Male Foley Catheter – My Shepherd Connection

An indwelling catheter is also called a foley catheter or “Foley.” It can be used in males or females. A Foley is usually left in the bladder and drains the bladder continuously.

Foley Catheter: Step by Step Process

1. Gather the Supplies

• Indwelling Foley Catheter Tray with a 10 cc balloon (size 16fr is a common size used for adults.) The tray comes with all the needed supplies
• Syringe to deflate the balloon of the existing catheter (if there is one already in the bladder)
• Soapy wash cloth and wet wash cloth

2. Wash hands with soap and water

3. Prepare all needed supplies

4. Lie flat on back with legs flat

5. If there is already a catheter in place, remove it by deflating the balloon.

• Attach the syringe to the end of the “Y” pigtail (side port).
• Withdraw the plunger of the syringe. This will deflate the balloon on the catheter inside the bladder.
• You will know it is completely deflated when you are unable to pull anymore water into the syringe.

6. Gently pull the catheter out from the bladder. 

 7. Wash penis

Wash with the soapy cloth and rinse with the wet cloth. Dry well.

8. Wash hands again.

9. Open the Indwelling Catheter Tray carefully. Set up the supplies.

• Place paper pad under hips.
• Put on the gloves if this is not a self catheterization.
• Pour the Betadine onto the cotton balls
• Remove the plastic cover from the catheter (be careful not to touch the catheter tube) & squirt the lubricating jelly onto the catheter.
• Remove the rubber cap from the syringe with the water in it.
• Connect the end of the catheter to the drainage bag

10. Choose your “clean” and “dirty” hand.

Whatever hand comes in contact with the body, the one that holds the penis, is dirty. The one that touches the catheter supplies is clean. Never mix clean and dirty hands in regard to the catheter supplies. It is important that this procedure stay “super clean” so as not to allow germs to enter the bladder.

11. Hold the penis.

Remember, the hand touching the body will now be the dirty hand.

12. Clean urinary opening on penis

• Use clean hand to touch items in the kit
• Clean penis with the cotton balls soaked in Betadine.
• Use 1 cotton ball per wipe.
• Always wipe from the tip of the penis toward the shaft of the penis.
• Never re-use a cotton ball.

13. Insert the catheter slowly and gently into the urinary opening on the penis. 

14. See the urine flow into the catheter

Continue to insert the catheter until the “Y” pigtail section of the catheter becomes very close to the end of the penis.

15. Blow up the balloon

While holding the catheter in place, attach the pre-filled syringe in the kit to the “Y” pigtail port and insert all of the water from the syringe. 

If it is easier, you can attach the syringe before you insert the catheter so it is ready when you need it. Do not blow up the balloon until the catheter is in and you see urine flowing.

Below is a picture of a catheter with an inflated balloon…this is what it would look like inside the bladder

16. Wash off the extra Betadine from the penis.

17. Always hang/attach the drainage bag to chair/bed frame below the level of the penis.

This will allow for the best drainage.

18. Consider wearing a leg strap.

The leg strap attaches the catheter to the inner thigh. It helps to keep the catheter secure.

19. If wearing a leg bag, always wear it below the knee.

Real Questions from Real People

1. How often does the catheter need to be changed?

Catheters can stay in for about a month as long as it is not leaking or having crusty areas around it near the urethral opening. You should wash the urinary opening at least twice a day while the catheter is in place. Change the catheter by the schedule given to you by your doctor.

2. Should I save anything from the catheter kit incase problems arise with the catheter?

Yes. Save the syringe so you can deflate the balloon when the catheter needs to be removed.

3. What if touch the catheter with my dirty hand or I drop the catheter on the floor before I have it safely inserted?

Stop and get another catheter or kit. It is important that germs do not enter the bladder during this procedure.

4. What if I have spasms while the catheter is being inserted?

Stop and wait for the spasm to pass; then continue with the insertion.

5. What if the catheter will not go in easily or I feel like I meet resistance when inserting it?

Do not force the catheter in. Call the doctor for further advice.

