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03.01 Inserting a Foley (Urinary Catheter) – Female

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Overview

  1. Purpose
    1. Placement of a foley catheter is done to collect urine for the following possible reasons:
      1. Urinary retention
      2. Genitourinary surgery  or trauma
      3. Divert urine away from perineum due to large open wound
      4. During surgery or in women with an epidural
    2. It should NOT be placed solely for incontinence
    3. Foley catheters should be removed ASAP to prevent Catheter-Associated Urinary Tract Infections (CAUTI)

Nursing Points

General

  1. Supplies needed
    1. Sterile gloves
    2. Foley Insertion Kit
      1. Sterile gloves
      2. Foley catheter
      3. Drainage bag
      4. Stat-Lock (securing device)
      5. Povidone Iodine swabs or a pouch + cotton balls/applicactor
      6. Lubricant jelly
      7. 10mL syringe of saline
      8. Drapes
        1. One full drape
        2. One with hole
    3. Supplies for perineal care

Nursing Concepts

  1. Steps and Nursing Considerations
    1. Verify order
    2. Explain procedure to patient
    3. Gather supplies on bedside table
    4. Perform hand hygiene
    5. Don clean gloves
    6. Raise the bed to working height
    7. Assist patient into appropriate position
      1. For women – supine, knees bent with feet close to hips, allow knees to fall to the side
    8. Perform perineal care if needed with warm soapy water or bath wipes – dry the area well
    9. Remove clean gloves
    10. Perform hand hygiene
    11. Open the foley kit, remove the package from the plastic bag.
      1. Fold the top of the bag over to create a trash receptacle
    12. Open the sterile kit on the bedside table, opening the kit away from you
    13. Place the kit between the patient’s legs, reminding them not to move their legs or touch the kit
    14. Carefully grasp the sterile gloves off the top of the  package without touching any other items
    15. Apply sterile gloves without turning your back on the sterile kit
    16. Remove the full drape and carefully place under the patient’s perineum
      1. Your hands should not touch the patient or the sheets
      2. Roll the drape around your hands
      3. Shiny side DOWN
      4. The top side should not touch the patient or bed
    17. Apply the drape with a hole in it over the patient’s perineum gently, without touching the patient’s skin
    18. Slide the kit towards the patient’s feet and remove the plastic tray – place the plastic tray on the sterile field closer to the patient’s perineum (over the drape)
    19. Prepare the items in your kit:
      1. Remove the plunger from the lubricant syringe
      2. Carefully remove the catheter from its package (usually has a perforation of some sort)
      3. Place the end of the catheter in the lubricant syringe, then set down on the tray
      4. Attach the saline syringe to the balloon port, but do NOT inflate
        1. **NOTE – it is NO LONGER recommended to inflate the balloon prior to insertion!
      5. Apply the iodine to the cotton swabs OR open the swabs package
    20. Use your nondominant hand to spread the labia majora and hold them open (don’t move your hand once you’ve held it open!)
      1. Always let the patient know you’re going to touch them
    21. Use your dominant hand to cleanse the meatus
      1. From front to back on the right
      2. Front to back on the left
      3. Front to back down the center
    22. In females – look for the ‘wink’ of the urethral opening as you cleanse
    23. Holding the labia open with your nondominant hand, carefully pick up the catheter out of the lubricant syringe with your dominant hand
    24. Warn the patient they will feel some pressure
    25. Gently insert the catheter into the urethral opening until you see a flash of urine in the tube
    26. Advance 1 inch further, then inflate the balloon
      1. If you meet ANY resistance, deflate the balloon, advance the catheter 1 more inch, then reinflate
      2. This should NOT be painful!
    27. Once the balloon is fully inflated, remove the syringe quickly or it will deflate on its own
    28. Gently pull the catheter out until slight resistance is felt
    29. Secure the catheter to the patient’s upper thigh, leaving slack for movement
    30. Remove the drape and supplies from between the patient’s legs and discard in the appropriate waste container
    31. Hang the drainage bag
      1. On the bed
      2. Off the floor
      3. Below the bladder
    32. Remove gloves
    33. Perform hand hygiene
    34. Return the bed to a low/locked position
    35. Return the patient to a comfortable position
      1. Apply clean gloves and perform perineal care again if needed
    36. Document
      1. Urine color, clarity, and amount
      2. Procedure
      3. Size of catheter
      4. Patient’s response / tolerance
  2. Notes
    1. If catheter is accidentally placed in vagina
      1. LEAVE the catheter in place.
      2. Get a new kit and start over
      3. This helps to know where NOT to go!

