Changing an indwelling urinary catheter requires strict adherence to sterile technique to prevent infection. An indwelling catheter, often called a Foley, is a flexible tube inserted through the urethra into the bladder to drain urine into an external collection bag. Because this tube creates a direct pathway into the bladder, the procedure must prioritize hygiene to minimize the risk of introducing bacteria. This information describes the steps involved but is not a substitute for formal training and should only be performed after instruction and supervision by a medical professional.
Essential Preparation and Supply Checklist
Preparation begins with meticulous hand hygiene, washing hands thoroughly with soap and water before gathering any supplies. The necessary equipment is often provided in a pre-packaged catheterization kit, which helps streamline the process and maintain sterility. This kit typically contains:
- Sterile gloves
- Drapes
- Antiseptic cleansing solution
- A specimen container
Other required items include:
- The new indwelling catheter, which must be the correct size as prescribed
- A syringe pre-filled with sterile water for balloon inflation
- A separate syringe for deflating the old catheter’s balloon
- Sterile lubricating gel
- A new drainage collection bag
Before approaching the patient, organize all supplies on a clean, stable surface to create a sterile field. Position the patient comfortably, typically lying on their back with legs slightly spread.
Detailed Procedure for Safe Catheter Removal
Safe removal starts with disconnecting the drainage bag from the catheter tubing and placing it on the protective drape. Locate the balloon inflation port, a small valve separate from the main drainage port, and attach a syringe. Allow the sterile water to passively drain back into the syringe without pulling back on the plunger. Active aspiration can cause the inflation channel to collapse.
Check the volume of fluid withdrawn against the volume listed on the catheter port to confirm complete deflation of the retention balloon. A partially inflated balloon can cause severe trauma to the urethra during withdrawal. Once deflation is confirmed, gently and steadily withdraw the catheter from the urethra. If resistance is felt, immediately recheck the deflation step to ensure the balloon is not still partially inflated.
Step-by-Step Guide for New Catheter Insertion
Following removal of the old catheter, the area around the meatus (the external opening of the urethra) must be meticulously cleaned using the antiseptic solution from the sterile kit.
Female Patients
Separate the labia with the non-dominant hand. Wipe the area from front to back, using a fresh antiseptic swab for each stroke to prevent contamination from the anal region.
Male Patients
Hold the penis upright. Clean the meatus with circular strokes, moving outward from the opening.
After cleansing, generously coat the tip of the new catheter with sterile lubricating gel to minimize friction and urethral irritation during insertion. A syringe containing a local anesthetic gel may also be instilled into the urethra for several minutes to promote patient comfort. This waiting period allows the anesthetic to take effect before insertion begins.
Grasp the catheter a few inches from the tip using the dominant, sterile hand, and slowly insert it into the meatus. For female patients, advance the catheter until urine flow is visible in the tubing, indicating entry into the bladder. Once urine flow is established, advance the catheter an additional one to two inches to ensure the retention balloon is fully within the bladder cavity.
For male patients, hold the penis at a 90-degree angle to straighten the urethra’s natural curve. Advance the catheter about 8 to 12 inches until urine flow is seen. The catheter must then be advanced one to two inches further into the bladder after initial urine return. The non-dominant hand, which touched the patient, is now considered non-sterile and must not touch the catheter or any sterile supplies.
With the catheter positioned correctly, attach the syringe filled with sterile water to the inflation port and inject the volume to inflate the retention balloon. Sterile water is used because saline solution can crystallize and obstruct the deflation channel over time. Perform a gentle tug on the catheter to ensure the inflated balloon is properly seated against the neck of the bladder, preventing accidental removal.
Post-Procedure Monitoring and Recognizing Complications
After insertion, connect the tubing to the new, sterile drainage collection bag. Secure the catheter to the patient’s thigh using a securement device or tape, ensuring slight slack in the tubing. This prevents tension on the urethra, which can cause irritation or damage. Discard the old catheter and all used supplies into the appropriate waste receptacles.
Initial monitoring focuses on urine output, observing the color, clarity, and volume of the urine collecting in the new bag to ensure proper drainage. The most concerning complication is a Catheter-Associated Urinary Tract Infection (CAUTI). Signs of a possible CAUTI include:
- Fever
- Chills
- Pain in the lower abdomen or flank
- Cloudy or foul-smelling urine
Persistent bleeding, inability to insert the new catheter, or leakage around the catheter despite balloon inflation are reasons to seek immediate medical attention. In older patients, a CAUTI can present solely as an abrupt change in mental status or confusion without the typical pain symptoms. Should any of these warning signs appear, contact a healthcare provider.