How To Do Urethral Catheterization in a Male – Genitourinary Disorders

By

Paul H. Chung

, MD, Sidney Kimmel Medical College, Thomas Jefferson University

Reviewed/Revised May 2023

View Patient Education

Topic Resources

Urethral catheterization is the standard method of accessing the urinary bladder. A flexible catheter is passed retrograde through the urethra into the bladder. Several types of catheters are available. Sometimes the urethra is impassable, requiring suprapubic catheterization of the bladder.

(See also Bladder Catheterization Bladder Catheterization Bladder catheterization is used to do the following: Obtain urine for examination Measure residual urine volume Relieve urinary retention or incontinence Deliver radiopaque contrast agents or. .. read more .)

• Relief of acute or chronic urinary retention, such as due to urethral or prostatic obstruction (obstructive uropathy Obstructive Uropathy Obstructive uropathy is structural or functional hindrance of normal urine flow, sometimes leading to renal dysfunction (obstructive nephropathy). Symptoms, less likely in chronic obstruction… read more ) or neurogenic bladder Neurogenic Bladder Neurogenic bladder is bladder dysfunction (flaccid or spastic) caused by neurologic damage. Symptoms can include overflow incontinence, frequency, urgency, urge incontinence, and retention…. read more

• Treatment of urinary incontinence

• Monitoring of urine output

• Measurement of postvoid residual urine volume

• Collection of sterile urine for culture (usually for infants and women only)

• Diagnostic studies of the lower genitourinary tract Genitourinary Imaging Tests Imaging tests are often used to evaluate patients with renal and urologic disorders. Abdominal x-rays without radiopaque contrast agents may be done to check for positioning of ureteral stents… read more

• Bladder irrigation or instillation of medication

Absolute contraindications

Relative contraindications

• History of urethral strictures Urethral Stricture Urethral stricture is scarring that obstructs the anterior urethral lumen. Urethral stricture can be Congenital Acquired Anything that damages the urethral epithelium or corpus spongiosum can… read more

• Current urinary tract infection Introduction to Urinary Tract Infections (UTIs) Urinary tract infections (UTIs) can be divided into upper tract infections, which involve the kidneys ( pyelonephritis), and lower tract infections, which involve the bladder ( cystitis), urethra… read more (UTI)

• Prior urethral reconstruction

• Recent urologic surgery

• History of difficult catheter placement

*Urethral injury may be suspected following blunt trauma if patients have blood at the urethral meatus (most important sign), inability to void, or perineal, scrotal, or penile ecchymosis, and/or edema. In such cases, urethral disruption should be ruled out with imaging (eg, by retrograde urethrography Genitourinary Imaging Tests Imaging tests are often used to evaluate patients with renal and urologic disorders. Abdominal x-rays without radiopaque contrast agents may be done to check for positioning of ureteral stents… read more ) before attempting urethral catheterization.

Complications include

• Injury to the urethra, prostate, or bladder with bleeding (common)

• UTI Introduction to Urinary Tract Infections (UTIs) Urinary tract infections (UTIs) can be divided into upper tract infections, which involve the kidneys ( pyelonephritis), and lower tract infections, which involve the bladder ( cystitis), urethra… read more (common)

• Creation of false passages

• Scarring and urethral strictures Urethral Stricture Urethral stricture is scarring that obstructs the anterior urethral lumen. Urethral stricture can be Congenital Acquired Anything that damages the urethral epithelium or corpus spongiosum can… read more

• Paraphimosis Paraphimosis Phimosis is inability to retract the foreskin. Paraphimosis is entrapment of the foreskin in the retracted position; it is a medical emergency. Phimosis is normal in children and typically resolves… read more , if the foreskin is not reduced after the procedure

Prepackaged kits are typically used but the individual items needed include

• Sterile drapes and gloves

• Povidone iodine with application swabs, cotton balls, or gauze

• Water-soluble lubricant

• Urethral catheter* (size 16 French Foley catheter is appropriate for most men; in the setting of prostatic hypertrophy Benign Prostatic Hyperplasia (BPH) Benign prostatic hyperplasia (BPH) is nonmalignant adenomatous overgrowth of the periurethral prostate gland. Symptoms are those of bladder outlet obstruction—weak stream, hesitancy, urinary… read more or urethral stricture Urethral Stricture Urethral stricture is scarring that obstructs the anterior urethral lumen. Urethral stricture can be Congenital Acquired Anything that damages the urethral epithelium or corpus spongiosum can… read more , an alternate size or style of catheter may be required†)

