Urinary Catheter Insertion (Foley Catheter)
Category: Urological
Overview
A sterile procedure involving insertion of a flexible tube into the bladder through the urethra to drain urine continuously.
Indications
Urinary retention, accurate measurement of urine output in critically ill patients, perioperative use for surgeries >2 hours, immobilized patients unable to use bedpan, chronic incontinence when other methods fail, bladder irrigation.
Contraindications
Urethral trauma or obstruction, severe prostatitis, recent urethral surgery, suspected urethral stricture, patient refusal when not medically necessary, active urethral bleeding.
Equipment Needed
Sterile catheter insertion kit containing: Foley catheter (14-16 Fr for adults), sterile gloves, antiseptic solution (betadine or chlorhexidine), sterile water-soluble lubricant, 10mL syringe for balloon inflation, closed drainage bag, sterile drapes, cotton balls or gauze, specimen container if needed.
Procedure Steps
1. Verify physician order and explain procedure to obtain consent
2. Ensure privacy and position patient appropriately (female: supine with knees flexed; male: supine)
3. Perform hand hygiene and don sterile gloves
4. Open catheter kit maintaining sterility
5. Test balloon integrity with sterile water
6. Drape patient with sterile drapes exposing only urethral meatus
7. Clean urethral meatus with antiseptic (female: labia majora to minora, anterior to posterior; male: retract foreskin, cleanse in circular motion from meatus outward)
8. Lubricate catheter tip generously (2 inches for female, 7 inches for male)
9. Insert catheter gently until urine returns (6-8 inches female, 8-10 inches male)
10. Insert additional 1-2 inches to ensure balloon is in bladder
11. Inflate balloon with sterile water per manufacturer instructions (usually 10mL)
12. Gently pull catheter until resistance is felt (balloon at bladder neck)
13. Connect to closed drainage system and secure catheter to thigh
14. Position drainage bag below bladder level
15. Document insertion, balloon volume, and initial drainage
Safety Considerations
Maintain strict sterile technique throughout procedure. Use adequate lubrication to prevent urethral trauma. Never force catheter insertion - stop if resistance is met. Ensure balloon is in bladder before inflation. Secure catheter to prevent tension on urethra. Use smallest appropriate catheter size.
Potential Complications
Urethral trauma, bleeding, catheter-associated urinary tract infection (CAUTI), bladder perforation, paraphimosis (in uncircumcised males), balloon rupture, catheter obstruction, bladder spasms.
Documentation
Record date and time of insertion, catheter type and size (French), balloon size and volume of inflation, initial urine output characteristics (color, clarity, amount), patient tolerance, any complications, and nurse initials.
References
Centers for Disease Control and Prevention. (2019). Guideline for Prevention of Catheter-Associated Urinary Tract Infections. https://www.cdc.gov/infection-control/hcp/cauti/?CDC_AAref_Val=https://www.cdc.gov/infectioncontrol/guidelines/cauti/index.html