Inserting a Foley catheter is a common skill that nurses perform in the healthcare setting. In this article and video, you’ll learn some of the key concepts to remember when performing Foley catheter insertion on a female patient.
Things to Do Before Inserting a Foley Catheter
Before you go to insert a Foley catheter, you’ll want to remember these important steps.
- Verify your facility’s protocols before performing this skill to ensure you are following the latest guidelines for your area and patient population, and read over the manufacturer’s instructions in any equipment or Foley kits for important details.
- Ensure you have a doctor’s order for the procedure, and verify the details.
- Verify everything, ensuring you have the right patient, right type of Foley kit, etc.
- Consider patient allergies. Two big allergies to consider are iodine, which is often included as a cleaning solution in most Foley kits, as well as latex allergy. If either are present, consult your facility for appropriate alternative kits containing silicone and/or other cleaning solutions.
- Gather your supplies and perform hand hygiene. During this time, make sure your kit has everything you’ll need. You might want to grab an extra pair of sterile gloves in case the gloves provided by your Foley kit break or are not sized correctly. PPE may be needed for patients under contact precaution. You’ll also want to grab some alcohol pads for cleansing the skin before applying the stabilization device.
- Get an assistant. It is good practice to have someone with you during a procedure like this. This person can help with positioning the patient, getting extra supplies if needed, and (if this person is another RN) helps ensure sterility is maintained throughout the procedure because they act as an observer.
- Educate the patient about the procedure, answer any questions he/she may have, and gain consent for performing the procedure.
Video Demonstration on Foley Catheter Insertion
Position the Patient for Foley Insertion
Once you’ve performed all of the steps above, you can proceed to position the patient for the procedure. Adjust the height of the bed so that you’re at a comfortable position to access the patient’s genital area.
In addition, make sure you are setting up the supplies so that your non-dominant hand will be closest to the patient. The non-dominant hand is used to help assist with spreading the labia during insertion and needs to be closest to the patient (the dominant hand will be used to insert the catheter).
The female patient can be positioned in one of two positions: the dorsal recumbent position (if mobility is good), or the Sims’ position (if mobility is impaired).
During positioning of the patient, place a waterproof pad under them to help protect the linen and make cleanup easier.
In addition, cover the patient to make them feel comfortable and less exposed, but be careful that you keep that sheet out of the way so it’s not going to contaminate your sterile field.
Prepare Foley Catheter Kit
Please note that there are a variety of Foley catheter kits on the market, and each kit varies in its contents. The kit used for this article and video is the Bard SureStep.
First, open the clear plastic bag of the catheter kit that contains the actual kit that is wrapped in the CSR wrap. You do this by lifting up the white adhesive sides, and then pull the tray out of the plastic bag.
Located on top of this catheter tray is a periurethral cleanser kit. This is used to clean the labia minora and urethral opening. It’s important to note that this area will be cleaned twice. Once with the provided periurethral cleanser kit, and then later on with the betadine solution (this is done right before catheter insertion).
Therefore, before opening the actual kit, clean the periurethral area.
To do this, perform hand hygiene and don clean gloves. Then, open the plastic bag and inspect its content. This bag contains 3 soap towelettes that are used to clean the periurethral area and hand sanitizer to wash your hands with once done with the cleaning procedure.
Periurethral Care (Peri-care) Before Insertion
Peri-care is a great time to get a good visualization of the anatomy of the patient and locate the urethral meatus. This will help you be more successful with insertion of the catheter.
To do this, let the patient know you will be touching them and take your non-dominant hand and spread the labia minora. Note the location of the urethral meatus.
Can’t find it? In the female, there are three openings. The top opening is the urethral meatus. Located below this opening is the vaginal opening, and located below this is the anus. The top opening is always used for catheter insertion.
If you are having trouble finding the urinary meatus, you can try this:
- Have your assistant shine a penlight or flashlight on this area to illuminate it.
- If possible, tell the patient to bear down or try to urinate. This will relax the opening and make it more prominent.
- Use landmarks to help you. Find the labia minora and note the area where these two folds meet together (this is called the frenulum). Typically, a few centimeters below the frenulum will be the urethral meatus.
Once the urinary meatus has been located, proceed with periurethral care. Spread the labia minora with your non-dominant hand. Then, take your dominant hand and use one of the three soap towelettes to clean the labia minora furthest away and clean from top to bottom all the way to the anus. Then, discard this towelette. Use another towelette to clean the labia minora closest to you from top to bottom all the way to the anus. Discard this towelette. Lastly, use the third towelette to clean the middle area from top to bottom all the way to the anus. It’s important to focus on the urethral meatus. Then, discard this towelette. Doff gloves and perform hand hygiene.
Preparing Foley Catheter Kit
Take the wrapped kit and place it in between the patient’s legs so it will be set up in a way where the kit is pointing toward the insertion site. (Watch the video above for a visual demonstration of this placement).