Patient Education

  1. Purpose for catheter
  2. May feel like you have to void/are voiding – but the catheter will catch it
  3. Signs of UTI to report to nurse
  4. Criteria for removal of catheter (if appropriate)

Reference Links

Study Tools

Video Transcript

In this video, we’re going to look at inserting a foley catheter in a female. Of course make sure you’ve verified your order and told the patient what’s happening. You’ll also typically want to perform perineal care before you start.

Then you’ll want to assist the patient into the appropriate position. For females, that’s supine with their knees bent and feet close to their hips – allowing their knees to fall to the side. You may need a helper to help hold the patient in this position.
Then you’ll open the foley kit and remove the package from the plastic bag. Fold the top of the bag over to create a little trash bag and set it beside the patient’s hips near you.
Open the sterile kit on the bedside table, opening the kit away from you. Then pick up the kit from the bottom and place it between the patient’s legs, reminding them not to move their legs or touch the kit.
Carefully grasp the sterile gloves off the top of the package without touching any other items, and apply them… without turning your back on the sterile kit. See the sterile glove lesson if you need more details on this part.
Now you’ll want to grab the full drape and carefully place it under the patient’s perineum, shiny side down. Here’s the tricky part. Your hands should not touch the patient or the sheets… So I will wrap my sterile hands up in the drape and tuck it that way, so my hands are only touching the drape.
Then I grab the drape with a hole in it and place it over the patient’s perineum gently, without touching the patient’s skin.
Now you can slide the kit towards the patient’s feet and remove the plastic tray. Then, put the plastic tray on the sterile field closer to the patient’s perineum – I usually hook it on the side here to keep it steady. So now you’ve set yourself this nice wide sterile field to work with!
Now you’re going to prepare the rest of the items in your kit. You need to lubricate the catheter, so we’re going to show you our favorite trick. Remove the plunger from the lubricant syringe. Then carefully remove the catheter from its package. Careful, it might whip around! Then, place the end of the catheter in the lubricant syringe, then set it down on the tray. Not only does it lubricate it for you – but it also holds it for you! Genius, right!?
Next you will attach the saline syringe to the balloon port, but do NOT inflate. We USED to check the balloon, but evidence shows that is NO longer recommended!
Now you can apply the iodine to the cotton swabs OR open the swabs package. Now – we couldn’t apply the iodine to the mannequin, so for this ONE part, you’ll have to use your imagination, sorry guys!
Okay! Time to insert. Make sure you let the patient know. I usually say something like “you’re gonna feel me touching you now”. Use your non-dominant hand to spread the labia majora and hold them open. Once you do this, that hand is now NON-sterile and you can’t move it once you hold the labia open!
Use your dominant hand to cleanse the meatus. Always move front to back. Start on the right, then the left, then down the center. If you need to, go down the center again. You should look for the ‘wink’ of the urethral opening as you’re cleansing. Remember not to put these back on your sterile field – that’s what your little trash bag was for!
Keep holding the labia open with your nondominant hand, and carefully pick up the catheter out of the lubricant syringe with your dominant hand.
Warn the patient they will feel some pressure and then gently insert the catheter into the urethral opening until you see a flash of urine in the tube.
Once you see it, advance 1 inch further, then inflate the balloon. If you meet ANY resistance, deflate the balloon, advance the catheter 1 more inch, then reinflate. Inflating the balloon should be easy and PAINLESS.
Once the balloon is fully inflated, remove the syringe quickly or it will deflate on its own! Then gently pull the catheter out until slight resistance is felt. That just tells you it’s sitting at the base of the bladder.
Now you can secure the catheter to the patient’s upper thigh, usually with a StatLock or a piece of silk tape. Just make sure you leave enough slack for movement.
Now you can remove the drape and supplies from between the patient’s legs, cover them back up, and then discard your supplies in the appropriate waste container.
And, finally, you want to hang the drainage bag on the bed, below the bladder, but off the floor. Make note of the color and clarity of the urine, as well as how much came out and document the insertion.
So that’s it for inserting a foley in a female. If you want to see how to insert a foley in a male, we have a whole video for that as well!

We love you guys! Go out and be your best selves today! And, as always, happy nursing!

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