What is the procedure for removing a Foley catheter in a male patient?

Procedure for Removing a Foley Catheter in a Male Patient

To safely remove a Foley catheter in a male patient, deflate the balloon completely before gently withdrawing the catheter, and monitor for successful voiding within 4-6 hours after removal. 1

Preparation

• Gather necessary supplies:

  • Clean gloves
  • Syringe (10 mL)
  • Absorbent pad
  • Waste container
  • Cleansing wipes (if needed)

• Explain the procedure to the patient

• Position the patient appropriately (supine or semi-recumbent)

• Ensure privacy

• Perform hand hygiene and don gloves

Step-by-Step Removal Procedure

1. Deflate the balloon completely:

   • Locate the inflation port (smaller side channel)
   • Insert syringe into the inflation valve
   • Withdraw all fluid from the balloon (typically 5-10 mL)
   • Ensure complete deflation to prevent urethral trauma

2. Remove the catheter:

   • Place absorbent pad under the patient
   • Hold the catheter at the meatus
   • Ask the patient to take a deep breath
   • Gently and steadily withdraw the catheter during exhalation
   • Never force removal if resistance is encountered

3. Assess the catheter:

   • Ensure the catheter is intact
   • Confirm the balloon is completely deflated
   • Check for any abnormalities in the catheter

4. Post-removal care:

   • Clean the perineal area if necessary
   • Dispose of catheter and supplies properly
   • Document the procedure

Post-Removal Monitoring

• Monitor for successful voiding within 4-6 hours after catheter removal 1
• Document time and volume of first void
• Assess for signs of urinary retention:
  • Inability to void
  • Discomfort or pain in lower abdomen
  • Sensation of incomplete emptying
  • Frequent small-volume voids

Special Considerations

• Timing of removal: Remove the catheter as soon as possible, ideally within 24 hours after surgery to reduce risk of urinary tract infection 1
• Balloon deflation issues: If resistance is encountered during deflation, do not cut the inflation valve as this may lead to retained balloon fragments
• Resistance during removal: If resistance is felt during withdrawal, stop immediately and seek medical assistance to prevent urethral trauma
• Hematuria: Small amount of blood-tinged urine is normal; persistent bleeding requires evaluation
• Urinary retention: If no voiding occurs within 6-8 hours or if patient experiences discomfort, perform bladder scan to assess for retention

Assessing Voiding Efficiency After Removal

• The "back fill" technique is superior for assessing adequate bladder emptying after catheter removal 2:
  • Fill bladder with 300 mL saline before catheter removal
  • Patient attempts to void within 15 minutes
  • Measure post-void residual via straight catheterization
  • Successful voiding is defined as voiding ≥2/3 of total bladder volume

Common Pitfalls and How to Avoid Them

• Incomplete balloon deflation: Ensure complete withdrawal of fluid from balloon before attempting removal
• Premature removal: Confirm appropriate timing for removal based on clinical condition
• Forceful removal: Never pull against resistance; seek assistance if catheter does not remove easily
• Inadequate post-removal monitoring: Always document first void and assess for retention
• Improper technique: Maintain sterility and gentle handling to prevent urethral trauma and infection

By following these steps carefully, the risk of complications such as urethral trauma, bleeding, and urinary retention can be minimized while ensuring patient comfort and proper care.