Foley Catheterization

🔶 Objective

To safely insert a Foley catheter for urinary drainage while maintaining aseptic technique and ensuring patient comfort.

✅ Indications

Clinical Situation / indication	Reason for Catheterization
Urinary retention	Inability to void voluntarily (e.g., post-surgery, BPH)
Accurate urine output monitoring	ICU, post-operative, septic shock, or during fluid management
Surgical procedures	During or after urological/gynecological surgeries
Bladder irrigation	For hematuria or clot retention (with 3-way catheter)
Immobilized patients	For pressure sore prevention in patients with incontinence
Neurogenic bladder	E.g., spinal cord injury
Sterile sample collection	For uncontaminated urine culture

❌ Contraindications

Condition	Reason to Avoid or Use with Caution
Suspected or known urethral trauma	Common in pelvic fracture – blood at meatus is a red flag
Recent urethral surgery or stricture	Increases risk of injury or misplacement
Allergy to latex or catheter material	Use silicone catheter instead
Prostate enlargement with resistance	May require specialized catheter (e.g., coude tip)
Active urinary tract infection	Consider alternatives unless absolutely necessary
Severe urethral pain or bleeding during attempt	Abort and notify physician

🧰 Articles Required and Use Timing

Article	Used At Step	Purpose
Sterile Gloves	Step 2	Prevent contamination
Foley Catheter (12–16 Fr)	Step 5	Drain urine; size depends on patient condition
Lubricating Jelly	Step 4	Reduces trauma during insertion
Antiseptic Solution	Step 3	Cleans genitalia, reduces infection risk
Syringe (10 mL, sterile water)	Step 6	Inflates balloon after urine flow
Urine Bag	Step 5–7	Collects urine; always below bladder level
Tape/Catheter Strap	Step 8	Prevents dislodgement
Mackintosh & Towel	Step 1	Keeps bed clean
Waste Disposal Bag/Sharp Bin	Step 10	For biohazard disposal
Documentation Sheet	Step 11	Records date, catheter type, nurse's name, findings, etc.

👥 Human Response (Patient Greeting & Communication)

“Hello [Mr./Ms.], I am [Your Name], a nursing student/nurse. Today, I will insert a catheter to help drain your bladder. I’ll ensure your privacy and comfort throughout. Do you have any questions before we begin?”

🛏️ Patient Positioning & Sites

Sex	Position	Insertion Site	Approx Length
Female	Dorsal recumbent	Urethral meatus (between labia)	5–7 cm
Male	Supine	Urethral opening at penis tip	17–22 cm

⚠️ Abnormal Findings & Action

Finding	Possible Cause	What to Do
Resistance during insertion	Enlarged prostate or urethral stricture	Stop, notify physician
Catheter enters vagina (female)	Poor visibility	Leave in place, use new sterile one
No urine output	Not in bladder or blockage	Reposition or flush
Pain or bleeding	Trauma	Stop immediately, report
Cloudy or foul-smelling urine	UTI	Monitor and report

✅ Step-by-Step Procedure with Details

1. Preparation & Patient Communication

Articles Used:

• Mackintosh

• Towel

• PPE (gloves, apron, mask)

Steps:

• Wash hands thoroughly.

• Introduce yourself to the patient.

• Verify identity using name, age, and wristband (if available).

• Explain the procedure:"This is a sterile procedure to help you empty your bladder. You might feel a little discomfort during insertion, but I’ll guide you through it."

• Gain informed consent verbally.

• Provide privacy using curtains or screens.

• Position the patient:

  • Female: Dorsal recumbent (lying on back, knees bent and apart).

  • Male: Supine with legs slightly apart.

• Place mackintosh and towel under the buttocks to protect bedding.

2. Set Up Sterile Field & Equipment

Articles Used:

• Sterile catheterization kit

• Sterile gloves

• Sterile drape

• Sterile tray

• Pre-filled syringe with sterile water (10 mL)

Steps:

• Open sterile tray and catheter pack on a clean surface.

• Don sterile gloves using correct technique.

• Arrange all articles in sterile order (catheter, lubricating jelly, syringe, etc.).

• Place sterile drape over perineal area.

