Foley Catheter Insertion – Female

Equipment:

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• Catheter kit with all sterile items
• Sterile drainage tubing and bag (if not included in indwelling catheter insertion kit)
• Device to secure catheter (if not included in kit)
• Extra sterile gloves and catheter (optional)
• Clean gloves
• Basin with warm water washcloth
• Towel and soap for perineal care
• Flashlight or other additional light source
• Bath blanket
• waterproof absorbent pad
• Measuring container

Steps:

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1. WIIAPA:

1. 1. Wash hands
   2. Introduce self
   3. Identify patient (use 2 identifiers)
   4. Allergies – don’t forget food allergies
   5. Plan of care
   6. Assess patient

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2. Educate patient catheter insertion and rational.
3. Provide privacy by closing room door and bedside curtain.
4. Raise bed to appropriate working height.
5. Place waterproof pad under patient.
6. Position female patient in a dorsal recumbent position (on back with knees flexed) and ask them to relax thighs to accommodate hip rotation.
7. Drape female patient with a bath blanket.
8. Position light to illuminate genitals or have assistant available to hold light source to visualize urinary meatus.
9. Clean perineal area with soap and water, rinse, and dry. Use gloves to examine patient and identify urinary meatus. Remove and discard gloves. Perform hand hygiene.
10. Open outer wrapping of catheterization kit. Placing inner wrapped kit on a clean accessible surface.
11. Open inner, sterile wrap covered tray, containing catheterization supplies using sterile technique. Fold back each flap of sterile covering one at a time, ensuring not to extend over sterile contents.
12. Apply sterile gloves.
    **Option: apply sterile under-drape with ungloved hands when drape is packed as first item. Touch only 1” edge of drape and then apply sterile gloves. 
13. Drape perineum, including fenestrated drape. Keep gloves and working surface of drape sterile.
14. Place sterile tray close to patient. Arrange remaining supplies on sterile field, maintaining sterility of gloves.
    1. Place sterile tray with cleaning solution (premoistened swab sticks or cotton balls, forceps and solution), lubricant, catheter, and prefilled syringe for inflating balloon (indwelling catheterization only) on sterile drape.
    2. If kit contains sterile cotton balls, open package of sterile antiseptic solution and pour over cotton balls. If kit contains premoistened swab sticks, open end of package for easy access.
    3. Open sterile specimen container if specimen is to be obtained.
    4. Open sterile wrapper of catheter and leave catheter on sterile field.
    5. Open packet of lubricant and squeeze out on sterile field.
    6. Lubricate catheter tip by dipping it into water-soluble gel.
    7. Attach prefilled syringe to port at end of catheter.
15. Clean urethral meatus.
    1. Separate labia with fingers of nondominant hand (now contaminated) to fully expose urethral meatus.
    2. Maintain position of nondominant hand throughout procedure.
    3. Holding forceps in dominant, sterile hand, pick up one moistened cotton ball or pick up one swab stick at a time. Clean labia and urinary meatus from clitoris toward anus, starting with far labial fold, then near labial fold, then directly over center of urethral meatus. Use new cotton ball or swab for each area that you clean.
16. With sterile hand, pick up and hold catheter 7.5-10 cm (3-4 inches) from catheter tip with catheter loosely coiled in palm of hand.
17. To insert lubricated catheter, ask patient to bear down gently and slowly insert catheter through urethral meatus. Advance catheter total of 5 to 7.5 cm (2-3 inches) or until urine flows out of catheter.
18. Once urine is seen advance catheter another 2.5 to 5 cm (1-2 inches). Do not use force to insert catheter.
19. Release the labia and hold catheter securely with nondominant hand.
20. Collect urine specimen as needed (if applicable)
21. Inflate catheter balloon with amount of fluid designated by manufacturer by continuing to hold catheter with nondominant hand and slowly injecting total amount of solution with free dominant hand.
22. After inflating catheter balloon, release catheter from nondominant hand. Gently pull catheter until resistance is felt and then advance catheter slightly to avoid pressure on bladder neck.
23. Secure indwelling catheter with securement device making sure to leave enough slack to allow leg movement. This should be on the inner thigh, allowing enough slack to prevent tension.
24. Position drainage bag lower than bladder by attaching to bedframe ensuring that it is not attached to side rails.
25. Check to ensure that there is no obstruction to urine flow.
26. Provide hygiene as needed and help patient to a comfortable position.
27. Dispose of supplies in appropriate receptacles.
28. Measure urine and record.
29. Remove gloves and perform hand hygiene.
30. Document