Foley catheter insertion is a basic nursing procedure which refers to the insertion of an indwelling urinary catheter into the bladder to drain urine. The catheter usually remains intact into the bladder through an inflated balloon for a continuous urine flow to relieve bladder distention caused by urine retention secondary to trauma, surgery and post child delivery. Other instances where foley catheter insertion is indicated would include urinary tract obstruction (like new growth or prostatic hypertrophy), urinary tract infection or urine retention related to spinal cord injury and in any case where urine monitoring and evaluation is crucial for patient’s plan of care.
The procedure entails the insertion of a foreign object into the body, hence, sterile technique should be observes during the entire procedure to avoid contamination which may be a possible source of infection. Likewise, extreme care is also needed when inserting the catheter to prevent trauma into the urethra.
Step by Step Procedure of Foley Catheter Insertion
1. Check doctor’s order for catheter insertion, wash hands and prepare all the materials needed for the procedure to minimize nurse travel conserving energy and time.
- Foley Catheter refers to a thin, sterile tube made up of latex or silicone with varying sizes measured in terms of French(FR) where one French is equal to 1/3 of 1mm. Sizes vary from #10- 22(Average adult size is #14 to #16). Size usually indicates the circumference of the catheter tip.
- Syringe filled with 10 cc sterile water or saline solution (take note that there are varying sizes for the balloon so always check how much the balloon is made to hold when inflating it with water)
- Sterile gloves(size depends on whoever will be in charge in doing the procedure)
- Sterile drapes to safeguard the privacy of the patient
- Cotton swabs and cleansing solution
- Lubricant(water based jelly is preferred)
- Urine bag
Examples of catheter
2. Identify client by asking her name. Explain procedure to the client at his level of understanding. Explaining procedure to the client promotes cooperation, relaxes the patient and avoids anxiety thus, doing the procedure would be more efficient.
- Assist client in assuming dorsal recumbent position. This position allows visualization of the urethra also, the bladder is relaxed thus, facilitating smoother catheter insertion.
- Put on sterile gloves. The urethral cavity is a sterile area. Putting on sterile gloves limits the possibility of introducing harmful bacteria that may cause infection.
5. Open the catheter assembly or kit. Ensure that the correct catheter is on hand with special consideration to FR size and the material used.(For patients known to be allergic to latex, a catheter made of silicon may more appropriate)
- Protect privacy of client by putting on drapes.
- Disinfect the genital area using cotton swabs soaked in a disinfecting solution. This eliminates microorganism which may gain entry into the urethra during insertion preventing infection.
Using your dominant hand, separate the labia, wipe one side of the urinary meatus with a single downward motion using the disinfectant soaked cotton swab. Do the same with the other side using a new cotton swab. Then another stroke(use 3rd piece of cotton swab) over the meatus taking care not to contaminate the sterile gloves.
Using non dominant hand, hold the penis perpendicular to the body(this position must be maintained during the entire procedure to straighten the urethra), get a cotton swab and cleanse the glans penis using a circular motion from inner to outer. (Take note that if the penis is uncircumcised, the foreskin must be retracted to expose the urethral opening)
8. Pick up catheter using dominant hand. Loosely coil end of catheter to palm of dominant hand.
9. Apply water based lubricant at the tip of the catheter (about 2-5 cm).
10. Gently insert the catheter into the urethral meatus.
Using non dominant hand, spread the labia, while the dominant hand which holds the catheter will be used in the gentle insertion of the catheter into the urethral meatus.
Hold the penis perpendicular to the body to straighten urethra using non dominant hand while the dominant hand is gently inserting the catheter.
Note: Instruct client to take a deep breath while inserting the catheter to relax the sphincter which eases insertion. Hold the catheter close to the tip while insertion to control the direction of the insertion.
11. While inserting, observe closely the point at which urine flows indicating that the catheter has already reach the urinary bladder. Attach the urine bag(if it is indicated, obtain urine specimen at the middle of the flow before attaching it to the urine bag) and secure it.
12. Inflate the balloon using the 10 cc syringe filled with sterile water or saline solution. Gently pull the catheter after inflating the balloon to ensure that the catheter is snug against the bladder neck. Secure the catheter by tailing it into the patient’s thigh. Likewise, the drainage bag should also be secured at a level lower than the patient’s bladder to ensure gravitational flow of urine preventing ascending infection.
13. Do after care of the materials used.
14. Document the procedure taking note of the color, amount, consistency of urine in the patient’s record.
Catheter insertion may be a basic nursing procedure, fundamental as it may seem but a very important nursing skill which aspiring as well as professional nurses must be adept with in order to be efficient and effective in delivery pertinent nursing care to patients.