter itself.
    • If resistance felt and catheter cannot be easily removed do not force, leave catheter in situ and consult medical team. 
    • Consider cutting the catheter at the balloon inflation point to ensure the balloon is deflated. 
    • Once removed inspect catheter for intactness. Report if not intact.
• Perform hand hygiene.
• Document catheter removal in the LDA activity.
• Observe for urine output post catheter removal.
• If the patient has not passed urine 6 – 8hours post catheter removal
  assess the patient’s hydration status and consider the need to perform a
  bladder scan. Discuss findings with the treating medical team. 

Complications 

• Inability to catheterise: ensure appropriate catheter size has been
  selected based on the age/size of the child. Ensure adequate procedural pain relief
  and distraction is in place during the procedure.
  • Escalate to the treating medical team and consider the need for a
    referral to the urology team.  
  • In young girls, the urethra can be difficult to localise and the
    catheter can go directly in the vagina. In this case, leave the first catheter
    in the vagina and use another one to place immediately above, which will be
    more likely to go in the urethra.
• Urethral injury may occur from trauma sustained during insertion or
  balloon inflation in incorrect position: it is very important to ensure the
  catheter is in the bladder before inflating the balloon, this can be confirmed
  by visualising the stream of urine prior to balloon inflation.
• Haemorrhage
• False passage (catheter pushed through urethral wall): The risk of false
  passage is actually higher when using a smaller catheters, ensure catheter size
  utilised is appropriate for child’s age and size.
• Urethral strictures following damage to urethra. This may be a long term
  problem
• Infection
  • To minimise risk of infection insertion of IDC’s must be performed using surgical aseptic technique with single use sterile gloves.  
  • Regular hygiene should be maintained whilst IDC is in situ. 
  • Where possible avoid disconnecting the IDC circuit to minimise risk of contamination
  • Monitor for and report signs of infection including fever, offensive smelling urine, unexplained blood or cloudy urine.
• Psychological trauma
• Paraphimosis due to failure to return foreskin to normal position following catheter insertion:
  • To minimise risk, remember to replace the foreskin to normal position in non-circumcised patients and check at catheter care or nappy change that the foreskin is in place.

Discharge information

• Some children will be discharged from the hospital with their IDC
  insitu. It is important to teach the families how to care for the catheter, how to
  perform hygiene, how to monitor the output and how to troubleshoot. Refer to  Kids Health
  Info Fact Sheet: Indwelling urinary catheter


Companion documents

Other RCH IDC resources available:

• Kids Health Info Fact Sheet: Indwelling urinary catheter

• RCH Teaching and supporting clean
  intermittent catheterisation for parents and children

References

• Anderson, C. , & Herring, R. (2019). Pediatric Nursing Interventions and Skills. In M. Hockenberry, D. Wilson, & C. Rodgers (Eds.), Wong’s Nursing Care of Infants and Children (pp. 701-704) St. Louis, Missouri: Elsevier.
• Australia and New Zealand Urological Nurses Society, (2014). Catheterisation Clinical Guidelines
• Australian Guidelines for the Prevention and
  Control of Infection in Healthcare (2019) pages 137-140
  https://www.nhmrc.gov.au/guidelines-publications/cd33
• Fasugba, O., Koerner, J., Mitchell, B. G., & Gardner, A. (2017). Systematic review and meta-analysis of the effectiveness of antiseptic agents for meatal cleaning in the prevention of catheter-associated urinary tract infections. Journal of Hospital Infection, 95(3), 233-242.
• Galiczewski, J. M. (2017). An intervention to improve the catheter associated urinary tract infection rate in a medical intensive care unit: direct observation of catheter insertion procedure. Intensive Critical Care Nursing. 40:26–34. Intensive & Critical Care Nursing, 41, 2. https://doi.org/10.1016/j.iccn.2017.04.002
• Gould, C., Umscheid,C., Agarwal,R., Kuntz,G., Pegues, D., & the Healthcare Infection Control Practices Advisory Committee (HICPAC). (2009) Guideline for prevention of catheter associated urinary tract infections (2009) Updated: June 6, 2019. https://www.cdc.gov/infectioncontrol/pdf/guidelines/cauti-guidelines-H.pdf
• Government of Western Australia Department of Health (2015). Indwelling Catheter: Blockage. Clinical Guideline, Women’s and Newborn Health Service, King Edward Memorial Hospital.
• Government of Western Australia Department of Health. Urethral Catheterisation Neonatal Guideline. (2019).
• Holroyd, S. (2019). Indwelling catheterisation: evidence-based practice. Journal of Community Nursing, 33(5), 40-46.
• NHS Southern Health, Urinary Catheter Care Guidelines (2020)
• Pradhan, S. K., & Das, K. (2017). Urinary Bladder Catheterization. Practical Procedures in Pediatric Nephrology, 4.
• Royal College of Nursing Catheter Care RCN Guidance for Healthcare Professionals (2019)
• Rowe, J. (2020). Urinary catheter management. Starship Hospital New Zealand.

