I.

Introduction
Foley Catheterization
a. Involves the introduction of a rubber or plastic tube through the
urethra into the bladder
b. A urinary catheter is a hollow, partially flexible tube that collects
urine from the bladder and leads to a drainage bag. Urinary
catheters come in many sizes and types and can be rubber,
plastic or silicone

II. Discussion
a. Importance
i. Catheters are generally necessary when someone cant
empty their bladder. If the bladder isnt emptied, urine can
build up and lead to pressure in the kidneys. The pressure
can lead to kidney failure, which can be dangerous and
result in permanent damage to the kidneys
ii. Most catheters are necessary until you regain the ability to
urinate on your own, which is usually a short period of
time. Elderly people and those with a permanent injury or
severe illness may need to use urinary catheters for a
much longer time or permanently
iii. The insertions of Foley Catheterization can help health care
professionals determine any abnormalities and possible
treatment options

b. Purpose
i. To relieve acute or chronic urinary retention
ii. To empty the bladder before, during and after surgery and
before certain diagnostic procedure
iii. To determine amount of residual urine after voiding
iv. To measure accurately the hourly urine output of critically
ill patients
v. To instill medications into the bladder
vi. To irrigate the bladder
vii. To obtain urine specimen for diagnostic purposes

c. Types:
i. Intermittent Catheters
This is also known as straight catheters which are
placed into the bladder for short periods of time
ii. Indwelling/retention or Foley Catheter
Are those placed into the bladder for extended
periods of times
 These catheters have a balloon at the distal end that
is inflated after insertion
iii. Condom Catheters
A device that looks like a condom covers the penis
head. A tube leads from the condom device to a
drainage bag
These catheters are generally more comfortable and
carry a lower risk of infection than indwelling
catheters

d. Steps included
i. Assess the bladder fullness before performing procedure,
and question patient about any allergy especially to latex
and iodine
ii. Ask the patient if she has been catheterized. If she had an
indwelling catheter previously, ask why and for how long it
was used. The patient may have urethral stricture that
make insertion difficult

Urethral Catheterization Female

1. Begin by introducing yourself to the patient and clarify the identity.

Explain what you would like to do and obtain her consent
a. Rationale: explanation encourages patient cooperation and
reduced apprehension
2. Prepare your equipment for the procedure:
a. FC pack (12 14 FC, catheter bag)
b. Antiseptic Solution
c. Sterile Gloves
d. 10ml saline filled syringe
i. Rationale: organization facilitates performance of the task
3. Position the patient on her back, lying as flat as possible. Ask her to
put her ankles together and let her knees fall apart
a. Rationale: Good visualization of the meatus is important.
4. Using an aseptic technique open the catheter pack and pour antiseptic
solution into the receiver. Open the rest of your equipment onto the
sterile field.
a. Rationale: Placement of equipment near worksite increases
efficiency. Sterile technique protects patient and prevents the
spread of microorganism
5. Wash and dry your hand, then put on the sterile gloves
a. Rationale: Hand hygiene defers spread of microorganisms
6. Drape the patient and place a collecting vessel between the patients
legs
 a. Rationale: Exploiting and tension can interfere with catheter
insertion thus patient comfort will promote relaxation.
7. With your non-dominant hand, part the labia. Using a saline soaked
gauze balls clean the urinary meatus with your right hand. Remember
to single downward movements each
a. Rationale: Moving from one area where there is likely to be less
contamination helps prevent the spread of microorganism.
Cleaning the meatus last helps reduce the possibility of
introducing microorganism into the bladder
8. Using your dominant hand only, pick up the catheter by its sleeve and
start it to insert it into the meatus. Continuing to use the sleeve, insert
insert the catheter until the end arm reaches the meatus. At this point,
urine should start to flow into the collecting vessel.
a. Rationale: The female catheter is about 3.7 to 6.2 cm (1.5 to
2.5) long. Applying force on the catheter is likely to injure the
mucous membrane. By asking the patient to breathe deeply, this
will allow the sphincter to relax and the catheter can enter the
bladder easily.
9. Inflate the balloon using 10ml of saline, ensuring that it does not
cause any pain. NB the volume used to fill the balloon may vary
depending upon the size of the catheter used, check the packaging got
the exact volume to use.
a. Rationale: The balloon anchors the catheter in place in the
bladder. Sterile water is used to inflate the balloon as a
precaution in case the balloon ruptures
10. Attach the catheter bag
a. Rationale: Closed drainage system minimizes the risk for
microorganism being introduced into the bladder
11. Gently pull on the catheter until resistance is felt. This is when
the balloon will be resting n the urethral opening of the bladder
a. Rationale: Improper inflation can cause patient discomfort and
improper position of the catheter
12. Dispose of gloves and equipment in the clinical waste bin. Wash
your hands
13. Afterwards record the volume of the urine collected in the
catheter bad and ensures that the patient is comfortable
a. Rationale: This facilitates drainage of urine and prevents any
backflow of urine. A careful record is important for planning the
patients care

e. Precautions
i. Urine flow contains large amount of sediments and then
suddenly stops; bladder remains palpable
 Nursing Action: Urinary catheter may be clogged
with sediments. After obtaining the physicians order,
gently irrigate the catheter
ii. After balloon is inflated, patients void large amount of
urine
Nursing Action: Check to make sure that required
amount of solution has been injected into the
balloon. Do not over inflate balloon. Leaking around
a catheter is a common occurrence when initially
inserting catheter owing to a large amount of urine
pressure. If this continues to happen, a larger
catheter may need to be inserted
iii. Patient complains of extreme pain after inflating the
balloon
Nursing Action: STOP inflation of balloon. Balloon is
most likely still in urethra. Allow solution in a balloon
to withdraw. Insert catheter an additional 1.3 to
2.5cm and slowly attempt to inflate the balloon
again.
iv. If there is no immediate flow of urine after the catheter
has been inserted, several measures may prove helpful:
Have the patient take a deep breath, which helps to
relax the perineal and abdominal muscles
Rotate the catheter slightly, because a drainage hole
may be resting against the bladder wall
Raise the head of the patients bed to increase the
pressure in the bladder area
III. Termination of Care
a. Encourage use of the bedside commode or bathroom within 4-6
hours after the Foley is removed
b. Clients may have trouble urinating. If this happens, try sitting in
a few inches of warm water (sitz bath). This may help the client
to relax.
c. Client may have some burning the first few times urinate. If the
burning lasts longer, it may be a sign of an infection and would
need to notify MD
d. Advise to drink plenty of fluids to flush out the urinary stasis in
the bladder
e. Wear loose cotton underwear if client has irritation or
a rash from catheter use
IV. When To Replace
a. If a Foley catheter has been in place for 3 days (72 hours) or
longer, the nurse should provide daily reminders to the physician
recommending the removal of the Foley catheter (unless the
Foley catheter is still indicated).
i. Indications for continued Foley usage include:
unresolved urinary retention, urinary tract obstruction,
critically ill patients, acute renal insufficiency fluid
challenge, comfort care of the terminally ill, to promote
healing on an area of skin breakdown, to provide
medications directly to the bladder, and for the
management of neurogenic bladder
V. Conclusion
a. As part of the HC professional, we should ensure to adhere to
protocols given by the facility. Our goal would always be the
patients safety, by keeping in mind that performing the
procedure correctly and aseptically. By following each steps and
anticipating where red flags usually noted, we can decrease the
incidence of hospital acquired infections suffered by our clients.