When inserting an indwelling Foley catheter in a patient, there are several steps you must follow to maintain a sterile field.
In this article (and video), I’ll give you some quick tips on setting up your Foley catheter kit, and detail the supplies that are often included in popular kits that are used by many healthcare facilities.
For this demonstration, I’ll be using Bard’s SureStep Foley Tray System.
Foley Catheter Kit Setup in Nursing
Before practicing nursing skills, always verify and follow your facility’s protocols, as well as the manufacturer’s instructions for any supplies used, as these may vary by location or change over time.
You also want to perform all of the necessary steps such as confirming you have the right patient, explaining the procedure to the patient, and other important steps required by your facility.
1. Perform hand hygiene and don clean gloves. Determine whether the kit contains peri-care supplies. This Bard kit contains our peri-care supplies, but if your kit does not, you’ll need to perform peri-care before opening the kit, performing hand hygiene and wearing gloves as appropriate.
2. Open the clear plastic cover of the kit (you can use this as a garbage bag and set it beside the patient). Set the kit (still wrapped) on the bedside table and use the supplied items on the top to provide peri-care (or peri-urethral care).
3. To perform peri-care, use the provided wipes to clean front to back on the patient’s genital area. Explain to the patient that you now have to clean the genitals, and separate the labia with index finger and thumb in between labia and clean toward the anus. Use different parts of cloth with each swipe, and dry. Be sure to clean labia minor farthest away, then closest labia minora, and then down the middle. This is a good time to get a visual of the urethral meatus (opening to the bladder), so you can easily find it during Foley insertion.
4. Doff gloves and perform hand hygiene (this kit comes with hand sanitizer).
5. Set-up supplies: Get on the side of the patient where you non-dominant hand is closest to the patient, because this hand will be used to assist with opening the labia during insertion. Place the kit on your working surface between patient’s the legs and position the kit so that the arrow on the paper is pointing toward the patient (this ensures you are setting up the contents properly and won’t have to move it around, which can break sterile field). Then take the wrapped part of the kit and open it. The outer “shiny side” is not sterile because it will come into contact with the surrounding surfaces, so it is safe to touch.
6. Open kit in a specific way so that your hand is not reaching over the opened contents of the kit and breaking sterile field. Open the tab by grasping the outside of the cover and pulling it away from you, and then pull away the side tabs and the last tab.
7. Don sterile gloves. It’s time to set up sterile field. Never turn your back on the sterile field. If you do, you will have to start over. Once the sterile gloves are on, you can’t touch things that are outside the kit. You can only touch things that are in the kit because everything in there is sterile.
8. Next, drape the patient and extend the sterile field you’ll be working in. First, place the underpad under the patient. Carefully unfold the drape and don’t let it touch anything. There is a shiny and dull side on the drape. The shiny side will be going down on the surface and the dull will be the side that is facing up. When placing the drape, you have to be careful with this so your gloves don’t touch the patient or surrounding areas. Take the drape by grasping it on the dull side with your sterile gloves and carefully let the top fold down over your sterile gloves. Have your assistant help the patient lift their bottom and place it under the patient.
9. Now place the fenestrated drape over the genital area. Again, the shiny side will be lay on the patient’s skin and the dull side will be up toward you. Grasp the dull side and let it lay on the patient with the fenestrated part (opening) exposing the genital area.
10. Read the instructions for the other supplies in the kit. This tray has all the steps labeled for how to set up the supplies.
11. Open the iodine/betadine. Then pour it where the arrow is pointing onto the 3 swabs. These swabs will be used to disinfect the genital area before insertion.
12. Attach the water syringe to the catheter’s balloon port. This will have a colored part to it and numbers that tell you the french size and amount of water needed to inflate the balloon. This is a double lumen catheter in this kit. One port is the balloon port, which you will inflate with the syringe after the catheter has been positioned within the bladder (the balloon keeps it in place). The other port is where the urine will drain.
Note: Most protocols suggest that you DO NOT inflate the balloon prior to insertion, because it can change the shape of the balloon and cause damage to the urethra as you insert. This increases the risk of infection. However, always follow your protocols.
13. Dispense the lubrication from the other syringe into the tray. Carefully remove the catheter from the plastic sheathing, and coat 2 inches of the catheter tip for females, or around 7 inches for males, to assist with catheter insertion. Let the tubing and tip rest in the lube until you are ready to insert.