Inserting an Indwelling (Foley) Catheter in a Female Client

Time: 10 minutes
Equipment: catheterization tray with #10 to #12 French catheter, bath blanket(s), sterile gloves,
light source, tape, equipment required for perineal care, if necessary.
Indications: Swollen urinary meatus from childbirth, surgery, trauma, or obstruction, spinal cord
injury; and need to calculate and closely monitor urinary output.
Objectives:

 To relieve bladder distention from urinary retention.

 To provide continuous drainage of urine.
Procedure:

STEPS RATIONALE
1.Check doctor’s order.
2. Identify the client, provide privacy, and
explain procedure.
3. Wash hands.
4. Place client in supine with her knees flexed
and her hips externally rotated. Drape her
with bath blanket for privacy.
5. Put on clean gloves. Examine the urinary
meatus and assess for abnormalities, such
as exudates or inflammation. Provide
perineal care, then remove gloves and wash
hands.
6. Open the sterile catheter tray on a nearby
clean surface. Place the waterproof drape
under her buttocks and the fenestrated drape
with the opening over her perineum.
7. Put on sterile gloves. Saturate the cotton
tips of the swab sticks in the catheter kit with
povidone-iodine.
8. Attach the sterile water syringe to the
catheter inflation hub and inspect the balloon
for defects.
9. Open the water-soluble lubricant and
lubricate catheter tip. Lubricate 1 to 2 inches
(2.5 to 5 cm) of the catheter tip and leave the
catheter in the sterile tray.
10. Separate the labia minora with your non
dominant hand and keep this hand which in
contaminated in place.
11. With your other hand, pick up the swab
sticks. With one downward stroke, cleanse
the outside then the inside of each labium,
discard each used swab stick after use so it
won’t contaminate other equipment. Clean
 the meatus last, the place the catheter tray
between the client’s lower legs.
12. Grasp the sterile catheter 2 to 3 inches (5
to 7.5 cm) from the tip and keep it from
touching anything. Ask the client to take a
deep breath and slowly exhale while you
insert the catheter tip. Advance it 2 to 3
inches until urine flow starts. Advance it
another 1 to 2 inches to make sure it’s in the
bladder. If you meet resistance, slightly rotate
the catheter or maintain pressure on it until
the sphincter relaxes.
13. Wait for complete urine drainage and
remove the catheter if only straight
catheterization is required.
14. Holding the catheter in place, inflate the
balloon. Keeping the plunger down,
disconnect the syringe from the port. Pull
gently on the catheter until you feel
resistance.
15. Secure the catheter to your client’s thigh
with enough slack to prevent movement from
creating tension on the catheter (either with a
catheter leg strap or tape). Secure the
drainage bag on the bed frame below her
bladder level.
16. Provide perineal care, ensure client for
safety and comfort, then remove gloves.
17. Wash hands.
18. Chart: Document the date and time, the
catheter size and type, and the client’s
response. Record the amount, odor, color,
and consistency of urine and whether you
obtained a specimen.

NURSE ALERT: Do not use excessive force in inserting catheters. For the female client, the
only way you can be sure you have reached the bladder is when urine returns in the tubing. You
must see the urethral opening. A side-lying position with the top leg elevated on a pillow is
easier for the client with arthritis of the hip. Reassess client’s condition after catheterization.
Don’t use the catheter if it accidentally touches the labia or enters the vagina.
Contraindications: If unable to insert catheter fully, discontinue the procedure, record, and
notify the doctor. Urethral trauma or injury.
Client Teaching: Encourage fluid intake if not contraindicated.
 Inserting an Indwelling (Foley) Catheter in a Male Client
Time: 10 minutes
Equipment: catheterization tray with #10 to #12 French catheter, which will include; a moisture
proof under buttocks drape, lubricating jelly, 10 to 30 cc pre-filled sterile syringe, urinal bath
blanket (s), sterile gloves, light source, sterile cotton balls, clean gloves, tape, equipment for
perineal care, if necessary.
Indications: For a male client with an infection, enlarged prostate, or urinary surgery disrupts
normal urination, or if his bladder, must be kept empty.
Objectives:

 To provide continuous drainage of urine.

 To relieve bladder distention from urinary retention.
Procedure:

STEPS RATIOANALE
1.Check doctor’s order.
2. Identify the client, provide privacy, and
explain procedure.
3. Wash hands.
4. Have him lie on his back with his thighs
slightly apart, and drape him so his penis is
not covered. Put on clean gloves.
5. Wash his penis with soap and water. Rinse
and dry it, then remove your gloves and wash
hands.
6. Open the sterile catheter kit on a clean
surface. Put on sterile gloves.
7. Without contaminating the center, place
the water proof drape under your client’s
penis on his upper thigh. Place the
fenestrated tape over his penis.
8. Open water-soluble lubricant and lubricate
the catheter tip. Lubricate 6 to 7 inches (15 to
17.5 cm) of the catheter tip. Using supplies in
the kit, pour povidone-iodine over the cotton
swabs. Follow the manufacture’s
recommendations to verify catheter balloon
integrity.
9. With your non dominant hand, gently grasp
the shaft of your client’s penis, just below the
glans, at a 90-degree angle. Keep your hand
in place, is it is now contaminated. If client’s
uncircumcised, use the same hand to retract
the foreskin.
10. With your dominant hand, pick up a
saturated cotton swab stick. Clean the
meatus with downward strokes 3-4 times,
then swab around in a circular motion to the
base of the glans. Discard the cotton swab.
Do this three times. Place the catheter tray
between your client’s lower legs.
11. With your dominant hand, pick up the
catheter about 3 inches (7.5 cm) from the tip.
Use the non-dominant hand to lift the penis
perpendicular to your client’s body, apply
slight traction, and gently press both sides to
help open the meatus.
12. Encourage your client to deep breath as
you gently insert the catheter tip into the
meatus. Advance it 7 to 9 inches (17.5 to
22.5 cm) or until urine starts draining, then
advance it another inch (2.5 cm). if you meet
 any resistance, rotate or withdraw the
catheter slightly. Return the retracted foreskin
to its original position.
13. Wait for complete urine drainage and
remove the catheter if only straight
catheterization is required.
14. Holding the catheter in place, inflate the
balloon according to the manufacture’s
recommendations. Gently tug the catheter
until you feel resistance.
NOTE: Gentle tugging on the tube
immediately after insertion and inflation of the
balloon ensures that the catheter is in the
urethral orifice.
15. Secure the catheter to our client’s lower
abdomen or upper thigh, allowing some slack
in the tubbing (tape or catheter leg straps).
Secure the drainage bag to the bed frame
below his bladder level.
16. Provide perineal care.
17. Ensure client safety and comfort.
18. Remove gloves and wash hands.
19. Chart: Record the urine amount, odor,
color, and consistency and indicate whether
you collected a specimen.

NURSE ALERT: Do not use force if you feel resistance during catheter insertion. Don’t pull the
catheter while inflating the balloon. Empty the catheter.
Contraindications: If you unable to insert the catheter fully, discontinue the procedure, record,
and notify the doctor. Urethral trauma or injury.
Client Teaching: Encourage fluid intake if not contraindicated.