Evidence table

Indwelling urinary catheter insertion and management evidence table

Please remember to
read the disclaimer.

The
development of this nursing guideline was coordinated by Liam Cunningham, RN, Day Medical Unit, and approved by the Nursing Clinical Effectiveness Committee. Updated September 2020.  

How to insert a Foley catheter?

Foley catheter is a type of urinal that differs in the form of a retaining inflatable balloon. The equipment was named in memory of the American urologist Frederick Foley and is actively used:

• for the removal of urinary fluid;
• drug withdrawal;
• in X-ray studies;
• in obstetrics;
• in traumatology.

Widespread in medicine due to increased sterility, and large lateral holes provide strong drainage. The device is considered safe for insertion into the bladder due to the high patency through the urethra – suitable for a short or long period.

Indications for catheter insertion

Bladder drainage is a common procedure in urological clinics. The process is presented in the form of introducing a special tube – a catheter – into the bladder. It is used for diagnostic or prophylactic purposes. The use of a Foley catheter to drain the urethra is recommended by doctors if the following symptoms appear:

• urinary retention;
• kidney problems;
• inflammation inside the bladder;
• diagnosis of the amount of residual urine;
• administration of drugs into the urethra;
• operations using anesthesia or standard anesthesia.

If you have at least one of the above symptoms, you should contact your doctor for advice to provide timely assistance to the body!

Types of Foley catheters

When buying a Foley catheter, you should pay attention to the material from which it is made. Depending on the components of the urinal, short-term or long-term drainage will be carried out in the absence of the ability to empty the bladder on their own. Foley catheters are divided into two main types, divided by size into men’s, women’s and children’s.

1. Latex catheters

When using a latex Foley catheter for more than 30 days, inflammatory or allergic processes are formed. Latex devices with a hydrophilic coating are less traumatic and, upon contact with the water surface, become smooth and slippery – this makes it possible to drain the urethra painlessly.

Main parameters of latex catheters:

• high strength;
• high level of elasticity;
• anti-deformation.

2. Silicone catheters

Despite the large number of advantages, the main disadvantage is the high cost due to the difficulties in production. Silicone catheters have the following characteristics:

• human biocompatible component – silicone;
• high temperature resistance;
• is intended for long-term catheterization, up to 12 weeks;
• does not cause allergies due to the biological compatibility of silicone with humans;
• absence of saline encrustations (formation of blockages) in the catheter;
• slow growth of bacteria due to silicone material.

The forerunner of silicone catheters is considered to be silver-plated, made of silicone with a layer of silver.

Detailed Instructions for Foley Catheter Insertion

Attention! Only a physician should insert the catheter for safety and ease of insertion. Detailed instructions are given below and are suitable for inserting the catheter into the urethra for both men and women:

1. Thoroughly clean the vulva, then insert the disposable catheter into the bladder.
2. Next, attach the special funnel to the connecting tube of the equipment.
3. Make sure the catheter is secure and fill the balloon with the recommended amount of sterile water.
4. Drugs can be administered using an additional port in a 3-way Foley catheter.
5. Check the flow of urinary fluid into the balloon.
6. Do not pinch or twist the outside of the device.
7. If overfilled, remove fluid and install new bottle.

Detailed Instructions for Foley Catheter Removal

To remove a Foley catheter, patients are advised to go to the hospital to see their doctor. Removal of drainage from the bladder requires the use of local anesthesia and the insertion of a cystoscope. Inside the urinary canal, the free end of the tube is captured by a special tool – a maniple, after which the Foley catheter is removed from the human body. The operation is performed manually inside a sterile cabinet.

Complications after a catheter that require a doctor’s consultation

If the following symptoms appear after the catheter is removed, the patient should immediately contact the doctor to eliminate the problem:

• bloody discharge in the urine;
• bleeding from the vulva;
• burning in the intimate area;
• fever;
• onset of fever;
• specific smell of urine.

How often should a Foley catheter be changed?

• Silicone catheter can be used up to 30 days;
• Latex catheter used up to 7 days;
• Silver plated is an obsolete type of catheter and is used up to 3 months.

How to care for the catheter?