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 top 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.
It’s time to set up the sterile field. Don sterile gloves outside the tray on a clean surface. 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. If you need to review how to put on sterile gloves, you can watch this video on “donning sterile gloves”.
Next, drape the patient with the two drapes provided in the tray. This helps 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.
Now place the fenestrated drape over the genital area. Again, the shiny side will 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.
Open the 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.
Attach the water syringe to the catheter’s balloon port, but do NOT inflate the balloon to test it**. 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.
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.
Inserting the Foley Catheter
Once the tray has been prepared, it is time to clean the insertion again and insert the catheter.
To do this, take your non-dominant hand and spread the labia. NOTE: Once your non-dominant hand is touching the patient, it is no longer sterile and must stay on the patient to keep the labia spread UNTIL the insertion is complete.
Then take your dominant hand and use one of the three betadine swabs to clean the labia minora furthest away by cleaning from top to bottom. Then discard this swab.
Obtain the second betadine swab and clean the labia minora closest to you by cleaning from top to bottom. Then discard this swab.
Lastly, obtain the third betadine swab and clean the middle area top to bottom (concentrating over the urethra meatus). Then discard this swab. NOTE: It’s very important that the non-dominant does NOT move from this position and keeps the labia minora spread until after insertion.
Then, with your dominant hand, carefully grasp the lubricated catheter in the tray at about 2 inches from the catheter tip, and tell the patient to breathe in and out and bear down. When you hear an exhale, insert the catheter into the meatus about 2-3 inches until you see urine return.
Once you see urine return in the catheter tubing, advance another two inches. This ensures the catheter is in the bladder and not the urethra.
Then, remove your non-dominant (insertion is over) and have this hand firmly hold the catheter tubing in place while your dominant hand presses the plungers to instill the water into the balloon of the catheter. After instilling the water fully (this should be painless to the patient), detach the syringe, discard it, and gently tug on the catheter tubing to ensure it sets in the top of the bladder.
Now, secure the catheter.
How to Secure a Foley Catheter with StatLock Stabilization Device
Position the Foley catheter tubing so that the bifurcation of the tubing fits into the plastic clip on the stabilization device. The balloon inflation port should be closest to the hinge of the plastic retainer clip. The arrow on the top of the retainer clip should be oriented to point toward the direction of the catheter’s tip (insertion point). Once the bifurcation of the catheter is properly in the device, press the three lines on the device to close the device shut.
Locate an area on the patient to apply the stabilization device, per your facility’s protocols. For female patients, this is generally on the inner part of the upper thigh or the anterior (front) portion of the upper thigh. Once you find a placement location, lay the StatLock device on top of that area (without removing the adhesive backing), and then move it back around 1 inch to create slack in the tubing. This will allow you to see the area on the skin you will need to clean.
Place the StatLock device aside, open the alcohol pads, and thoroughly clean the area on the patient. You generally do not need to shave the patient’s hair unless there is excessive hair or if you facility recommends to do so. Clean along the entire area where the stabilization device will be placed. Allow this to dry completely.
Open the skin protectant wipes that came with the device and apply all of them on the skin, being sure to wipe in the direction of the patient’s hair growth if hair is present. Allow this to dry.
While this is drying, write the date and your initials on the StatLock stabilization device. This enables other healthcare workers to know when the device was placed, as most protocols will require replacement at a specified interval (often 7 days or per your facility’s recommendation).
Apply the StatLock stabilization device onto the skin in the area that was previously cleaned by peeling off one side of the backing and gently laying the stabilization device on the skin, then peel off the other side of the backing and allow the pad to gently adhere to the skin. Do not apply tension to the skin as you apply the device.
Foley Catheter Urine Collection Bag Placement
After securing the device, place the urine collection bag at the foot of the bed by hanging it on a non-movable part of the bed.
It is very important that the collection bag stays below the bladder at all times, is never on the floor, and is emptied routinely.
The drainage tubing should be secured to the bedsheets with the sheet clip on the drainage tubing. This tubing should never be kinked or looped. Instead, it should be positioned in a straight line so gravity can easily drain the urine.
Once this has been done, apply any stickers to the catheter and the patient’s chart per your facility’s protocol.
Clean up the materials, cover up the patient, doff gloves, and perform hand hygiene. Then, document the procedure.
References:
Bard Medical. (2016). SureStep Post Insertion Foley Catheter Care. Covington, Georgia; C.R. Bard Inc.
Lynn, P. (2014). Unit II Chapter 7 Promoting Healthy Physiologic Responses. In Skill checklists for Taylor’s clinical nursing skills : a nursing process approach (4th ed., pp. 358–359). essay, Wolters Kluwer.
Perry, A. G., Ostendorf , W., & Laplante , N. (2022). Chapter 18 Personal Hygiene and Bed Making . In P. A. Potter (Ed.), Clinical nursing skills & techniques (10th ed., pp. 528–529). essay, Elsevier.