3. Cleanse Genital Area (Aseptic Technique)

Articles Used:

• Antiseptic solution (e.g., povidone-iodine or chlorhexidine)

• Sterile cotton balls/swabs

• Artery forceps

Steps:

• Female:

  • Separate labia with non-dominant hand.

  • Clean one side of labia majora → minora (top to bottom).

  • Repeat on other side with new swab.

  • Final swab down the center over urethral opening.

• Male:

  • Retract foreskin (if uncircumcised).

  • Clean in a circular motion from the meatus outward.

  • Hold penis perpendicular to body.

⚠️ Do not let your non-dominant hand touch anything sterile once you start.

4. Lubricate and Insert Catheter

Articles Used:

• Foley catheter (12–16 Fr)

• Lubricating jelly

Steps:

• Squeeze lubricating jelly onto catheter tip (approx 5–7 cm).

• Insert catheter gently into the urethra:

  • Female: Insert 5–7 cm or until urine appears.

  • Male: Insert 17–22 cm until urine appears.

If resistance is felt:

• Never force.

• Ask patient to breathe deeply to relax pelvic muscles.

• Stop if resistance persists or bleeding occurs.

5. Confirm Placement and Inflate Balloon

Articles Used:

• 10 mL syringe with sterile water

• Catheter balloon port

Steps:

• Once urine flows, advance catheter 2–3 cm further to ensure it is inside the bladder.

• Inflate balloon with 10 mL sterile water slowly.

• Gently pull catheter until resistance is felt – indicates balloon is seated.

⚠️ Never inflate balloon before confirming urine flow – may injure urethra.

6. Connect Urine Bag & Secure Catheter

Articles Used:

• Closed urinary drainage bag

• Catheter securement device or tape

Steps:

• Attach catheter to urine bag tubing.

• Secure catheter to thigh (female) or lower abdomen (male) to prevent pulling.

• Ensure urine bag hangs below bladder level – not touching the floor.

• Loop tubing to prevent tension or backflow.

7. Clean Up & Dispose

Articles Used:

• Gloves

• Waste disposal bags

• Sharps container (if applicable)

Steps:

• Discard used items in appropriate bins (biohazard for contaminated items).

• Remove gloves, perform hand hygiene thoroughly.

8. Documentation

Record the following:

• Date and time of insertion

• Catheter type and size (e.g., Foley 14 Fr, 10 mL balloon)

• Volume of balloon inflation

• Characteristics of urine (color, odor, clarity, amount)

• Patient's tolerance and any abnormalities

• Signature and designation of performing nurse

  
  

✅ Sample of Documentation

Field	Example
Date & Time	22/04/2025 – 10:45 AM
Patient Name & ID	Mr. Ramesh, 208954
Catheter Type & Size	14 Fr Foley, 2-way
Balloon Volume	10 mL sterile water
Route	Urethral
Urine Output	Clear yellow, 120 mL
Patient Response	Cooperative, no discomfort
Performed By	S. Patel, 4th Year BSc Nursing Student

📌 Post-Procedure Care

• Observe for signs of infection, bleeding, or discomfort.

• Educate patient not to pull or tug catheter.

• Check urine output regularly.

🔍 Optional Notes for Ongoing Care:

• Monitor hourly urine output (if ordered).

• Keep bag below bladder level at all times.

• Check tubing for kinks or obstruction.

• Empty drainage bag when ¾ full.

• Perform catheter care per shift using aseptic technique.

📍 Sites of Insertion & Possible Abnormalities

Site/Patient	Notes	Abnormalities
Female urethra	Shorter length; use care not to insert into vagina	Vaginal misplacement, discomfort
Male urethra	Longer and may curve; consider coude tip if enlarged prostate	Resistance, trauma
Suprapubic (by MD only)	Alternative for long-term use	Redness, leaking, infection risk

🚩 Red Flags to Report Immediately

• No urine output within 30 min of insertion

• Bleeding from urethra

• Severe pain or resistance

• Balloon inflated without confirming placement

• Cloudy, foul-smelling urine or fever (possible UTI)

📚 Example Case

Case: Female patient post-hysterectomy, unable to void.Procedure: Foley 14 Fr inserted; urine output 250 mL in first hour.Notes: No resistance; balloon inflated with 10 mL; catheter secured; documented in EMR.