With proper use of the Foley catheter, cleansing is not required and occurs naturally. To enhance the cleansing properties, patients are given cranberry juice, berries and herbal decoctions in the diet. Flushing required after:

• appearance of salts on the walls;
• turbidity of the urinary fluid;
• clogging of the lumen of the urine output tube.

The fluid is drained every 3-4 hours – this is how long it takes to completely fill the balloon. Urinary fluid is drained from a reusable urinal and washed with antiseptics for subsequent use, and a disposable one is disposed of and replaced with a new sterile balloon.

How do I clean my catheter at home?

For rinsing, use a solution of “Dioxydin” in proportions of 1:40 with water or tablets “Furacillin” 0.1 milligram per 100 milliliters of water. You can rinse with a ready-made remedy from a pharmacy, which the doctor will prescribe for the patient.

Instructions for proper cleaning of the catheter:

1. Wash your hands and remove the syringe, draw up the solution.
2. Disconnect the urinal, treat the ends of the tube with antiseptic solutions.
3. Insert the syringe and slowly dispense the solution.
4. First pour 20-30 milliliters of solution, after draining, repeat the previous steps three times.
5. Attach the urinal back to the balloon.

Consult a doctor to clean the catheter yourself.

How do I shower with a catheter?

• you can take a standard shower with a night bag;
• it is not recommended to take a shower with the device attached to the leg in order to avoid complications;
• It is strictly forbidden to take a bath with a urinal installed, wait until the Foley catheter is removed, otherwise you risk infection.

Conclusion

Foley catheter is an effective medical device for the treatment of diseases of the urethra and drainage of urinary fluid. Modern catheters do not cause discomfort, are easy to maintain and are sterile. An additional advantage is a wide range of models in terms of size and service life, which greatly simplifies the work for patients or medical professionals.

In the Medprofi store you can buy a Foley catheter for yourself or your family. If you have any questions or need help with the choice, our consultants will be happy to help

The materials posted on this page are for informational purposes and are intended for educational purposes. Determining the diagnosis and method of treatment remains the prerogative of your doctor.

The materials posted on this page are for informational purposes and are intended for educational purposes. Determining the diagnosis and method of treatment remains the prerogative of your doctor.

Placement, replacement and maintenance of a Foley catheter.

Structure of the bladder

Placement of a Foley catheter.

Before placing a catheter, it is necessary to carry out hygiene procedures.

The clinician should wash the patient’s hands and perineum with soap and water, disinfect with an antiseptic, and wear sterile gloves. Prepare the catheter (take with sterile tweezers, treat with a lubricant if necessary).

Female catheter insertion procedure:

Lying on your back, bend and spread your legs.

After parting the labia and finding the opening of the urethra, carefully insert the catheter. As soon as urine has gone through the catheter, you should stop.

After that, through one of the passages at the outer end of the catheter, inject sterile water with a syringe in a volume sufficient to inflate the balloon. Then attach the urine collection bag to the outer end. It is necessary to ensure that the bag is always below the level of the belt in order to avoid backflow of urine through the catheter.

Catheter insertion procedure for men:

Catheter insertion is more difficult for men. Since the urinary canal is longer and has physiological constrictions. The patient needs to lie on his back and slightly bend his knees, relax, the catheter is inserted into the urethra slowly and smoothly, with rotational movements, clamping the catheter with 5 and 4 fingers of the right hand, and first the genital organ must be held vertically, and then tilted down. Carefully advance the catheter. The presence of urine indicates that the catheter is placed correctly.

For children:

When placing a catheter, it is necessary to ensure the psychological comfort of the child.

Disinfect the genital area twice and wrap it with a sterile drape. Lubricate the end of the catheter, such as Vaseline.

Do not force the catheter if an obstruction is felt – this can damage the urethra.

The procedure for inserting the catheter is similar to that for adults, but the insertion depth is less because the urethra is shorter.

Urinary Catheter Care:

Wash the area around the catheter with soap and water several times a day to avoid irritating the infection. Do this after every bowel movement. Women are washed from front to back.

Drain the bag in time, keeping it below the level of the bladder to prevent urine from flowing back into the catheter.

Change of catheter:

If urine flow is normal, change the catheter according to the recommendation of the doctor and instructions for use of the catheter.

Silicone have a shelf life of up to 30 days, latex up to 7 days, silicone with silver up to 90 days.

Never pull on the catheter. Disconnect the catheter only for rinsing or replacing it, as well as emptying the urinal.

Cases when you need to see a doctor:

– There are pains in the abdomen, flakes and blood in the urine.