Sterile Gloving and Catheterization Procedure


Foley Catheter Introduction

A Foley catheter is a thin, sterile tube inserted into the bladder to drain urine. Because it can be left in place in the bladder for a period of time, it is also called an indwelling catheter. It is held in place with a balloon at the end, which is filled with sterile water to prevent the catheter from being removed from the bladder. The urine drains through the catheter tube into a bag, which is emptied when full. The procedure to insert a catheter is called catheterization.

A Foley catheter is used with many disorders, procedures, or problems such as these:

  • Retention of urine leading to urinary hesitancy, straining to urinate, decrease in size and force of the urinary stream, interruption of urinary stream, and sensation of incomplete emptying
  • Obstruction of the urethra by an anatomical condition that makes it difficult for one to urinate: prostate hypertrophy, prostate cancer, or narrowing of the urethra
  • Urine output monitoring in a critically ill or injured person
  • Collection of a sterile urine specimen for diagnostic purposes
  • Nerve-related bladder dysfunction, such as after spinal trauma (A catheter can be inserted regularly to assist with urination.)
  • Imaging study of the lower urinary tract
  • After surgery

Foley Catheter Risks

  • The balloon can break while the catheter is being inserted. In this case, the doctor will remove all the balloon fragments.
  • The balloon does not inflate after it is in place. Usually the doctor will check the balloon inflation before inserting the catheter into the urethra. If the balloon still does not inflate after its placement into the bladder, the doctor will then insert another Foley catheter.
  • Urine stops flowing into the bag. The doctor will check for correct positioning of the catheter and bag or for obstruction of urine flow within the catheter tube.
  • Urine flow is blocked. The doctor will have to change the bag or the Foley catheter or both.
  • The urethra begins to bleed. The doctor will have to monitor the bleeding.
  • The Foley catheter may introduce an infection into the bladder. The risk of infection in the urine increases with the number of days the catheter is in place.
  • If the balloon is opened before the Foley catheter is completely inserted into the bladder, bleeding, damage and even rupture of the urethra can occur. In some individuals, long-term permanent scarring and strictures of the urethra could occur.
  • Bladder spasms can occur when a catheter is placed. This is a sudden intense urge to urinate and can be painful. Often, urine will leak around the outside of the catheter when a spasm occurs. Medication can be prescribed for bladder spasms.

Foley Catheter Preparation

Keep the genital area clean. Switch to looser-fitting cotton clothing, and do not use chemical irritants in the genital area prior to having the catheter inserted.

 

During the Procedure

Urinary catheterization kits are sterile. They contain a Foley catheter, water-soluble lubricant jelly, a 10cc syringe with sterile water for the Foley balloon, a sterile drainage bag with sample port and tubing, sterile drapes, sterile gloves, iodine, sterile gauze, sterile specimen cup, and forceps.

  • Female catheterization: The female urethra is short compared to the male urethra. It is located above the vagina in the pelvis. Insertion of the catheter is facilitated by having the patient lie down on his or her back with the buttocks at the edge of the examination table. Adequate exposure of the urethra is obtained by elevating and supporting the legs by stirrups or placing them in a frog-legged position. Finally, the labia are separated to expose the urethra.
  • Male catheterization: The male urethra is long compared to the female urethra. A catheter is placed while lying down or in the frog-legged position. If there is a foreskin, it is retracted to its maximal limit.
  • The doctor or medical assistant will insert the Foley catheter in this manner:
    • The urethra and the surrounding areas are cleaned with a cotton-ball dipped in antiseptic solution. Beginning at the urethra, the cleansing is performed in a circular motion, moving outward to the surrounding areas.
    • A Foley catheter, lubricated with water-soluble jelly, is inserted into the bladder through the urethra.
    • Once the catheter is passed, the balloon is in the bladder. It is then slowly inflated with about 10cc of water using a syringe. Inflating the balloon should not be painful.
    • At this time, urine, if present in the bladder, should flow back through the catheter and into the sterile drainage bag.
  • Drainage bag
    • While at the hospital, the urinary drainage bag will be hung to the bedside rail by a hook on the bag.
    • If the patient needs to be discharged from the hospital and sent home wearing the Foley catheter, the drainage bag will be replaced with a portable drainage bag (leg bag). Adhesive tape will be used to hold the bag to the calf area.
    • Removal of the catheter and bag
  • The catheter balloon is deflated by inserting a syringe into the catheter valve and pulling back on the syringe.
    • The pressure in the balloon will cause the water to flow into the syringe.
    • Once the balloon is empty, the Foley catheter can be pulled out.

After the Procedure

  • A slight irritation in the urethral area may be felt.
  • Switch to looser fitting cotton clothing.
  • Do not use chemical irritants in the genital area and keep the area clean.

The doctor will want to follow up with the patient in a few days. If the patient has any questions, he or she should not hesitate to call the doctor.

When to Seek Medical Care

Call the doctor if the patient experiences the following symptoms:

  • Any pink or red urine or bleeding from the urethra
  • Symptoms do not go away
  • Symptoms of infection
    • Burning sensation upon urination
    • Urgency and frequency
    • Increased lower abdominal pain
    • Fever
    • Foul-smelling discharge coming from the urethra or in the genital area
    • Redness or swelling in the genital area
    • Pain in the urethral area or genital area
  • If the patient is sent home with a Foley catheter or has had a catheterization performed, he or she should go to the hospital’s emergency department if they notice the any of the following:
    • Bleeding from the urethra
    • Nausea and vomiting
    • Dizziness
    • Symptoms of infection such as urinary frequency, urgency, or pain or burning sensation; blood in the urine; fever; increased lower abdominal pain; or foul-smelling discharge
    • Symptoms of acute urinary retention such as urinary hesitancy, straining to void, decrease in size and force of the urinary stream, interruption of urinary stream, sensation of incomplete emptying of the bladder
    • Irritative symptoms such as urinary frequency, urgency, pain or burning; increased urination at night; or wetting the bed at night
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This article is for education purposes only.  It is intended in this forum for nursing students.  Please check your facilities policy and procedures.
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Anna C. RN-BC, BSN, PHN, CMSRN Anna began writing extra materials to help her BSN and LVN students with their studies. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process. She is a clinical instructor for LVN and BSN students along with a critical care transport nurse.

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