What are the procedural steps for Foley bladder catheterization?

Procedural Steps for Foley Bladder Catheterization

The proper technique for Foley bladder catheterization requires strict adherence to aseptic technique, proper patient positioning, and careful insertion to minimize the risk of urinary tract infections and trauma.

Preparation

• Gather all necessary equipment before beginning: sterile gloves, sterile drapes, antiseptic solution (70% alcohol and/or 10% povidone-iodine), sterile lubricant, appropriate size Foley catheter, sterile water for balloon inflation, drainage bag, and tape 1
• Explain the procedure to the patient and obtain consent
• Position the patient appropriately: supine with legs spread and feet together (frog-leg position) for females; supine for males 1
• Perform thorough hand hygiene with antibacterial soap or alcohol-based hand cleaners 1

Sterile Field Setup

• Open the sterile kit using aseptic technique
• Don sterile gloves
• Create a sterile field and arrange all supplies within it
• Pour antiseptic solution over the cotton balls/swabs in the sterile field 1

Cleansing Procedure

• For females:
  • Separate the labia with non-dominant hand (now considered contaminated)
  • Use dominant hand to clean with antiseptic swabs, moving from anterior to posterior (front to back), using a new swab for each stroke 1
  • Clean the urethral meatus first, then move outward in single strokes
• For males:
  • Hold the penis with non-dominant hand (now considered contaminated)
  • Retract the foreskin if uncircumcised
  • Clean the glans penis in a circular motion starting from the urethral meatus and moving outward 1
  • Use a new antiseptic swab for each circular motion

Catheter Insertion

• Apply sterile lubricant to the catheter tip 1
• For females:
  • Maintain labial separation with non-dominant hand
  • Insert catheter 5-7.5 cm until urine flow is observed 1
• For males:
  • Hold penis perpendicular to body (at 90° angle) with non-dominant hand
  • Insert catheter 17-22.5 cm until urine flow is observed 1
  • Lower the penis after insertion

Securing the Catheter

• Once urine flow is established, advance the catheter an additional 2-5 cm 1
• Inflate the balloon with the recommended amount of sterile water (usually 5-10 mL, check catheter specifications)
• Gently pull back on the catheter until resistance is felt, indicating proper balloon placement
• Connect the catheter to the drainage system 1
• Secure the catheter to the patient's thigh (for females) or lower abdomen (for males) to prevent movement and urethral trauma 1

Post-Insertion Care

• Ensure the drainage bag is positioned below the level of the bladder to prevent backflow 1
• Document the procedure, including catheter size, balloon inflation volume, urine characteristics, and patient tolerance 1
• Maintain a closed urinary drainage system to minimize infection risk 1
• Remove the catheter as soon as clinically feasible, ideally within 24-48 hours after placement to minimize infection risk 2

Common Pitfalls and Complications

• Never force the catheter if resistance is met - this can cause urethral trauma 1
• Do not inflate the balloon until urine flow is established and proper placement is confirmed 1
• Avoid contaminating the sterile field or catheter during the procedure 1
• Monitor for signs of urinary tract infection, which can develop rapidly with indwelling catheters 3, 4
• Catheter-associated UTIs account for approximately 80% of hospital-acquired infections, with risk increasing about 5% per day of catheterization 1

Special Considerations

• Use the smallest appropriate catheter size to minimize urethral trauma and discomfort 5
• Consider intermittent catheterization instead of indwelling catheters when appropriate, as it is associated with lower infection rates 1
• For patients with recurrent catheter-associated infections, consider using silver alloy-coated catheters, which may reduce infection risk 2, 4
• Ensure proper documentation of the indication for catheterization 1