Foley Catheterization

Indications for catheterization include:

• Establish urinary drainage in an uncooperative or unconscious patient
• Establish urinary drainage in a patient with a mechanical obstruction
• Establish urinary drainage in a patient with a neurogenic bladder, i.e. Spinal cord injury
• Obtain an uncontaminated urine specimen for diagnostic purposes, i.e. culture
• Accurately monitor urine output post surgery, in critically ill patients, or if the patient is unable to cooperate
• Measure the volume of residual urine (after voiding, if concerned about urinary retention)
• Perform diagnostic procedures of the urinary tract

Contraindications for catheterization include:

• suspected urethral injury
  • pelvic fractures, blood at external urethral meatus, perineal hematoma or a ‘high riding’ prostate gland
  • perform radiographic contrast study to rule out urethral injury
• lack of an indication - (see Condom Catheter)

Female Catheterization

1. Explain the procedure to the patient including the indication and the likelihood of some discomfort. Obtain verbal consent where possible.

2. Position the patient supine with her hips abducted and feet together (frog leg position).

3. Place the catheter tray on a stand next to your dominant hand.

4. Open the tray in an aseptic fashion and place any additional equipment such as the catheter on the sterile field.

5. Put on sterile gloves.

6. If using a Foley catheter, test the balloon by inflating and deflating it with the water-filled syringe.

7. Open the Povidone - Iodine solution and pour it over the cotton swabs. Cleaning solution can also include savlon or 2% chlorhexidine auqeous solution, depending on availability.

8. Lubricate the tip of the catheter.

9. Place the sterile drape around the genital area and then place the urine collection container between the patient’s legs.

10. Gently separate the labia majora and minora with your non-dominant hand, exposing the urethra and vaginal orifice. This hand is no longer sterile and may not return to the sterile tray or equipment.

11. Using your sterile hand, cleanse the genitalia three times with Povidone- Iodine. This is done with three separate swabs, each making a single pass from front to back. Discard the swabs away from your sterile field.

12. Grasp the catheter in your sterile hand - hold it about two cm from the tip and coil the remainder in your hand.

13. Insert the catheter gently into the urethra. If resistance or pain is felt, stop then gently try again.

14. Continue to insert the catheter until urine begins to flow, collecting any urine in the sterile container.

15. Inflate the balloon and withdraw the catheter until it feels snug against the bladder neck. Remember, DO NOT inflate the balloon until urine begins to flow.

16. Connect the catheter to the drainage tubing and tape it to the patient’s inner thigh.

17. Position the drainage bag below the level of the bladder. This could be done by attaching the bag to the bedside frame. Avoid putting the bag on the floor.

Male Catheterization

male catheterization video (Dalhousie University Common Common Currency)

Explain the procedure to the patient including the indication and the likelihood of some discomfort. Obtain verbal consent where possible.

Position the patient supine with legs slightly abducted at the hips

Place the catheter tray on a stand next to your dominant hand.

Open the tray in an aseptic fashion and place any additional equipment such as the catheter on the sterile field. The catheter is usually ‘double wrapped’ with a sterile inner wrapper.

Put on sterile gloves.

If using a Foley catheter, test the balloon by inflating and deflating it with the water-filled syringe. The inflation valve will indicate the balloon capacity - usually 5 - 10 ml.

Open the Povidone - Iodine solution and pour it over the cotton swabs.

Lubricate the tip of the catheter.

Place the sterile drape around the genital area and then place the urine collection container between the patient’s legs.

Firmly (but politely) grasp the patient’s penis with your non-dominant hand. This hand is no longer sterile and cannot return to the sterile tray or equipment.

If the patient is uncircumcised, retract the foreskin using your unsterile hand.

Using your sterile hand, cleanse the glans penis, starting at the urethral meatus and circling outwards. Include the distal shaft of the penis. Repeat twice, discarding the swabs away from your sterile field.

If you plan to use Xylocaine viscous anaesthesia, place the injector tip inside the urethral meatus and inject slowly.

Using your unsterile hand, gently place traction on the penis upward to straighten the urethra.

Pick up the catheter with your sterile hand, holding it ~ 2 cm from the tip and coiling the rest into your hand. Insert the catheter into the urethra. Gently advance the catheter ‘to the hilt’, i.e. To the shoulder of the flared end. If you meet resistance, back up and gently try again. Never force.

Inflate the catheter balloon with saline and then gently pull the catheter back until the balloon comes up against the bladder neck. If there is resistance to balloon inflation or if the patient feels pain, re-advance the catheter to ensure it is in the bladder. Urine should now drain from the catheter into the sterile container.

Connect the catheter to the drainage tubing. Tape the catheter to the patient’s inner thigh.

Replace the foreskin in uncircumcised patients.