• 10-mL syringe with sterile water (for catheter balloon inflation)

• Local anesthetic (eg, 5 to 10 mL of 2% lidocaine jelly in a syringe [with no needle]) for distention and anesthesia of the male urethra

• Sterile collection device with tubing

*A closed-catheter system minimizes catheter-associated UTI Catheter-Associated Urinary Tract Infections A catheter-associated urinary tract infection (CAUTI) is a urinary tract infection (UTI) in which the positive culture was taken when an indwelling urinary catheter had been in place for &gt. .. read more .

†A coudé catheter is curved at the end and may facilitate passage in a male with significant prostatic hypertrophy.

• Sterile technique is necessary to prevent a lower urinary tract infection Introduction to Urinary Tract Infections (UTIs) Urinary tract infections (UTIs) can be divided into upper tract infections, which involve the kidneys ( pyelonephritis), and lower tract infections, which involve the bladder ( cystitis), urethra… read more .

• Place all equipment within easy reach on an uncontaminated sterile field on a bedside tray. You may put the box containing the catheter and the drainage system between the patient’s legs, so that it is easily accessible during the procedure.

• If not done already, attach the catheter to the collecting system and do not break the seal unless a different type or size of catheter or irrigation of the catheter is required.

• Test the retention balloon for integrity by inflating it with water, and apply lubricant to the catheter tip.

• Saturate the applicator swabs, cotton balls, or gauze with povidone iodine.

• Place the sterile fenestrated drape over the pelvis so that the penis remains exposed.

• Grasp the shaft of the penis using your nondominant hand, and retract the foreskin if the patient is uncircumcised. This hand is now nonsterile and must not be removed from the penis or touch any of the equipment during the rest of the procedure.

• Cleanse the glans penis with applicator swabs, gauze, or cotton balls saturated in povidone iodine. Use a circular motion, beginning at the meatus, and work your way outward. Discard or set aside the newly contaminated items.

• Inject viscous lidocaine into the urethra. Insert the hub of the lidocaine-containing syringe into the penile meatus and inject about 5 mL. Pinch the meatus closed, to retain the lidocaine within the urethra, for at least 1 minute. The lidocaine distends the urethra, as well as provides some anesthesia, thereby easing catheter passage.

• Hold the catheter in your free hand. If a coudé catheter is being used, the tip should point upward, so as to track the superior urethral wall during insertion.

• Advance the catheter slowly through the urethra and into the urinary bladder. Patient discomfort is common. Ask the patient to relax and take slow deep breaths as you continue to apply steady pressure on the catheter until it is fully advanced to the level of the side port. Urine should flow freely into the collection tubing.

• Slowly inflate the balloon with 5 to 10 mL of water. Obvious resistance or patient discomfort suggests incorrect placement. If this happens, deflate the balloon, withdraw the catheter slightly, and then reinsert the catheter all the way before trying to reinflate the balloon.

• Position the balloon at the bladder neck, after successful balloon inflation, by slowly withdrawing the catheter until you feel resistance.

• To prevent paraphimosis Paraphimosis Phimosis is inability to retract the foreskin. Paraphimosis is entrapment of the foreskin in the retracted position; it is a medical emergency. Phimosis is normal in children and typically resolves… read more , reduce the foreskin after the procedure.

VIDEO

• Remove the drapes.

• Secure the catheter to the thigh with an adhesive bandage, tape, or strap. Some advocate taping the catheter to the lower abdominal wall to minimize pressure on the posterior urethra.

• Place the bag below the level of the patient to ensure that urine can drain via gravity.

• Be sure to maintain strict sterile technique during the procedure to avoid urinary tract infection Introduction to Urinary Tract Infections (UTIs) Urinary tract infections (UTIs) can be divided into upper tract infections, which involve the kidneys ( pyelonephritis), and lower tract infections, which involve the bladder ( cystitis), urethra. .. read more .

• Be sure to reduce the foreskin after the procedure.

• Be careful not to use excessive force during insertion, which could potentially cause urethral injury.

