What are the guidelines for inserting a Foley catheter in a female patient?

Guidelines for Foley Catheter Insertion in Female Patients

For female urinary catheterization, maintain strict aseptic technique throughout the procedure, including proper hand hygiene, sterile equipment, and appropriate skin preparation with an antiseptic solution to minimize infection risk. 1

Preparation and Equipment

• Ensure all necessary equipment is gathered before beginning the procedure, including sterile gloves, drapes, antiseptic solution, sterile lubricant, catheter of appropriate size, and collection system 1
• Select the catheter based on intended purpose and duration of use, considering potential complications and patient-specific factors 1
• Perform proper hand hygiene before and after the procedure using antiseptic-containing soap and water or alcohol-based hand sanitizer 1
• Prepare in an environment that permits proper aseptic technique 1

Procedural Steps

Pre-Insertion

• Position the patient in a dorsal lithotomy position with knees flexed and legs abducted 2
• Wear clean or sterile gloves as appropriate for the procedure; sterile gloves are recommended for urinary catheterization 1
• Clean the perineal area thoroughly with an antiseptic solution (70% alcohol, chlorhexidine gluconate, tincture of iodine, or an iodophor) 1
• Allow the antiseptic to dry completely according to manufacturer's recommendations before proceeding 1

Insertion Technique

• Use sterile lubricant on the catheter to minimize trauma during insertion 2
• Separate the labia minora to visualize the urethral meatus, maintaining this position throughout insertion to prevent contamination 2
• Insert the catheter gently into the urethral meatus until urine flow is established, then advance an additional 2-5 cm to ensure proper placement 2
• Inflate the balloon only after confirming proper placement with urine return 2
• Connect the catheter to a closed sterile drainage system 1

Post-Insertion Care

• Secure the catheter properly to prevent movement and urethral trauma, typically to the patient's thigh 1
• Document the procedure, including date and time of insertion, catheter type and size, balloon inflation volume, and any complications 1
• Maintain a closed drainage system to reduce infection risk 1
• Do not submerge the catheter in water, though showering may be permitted if the catheter and connecting device are protected with an impermeable cover 1

Infection Prevention

• Designate trained personnel for insertion and maintenance of catheters to minimize complications 1
• Evaluate the catheter site regularly for signs of infection or complications 1
• Remove the catheter as soon as it is no longer clinically necessary 1
• Do not routinely apply topical antimicrobial or antiseptic ointment to the insertion site 1
• Do not administer prophylactic systemic antimicrobials routinely before insertion 1

Common Pitfalls and Considerations

• Inadequate visualization of the urethral meatus can lead to accidental vaginal insertion; if this occurs, leave the misplaced catheter as a landmark and use a new sterile catheter 2
• Inexperienced providers have been associated with higher rates of catheter-associated urinary tract infections; proper training and supervision are essential 3
• Forcing catheter insertion against resistance can cause urethral trauma; if resistance is encountered, do not force the catheter 2
• Premature balloon inflation before the catheter is properly positioned in the bladder can cause urethral trauma 2
• For patients with anatomical variations or previous pelvic surgery/trauma, consider specialized approaches or consultation with experienced providers 4