A urinary catheter is a flexible tube inserted through the urethra into the bladder to allow for continuous drainage of urine into an external collection bag. This indwelling catheter, often called a Foley catheter, features a small balloon at its tip that is inflated once inside the bladder to keep the device in place. The primary purpose of this procedure is to relieve urinary retention, manage incontinence, or monitor urine output, particularly in those recovering from surgery or who are critically ill. Maintaining a sterile technique is paramount to prevent catheter-associated urinary tract infections (CAUTIs), given the invasive nature of the procedure and proximity to the body’s microbial environment. This guide provides educational information but is not a substitute for formal medical training or adherence to local healthcare protocols.
Preparation and Necessary Equipment
Preparation involves ensuring patient comfort, maintaining privacy, and organizing a sterile environment. The patient should be positioned in the dorsal recumbent position: lying on their back with knees bent, hips flexed, and feet flat on the bed with legs comfortably apart. Adequate lighting is necessary to ensure clear visualization of the anatomy, which is a common challenge in female catheterization.
Hand hygiene must be performed thoroughly before opening the sterile catheterization kit. The kit typically contains sterile drapes, an antiseptic cleansing solution (like povidone-iodine), cotton swabs, sterile gloves, a syringe pre-filled with sterile water for balloon inflation, and a water-soluble lubricant. The catheter is usually a size 14 or 16 French (Fr) for adult females, and a closed drainage system is attached for collection. A waterproof pad underneath the patient’s buttocks helps maintain a clean field and protects the bed linens.
Identifying the Female Urethral Meatus
Locating the urethral meatus, the external opening of the urethra, is often the most challenging step due to the female anatomy. The female urethra is short, measuring approximately 3 to 4 centimeters in length, and exits the body in the vestibule between the labia minora. The labia majora are the larger, outer folds of skin and must be gently separated to visualize the inner structures.
Once the labia majora are parted, the labia minora—the smaller, inner folds—are revealed, framing the vestibule. The urethral meatus is a small, slit-like or circular opening situated anteriorly, located below the clitoris and above the larger vaginal opening. Careful visual confirmation is required before cleansing or insertion begins, as the larger, more posterior vaginal opening is often mistaken for the meatus. Continuous visualization must be maintained with the non-dominant hand holding the labia open throughout the cleansing and insertion steps to avoid contamination.
Establishing the Sterile Field and Cleansing
A strict aseptic technique must be followed to prevent introducing bacteria into the urinary tract. After donning sterile gloves, the catheter kit is opened, ensuring the contents remain untouched by any non-sterile surface. The sterile fenestrated drape is placed over the genital area, exposing only the perineum, and the antiseptic solution is prepared by soaking the provided cotton balls or swabs.
The cleansing motion must be precise and unidirectional to move bacteria away from the meatus. Using forceps or a sterile-gloved hand, each labial fold is wiped from front to back (from the clitoris toward the anus), using a fresh antiseptic-soaked swab for each wipe. The final wipe is directly over the urethral meatus itself, cleansing it last before all used swabs are immediately discarded away from the sterile field. If any sterile item touches a non-sterile surface, the procedure must be stopped, and a new sterile kit must be used to restart the process.
Step-by-Step Catheter Insertion
With the sterile field established and the meatus cleansed, the catheter tip is lubricated with water-soluble gel for the first 1 to 2 inches of the tube. The non-dominant hand, now considered contaminated, firmly holds the labia apart to keep the meatus exposed. The catheter is picked up with the dominant, sterile hand, held a few inches from the tip, and gently inserted into the meatus.
The catheter is advanced slowly through the short female urethra for approximately 2 to 3 inches until urine begins to flow into the drainage tube. Once urine return is observed, the catheter must be advanced an additional 1 to 2 inches to ensure the balloon port is fully within the bladder, preventing urethral injury upon inflation. The syringe pre-filled with sterile water is connected to the inflation valve, and the typical volume (often 10 milliliters) is injected to inflate the retention balloon. A gentle tug on the catheter should meet slight resistance, confirming the balloon is correctly seated against the bladder neck.
The catheter is then secured to the patient’s inner thigh with a securing device or tape. A small amount of slack must be left to prevent tension on the meatus. The drainage bag must be positioned and hung below the level of the bladder, ideally attached to the bed frame. This ensures gravity-assisted, continuous flow and prevents the backflow of urine, which can carry bacteria into the bladder.
Monitoring for Immediate Complications
Observation for complications begins immediately upon insertion, starting with the patient’s comfort level. If the patient reports sudden, sharp pain during balloon inflation, the procedure must be halted, and the sterile water should be withdrawn. This pain indicates the balloon may be inflating in the urethra instead of the bladder. The catheter should be advanced slightly further before attempting to re-inflate the balloon.
A common complication is the accidental insertion of the catheter into the vaginal opening instead of the meatus. If this occurs, the contaminated catheter must be left in place temporarily to serve as a landmark to prevent misdirection, and a new sterile catheter and kit must be prepared. If resistance is met during insertion, a gentle rotation of the catheter or asking the patient to relax and take a deep breath may help. Force should never be applied, as this risks urethral trauma. Monitoring for initial urine output and any signs of bleeding or persistent discomfort is necessary to confirm successful placement and patient tolerance.