Foley Catheter Insertion

Indications

• Urinary retention,
• close monitoring of urinary output: for example in shock and renal failure

(NB: incontinence is not an indication as the risks of infection outweight the benefits.)

Note

It is normal for the patient to feel the need to urinate after insertion. This happens because the balloon is resting on the lower trigone of the bladder and the detrusor starts contracting. To minimize this sensation, reduce the size of the balloon and lie the patient laterally.

Men

1. Explain the procedure and consent the patient
2. Use the aseptic technique with sterile surgical gloves (included). Lay out equiment on the trolley. 14-16 gauge is standard for adults
3. Test the balloon using 10ml air. Suck it out again.
4. Expose from umbilicus to below knee (so that during the procedure blanket doesn't rise up to aseptic area. Apply paper from the pack around the penis (if there is  not a hole in the pack for the penis then make one)
5. Clean the glans penis (dorsal to ventral) then perineum (always from clean to dirty). Use at least 2 cotton wool swabs.
6. Apply antiseptic gauze to penis. Hold from ventral side and clean the glans penis. Note use one hand to use the penis and the other to insert the catheter - do not change hands as the one holding the catheter is dirty.
7. Inspect the penis for discharge, growth, stenosis
8. Put bowl underneath penis to catch urine.
9. Use plastic syringe to squeeze local anaesthetic gel in to urethra. Squeeze over end of penis at first and then in bit by bit. Prevent the gel leaving whilst doing this by applying pressure to the urethra at the tip of the penis. Massage the urethra in a downwards direction as far down as the perineum.
10. Wait 5 min for the gel to act.
11. Insert the catheter. Hold the penis up and forward to lessen the bend in the urethra. If it is still difficult to insert can also put pressure at the bottom of the scrotum to further straighten it. Don't touch the shaft of the catheter when inserting it: do this by holding it by the bag, and shuffling it down the catheter (this is quite hard to do).
12. Once the catheter is inserted fully urine should drain in to the bowl
13. Inject 10 ml water (not saline) to fill up balloon. Watch patients face to make sure it is not in the urethra.
14. Pull out foley until resistance felt. Clean the catheter.
15. Collect specimen for m+c (first) then cytology then biochemistry (so not contaminated by local anaesthetic)
16. Replace prepuce to prevent paraphimosis: very important!
17. Attach bedside bag. Tape to upper thigh (not lower cos it will get stretched when erection present)

Notes on insertion in Women

This is normally performed by nurses, so it is less likely to come up in an exam.

• Clean outside first, then using new cotton wool to inside.
• The labia is higher in youger women, may be just under clitoris. Open labia.
• Do use LA but do not inject it in.