• Do not continue attempts at catheter placement if significant resistance is met or if the catheter feels to be buckling inside the urethra and not advancing.

• Urine will appear in the catheter before the balloon has advanced beyond the prostate. Continue advancing the catheter completely to the end of the catheter before inflating the balloon, to avoid inflating the balloon in the prostate or urethral lumen, which will cause significant bleeding.

• If the catheter appears to be in the correct position, but urine does not return, lubricant may be obstructing drainage of urine. Flush the catheter with normal saline to dislodge the lubricant and see if urine returns.

• If the balloon is difficult to inflate or the balloon port distends during inflation, the proximal end of the catheter is probably not in the correct position. Deflate the balloon and advance the catheter further into the bladder.

• If correct positioning is questioned, flush the catheter with 30 to 60 mL of normal saline. If the fluid can be flushed and aspirated easily, then the catheter is in the correct position. A catheter that will not irrigate is not in proper position.

• Consult a urologist for any questions regarding catheter size and style or difficulty placing a catheter.

NOTE:


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Placement of a urinary catheter for men – MEDIAN

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Bladder catheterization in case of pathological obstruction of the outflow of urine, as well as for diagnostic purposes, involves the use of a catheter in the form of a thin tube into the urethra.

Indications for catheterization

For therapeutic purposes, the placement of a urinary catheter is carried out in the following conditions:

• acute urinary retention;
• presence of blood clots, mucus and pus in the bladder;
• administration of chemotherapeutic agents;
• after operations to restore the patency of the urethra.

Catheterization is also used for diagnostic purposes.

1. Urine sampling for analysis can be done with a Nelaton urological catheter (it is a thin plastic tube).
2. Ultrasound diagnosis of the pelvic organs should be performed on a full bladder. Catheterization is used if, due to voluntary urination or other pathological conditions, the patient cannot fill it on his own.
3. In case of severe poisoning or comatose conditions of the patient, when it is necessary to control the daily volume of urine (diuresis).

The insertion of soft catheters is carried out by paramedical staff: a nurse and a paramedic – catheterization with a rigid catheter is carried out by a doctor.

Contraindications

These conditions are considered an absolute contraindication for elective catheterizations:

• acute bacterial infections of the prostate;
• damage to the urethral canal;
• narrowing of the urethra.

In urgent cases, insertion of the catheter with extreme caution is possible.

Features of the catheterization procedure in men

It is more difficult to place a urinary catheter in a man due to the peculiarities of physiology (long curved urethra).

To place a Nelaton or Foley catheter, the health worker must work under aseptic conditions, using sterile gloves and dressings.

After treatment with an antiseptic, the catheter is inserted into the glans penis to a depth of 20 cm or until urine appears. To relieve pain, the catheter is pre-lubricated with vaseline oil or glycerin.

A 2% solution of lidocaine can be used as an anesthetic (administered before the procedure in a volume of 2-3 ml).

Possible complications

In case of violation of the rules for installing a catheter, the following conditions may appear:

• violation of the integrity of the walls of the urethra, prostate gland;
• bleeding;
• damage or rupture of part of the catheter;
• development of an infectious process.

Bladder catheterization in Kyiv is carried out in our clinic by qualified specialists, so that patients can be confident in the correct insertion and the absence of possible complications.

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Installation, replacement and removal of the Foley catheter in Kiev at home and in the Yurinmed clinic

at home by prior arrangement

In case of problems with urination, the installation of the urinary Foley catheter helps to gently and quickly solve the problem. The miniature device is recommended for long-term use in women and men, controls the outflow of urine during injuries, after surgery, reducing the risk of complications. But there are a number of features during the introduction and removal that require professional help from doctors.

Foley Catheter Purpose

A small medical device or appliance comes in the form of a tube with a balloon that is carefully inserted into the bladder cavity. It is designed for forced emptying in the event of a malfunction of the genitourinary system. Depending on the type, the placement of a Foley urinary catheter is possible for a period of 5 to 30 days.

Bladder catheterization is a medical way to restore the function of urine excretion. With some diseases and injuries, the process is disrupted, which threatens the patient’s health with severe complications, severe pain. It can also be used to administer medications, flush, and take fluid for laboratory testing.

