What is the proper procedure for inserting a Foley catheter?

Foley Catheter Insertion Procedure

Foley catheter insertion requires strict aseptic technique with proper hand hygiene, sterile equipment, and appropriate antiseptic skin preparation to minimize infection risk, following a systematic approach from preparation through post-insertion care. 1

Pre-Procedure Preparation

Equipment Assembly

• Gather all necessary equipment before beginning: sterile gloves, sterile drapes, antiseptic solution (preferably 2% chlorhexidine, or alternatively tincture of iodine, iodophor, or 70% alcohol), sterile lubricant, appropriately-sized catheter, sterile water for balloon inflation, and a closed sterile drainage system 1, 2
• Select catheter size based on intended purpose, duration of use, and patient-specific factors 1
• Connect the catheter to a closed sterile drainage system before insertion 1

Hand Hygiene and Aseptic Technique

• Perform proper hand hygiene using antiseptic-containing soap and water or alcohol-based hand sanitizer before beginning the procedure 1, 2
• Maintain strict aseptic technique throughout the entire procedure 2
• Wear sterile gloves for urinary catheterization 1, 2

Insertion Procedure

Patient Positioning and Site Preparation

• For female patients: Position supine with knees flexed and legs abducted 1
• Clean the perineal area thoroughly with antiseptic solution (2% chlorhexidine preferred, or 70% alcohol, tincture of iodine, or iodophor as alternatives) 1, 2
• Critical step: Allow the antiseptic to dry completely according to manufacturer's recommendations before proceeding—povidone iodine must remain on skin for at least 2 minutes or until completely dry 2, 1
• Do not apply organic solvents (acetone or ether) to the skin 2

Catheter Insertion

• Apply sterile lubricant to the catheter tip 1
• Insert the catheter gently through the urethra into the bladder until urine flows 1
• Advance the catheter an additional 1-2 inches after urine return to ensure the balloon is completely within the bladder 1
• Inflate the balloon with sterile water (typically 10 mL, though normal saline is equally effective if sterile water is unavailable) 3
• Gently pull back on the catheter until resistance is felt, confirming proper balloon positioning 1

Post-Insertion Care

Immediate Securing and Documentation

• Secure the catheter to the patient's thigh to prevent movement and urethral trauma 1
• Document the procedure including date, time of insertion, catheter type and size, balloon inflation volume, and any complications 1
• Maintain a closed drainage system at all times to reduce infection risk 1, 2

Ongoing Management

• Designate trained personnel for catheter insertion and maintenance to minimize complications 2, 1
• Evaluate the catheter site regularly for signs of infection, urethral trauma, or other complications 1
• Remove the catheter as soon as it is no longer clinically necessary to minimize infection risk 1
• Do not routinely apply topical antimicrobial or antiseptic ointment to the insertion site 2, 1
• Do not administer prophylactic systemic antimicrobials before insertion 2, 1

Hygiene Considerations

• Do not submerge the catheter in water 2, 1
• Showering may be permitted if the catheter and connecting device are protected with an impermeable cover 1

Common Pitfalls to Avoid

• Failing to allow antiseptic to dry completely reduces its effectiveness and increases infection risk 2, 1
• Inflating the balloon before it is fully in the bladder can cause urethral trauma—always wait for urine return and advance further before inflation 1
• Not maintaining a closed drainage system significantly increases catheter-associated urinary tract infection (CAUTI) risk 1, 2
• Leaving catheters in place longer than clinically necessary is the single most important modifiable risk factor for CAUTI 1
• Touching the access site after antiseptic application breaks aseptic technique unless sterile technique is maintained 2