A Foley catheter is a specific type of indwelling urinary catheter, which is a thin, flexible tube designed to remain inside the bladder for a period of time to drain urine. The term “indwelling” refers to the small, inflatable balloon at the tip of the catheter, which is filled with sterile water once inside the bladder to prevent the device from slipping out. This catheter allows urine to flow continuously into an external collection bag, offering a reliable method of managing urinary output. Healthcare providers use a Foley catheter for several primary reasons, including relieving acute urinary retention, monitoring precise urine output in hospitalized or post-surgical patients, and managing urinary flow during certain surgical procedures. This controlled drainage helps prevent bladder over-distension and allows for accurate tracking of the body’s fluid balance.
Anatomical Identification for Insertion
Successful female catheterization requires accurate identification of the external urethral meatus, the small opening where the catheter must be inserted. This meatus is located within the vulvar vestibule, the smooth area bordered by the labia minora. It is positioned anterior to the vaginal opening and approximately two to three centimeters posterior to the clitoris. The female urethra itself is relatively short, typically measuring about four centimeters in length.
The initial step for visualization involves gently separating the labia majora and then the labia minora to fully expose the vestibule. Because the meatus can sometimes be difficult to see, especially in women with certain anatomical variations, adequate lighting is necessary. A good light source helps clearly illuminate the area between the clitoris and the vagina, allowing the provider to confirm the meatus before beginning the procedure. Once the opening is identified, the non-dominant hand must maintain gentle separation of the labia throughout the entire insertion process to prevent contamination.
Essential Preparation Steps
Meticulous preparation is necessary to maintain sterility and minimize the risk of a catheter-associated urinary tract infection (CAUTI). The patient must be positioned in the dorsal recumbent position, lying on their back with knees flexed and hips rotated outward, which provides optimal access and visualization of the perineal area. A waterproof pad should be placed beneath the patient’s buttocks to protect the bed linens from any fluids or cleaning solutions. The required sterile supplies, typically contained within a specialized catheterization kit, must be opened and organized onto a sterile field at the bedside.
Sterile Kit Contents
- Foley catheter
- Sterile gloves
- Antiseptic cleaning solution
- Sterile drape
- Lubricating jelly
After performing pericare with clean gloves, the provider must remove them, perform hand hygiene, and then don the sterile gloves. The sterile field is established by placing the under-drape and the fenestrated drape, ensuring all required materials are within reach.
The Insertion Procedure
Once the sterile field is established and the meatus is clearly visualized, the next step is to clean the surrounding area with the antiseptic solution provided in the kit. Using a new swab or cotton ball for each stroke, the provider wipes from top to bottom, cleaning the labium majus farthest away, then the labium majus closest, and finally cleaning directly over the meatus itself. This three-step process helps move microorganisms away from the insertion site and must be performed without allowing the non-dominant hand holding the labia to move or become contaminated.
The tip of the catheter is then generously coated with the sterile, water-soluble lubricating jelly to reduce friction and patient discomfort. Holding the catheter a few inches from the tip with the sterile, dominant hand, the provider instructs the patient to take a slow, deep breath or “bear down.” This maneuver helps to relax the external urethral sphincter, facilitating smoother passage. The catheter is then gently inserted into the meatus and advanced steadily until urine is observed flowing back into the tubing.
Upon seeing urine return, the catheter tip has entered the bladder. The tubing must be advanced further to ensure the balloon is clear of the narrow urethra before inflation. The catheter must be advanced an additional 2.5 to 5 centimeters (one to two inches) past the point of initial urine flow to fully seat the balloon within the bladder cavity. If resistance is met, the provider must not force the catheter, as this can cause urethral trauma.
Securing and Maintaining the Catheter
After the catheter is correctly positioned in the bladder, the retention balloon must be inflated to secure the device and prevent accidental dislodgement. The sterile water syringe is used to inject the recommended volume of sterile water, typically ten milliliters, into the balloon channel. The patient may report a brief sensation of pressure as the balloon inflates.
If pain occurs, the water must be immediately withdrawn and the catheter advanced slightly more, as the balloon may be inflating in the urethra. Following inflation, a gentle tug is applied to the catheter until a slight resistance is felt, confirming the inflated balloon is resting against the bladder neck.
The catheter is then secured externally to the patient’s inner thigh or lower abdomen using a manufactured securing device or tape. This anchoring stabilizes the catheter and reduces tension on the urethra, helping prevent pressure injury. The attached drainage bag must be positioned and secured to the bed frame, always remaining below the level of the patient’s bladder to ensure gravity facilitates continuous urine drainage and prevents backflow.