The main indications for the installation of a urinary catheter:

• the presence of stones in the bladder;
• tumors;
• prostate adenoma;
• postoperative period;
• finding the patient in an unconscious or comatose state;
• exacerbation of cystitis in women;
• injection of drugs into the bladder;
• lavage of the organ cavity in certain diseases;
• diagnostics and sampling of biomaterial for analysis.

Insertion of a catheter in a woman is recommended for natural induction of labor. It accelerates the opening of the uterus without drugs and painful procedures, while simultaneously removing excess urine before delivery. The technique is safe for the woman in labor and the fetus.

A bladder catheter is also inserted into women for the following diagnoses and conditions of patients:

• diabetes mellitus;
• preeclampsia;
• polyhydramnios;
• multiple pregnancy;
• high blood pressure;
• diseases and heart defects.

Insertion of a urethral catheter is indicated for injuries of the spinal cord and spine: loss of sensation often leads to impaired urination. It is recommended for abnormal structure of the urethra, severe swelling with allergies, side effects of drugs, some rare pathologies and diseases.

Types of catheter

Several types of urinary catheter are used in medical practice. They have an identical principle of operation, but differ in materials, shape and some details. It depends on the purpose and gender of the patient, so the selection of the size should be performed by a specialist after examining the patient.

There are several types of urinary Foley catheter:

• Silicone . The most popular and demanded model that can be used for a long time and repeatedly. High-quality material does not provoke an allergic reaction, inflammation, does not stimulate the development of pathogenic microflora. After the introduction, discomfort quickly disappears, so it is recommended for patients who are on home treatment.
• Latex . More flexible and secure design with easy insertion into the urethra. It can be subjected to heat treatment, therefore it is used repeatedly, it is distinguished by an affordable price and quality. It has a high degree of strength, so it can be used up to 1 month, but in rare cases it provokes allergies.
• Silver plated . The cost of the material affects the price of the urine catheter. But silver effectively destroys bacteria, speeds up recovery, and reduces the risk of secondary infection. Used to stimulate labor in women, for diagnostic procedures, treatment of cystitis and urethritis.

Depending on the severity of the patient’s condition and the proposed diagnosis, the doctor chooses different types of bladder catheter. The most effective in medical manipulations:

• 2-way . The product has one channel, which is inserted into the bladder. It is fixed with a balloon, which inflates and eliminates congestion or swelling. At the first stage, urine is excreted, at the second stage, washing or administration of a medicinal solution is carried out. Easily sterilized, but inconvenient if necessary for daily medical procedures.
• 3 way . A more perfect fixture with an additional channel. It allows you to administer drugs directly at the time of emptying the bladder, to do washing. Such a “female” urinary catheter is recommended for diseases of the uterus, it is prescribed after abdominal operations.

Depending on the size and sex of the patient, doctors select different types of catheters:

• Male urinary catheter . Given the structure of the genital organs and the duration of the urethral canal, it can reach a length of 40 cm. Silicone or latex is more often used, softer and more elastic, with minimal discomfort during insertion.
• Female urinary catheter . It does not exceed 26 cm in length. In patients of the weaker sex, the urethra is located in close proximity to the vagina, so many doctors recommend silver-plated models. They prevent the development of a bacterial infection, are safer during pregnancy.
• Child . Complemented with a special stylet for simplified and painless insertion, made of soft and light material.

For children, it is recommended to choose medical devices from 1. 1 to 3.3 mm in diameter. For adult men, more massive catheters up to 8 mm thick are selected. When choosing, doctors take into account the age and purpose of use, the period for which the balloon is supposed to be inserted.

Catheter placement – basic rules

The procedure must be entrusted to an experienced doctor to avoid complications or infection. All manipulations are performed with sterile gloves with the utmost care. The specialist additionally treats the genitals, the skin around the penis with an antiseptic.

A specific algorithm for insertion of the urinary Foley catheter has been developed:

• For ease of insertion, the tip is liberally lubricated with Vaseline. Women are recommended a high-quality lubricant with a moisturizing effect.
• The external genital organs are thoroughly washed, wiped with a solution based on furacilin, chlorhexidine.
• The patient is placed on his back, legs are bent and spread apart.
• Gently and slowly insert the soft tip into the urethral canal, turning slightly around the axis. A man needs to further move the foreskin to expand the channel.
• Insertion of a catheter into a man is carried out until urine appears in a transparent tube. Spotting in the first portion of urine is not considered an abnormality. Often a complication is associated with the presence of blood in the bladder during an inflammatory process or injury.

When a catheter is placed on a man by a specialist, there should be no acute pain or spasms. Before starting, the doctor carefully examines the history, pictures, to exclude injuries and ruptures. To reduce discomfort, apply a few drops of an anesthetic with lidocaine.

In women, the process of placing a catheter has certain nuances associated with the anatomical features of the body. Before preparing for surgery or labor, after inserting the tube into the urethra, the doctor further expands the channel with a balloon. Up to 10 ml of water is injected into it using a syringe. This ensures uninterrupted excretion of urine.

Women often have a catheter for severe cystitis. In addition to removing urine, an antiseptic solution is injected through thin soft tubes. It removes pathogenic bacteria, normalizes microflora, accelerates recovery.

The most difficult process is placing a urinary catheter in a child. The doctor needs to calm the baby, lay him on his back, carefully treat the external genitalia with a disinfectant. During the introduction, the specialist acts without pressure, in order to exclude rupture of the canal, injuries and pain, he always applies anesthesia. The maximum depth for catheterization of a boy is up to 15 cm, depending on age.

Features for changing and flushing the urinary catheter

The Foley catheter can be used multiple times. But the narrow tube often becomes clogged and requires regular cleaning and rinsing. On average, it can be used for up to 5 days, after which treatment is carried out:

• The doctor carefully treats the hands with an antiseptic, wipes the outer parts and tubes with a solution. A little chlorhexidine is applied to the injection site into the urethral canal.
• Carefully remove the catheter from the tubing and inject saline with a large syringe.
• The liquid after washing is drained, repeated until plaque is completely removed and the tubes are cleaned.

During cleansing, the urinary catheter is only removed from the outside. In this case, the patient does not remove the elements introduced into the urethra. This eliminates pain. If long-term catheterization is necessary, only silicone products are used: they do not deform during heat treatment.

Removing the urinary catheter

Despite the simplicity of the design, an experienced specialist must remove the tube according to a certain algorithm of actions:

• Be sure to treat your hands with a disinfectant solution and wear sterile gloves.
• Carefully remove the retaining clip that prevents the catheter from moving.
• Empty the bladder and tube completely.
• Ask the patient to take a supine position with legs spread apart, to relax as much as possible.
• Carefully remove the assembly slowly without jerks, making sure that there is no damage.

After removal of the Foley catheter, the genitals and urethra are carefully cleaned with an antiseptic solution. For several days, unpleasant sensations may persist during self-urination, which does not require additional treatment or anesthesia.

Urinary Catheter Contraindications

Before using the construct, the clinician must ensure easy and unhindered insertion. The procedure is contraindicated in the following diagnoses and pathologies:

• severe pelvic injuries;
• malignant and benign tumors of the prostate;
• ruptured urethra;
• spasms;
• acute inflammation of unknown etiology.

Do not insert a urinary catheter in men if there is damage to the external genitalia. In such a situation, a more complex system is used, in which the structure is installed in the area above the pubis.

Possible complications

Insertion and removal of a urinary catheter In Kyiv, at home, only an experienced doctor who takes precautions should be entrusted. Otherwise, you may face serious complications:

• infection of the genitourinary system, uterus in women;
• rupture or trauma of the urinary canal with sudden insertion;
• exacerbation of cystitis, urethritis, urolithiasis;
• microtrauma of the cervix.

In parturients, misuse of a Foley catheter can lead to abnormal labor that requires an emergency caesarean section. In some patients, with prolonged wear, irritation of the mucous membranes is observed at the point of contact with silicone or latex tubes.

It is imperative to consult a doctor if the patient’s condition worsens, an admixture of pus or blood appears in the urine. With a secondary infection introduced during the installation of the construct, the patient quickly develops signs of intoxication with fever, chills.