A Foley catheter is a flexible tube inserted through the urethra into the bladder for continuous urine drainage. It is typically used for monitoring urine output, managing urinary retention, or providing comfort in end-of-life care. The procedure requires strict adherence to sterile technique to prevent infection of the urinary tract. Proper training is necessary to perform this medical procedure safely and effectively.
Pre-Procedure Essentials
Preparation begins by assembling the necessary supplies, usually a pre-packaged catheterization kit, extra sterile gloves, and a water-soluble lubricant. A thorough hand wash must be performed before preparing the kit. The patient is positioned in the dorsal recumbent position (lying on the back with knees bent and hips rotated outward) to maximize visibility of the perineal area.
A sterile field must be established by placing the kit components on a clean, accessible surface to maintain aseptic conditions. Proper lighting is necessary to visualize the anatomy. The sterile drape is positioned to isolate the working area, and the clinician then dons sterile gloves.
Key Anatomical Identification
The target location for insertion is the external urethral meatus, the opening of the urethra. This opening is located within the vestibule, situated between the inner folds of the labia minora. It is positioned above the vaginal opening and approximately two to three centimeters below the clitoris.
The labia must be gently separated using the non-dominant hand, which remains in place to maintain visualization. This separation is crucial to correctly identify the meatus and prevent accidental insertion into the vaginal opening. The meatus often appears as a small, slit-like or dimpled opening. The non-dominant hand is considered non-sterile after touching the patient’s skin.
The Catheter Insertion Technique
Once the meatus is clearly visualized, the area must be cleansed using an antiseptic solution, typically following a three-swab technique. Swabs are used in a single, downward stroke: starting with the labial fold farthest from the clinician, then the nearest fold, and finally directly over the meatus. After cleansing, the catheter tip is generously lubricated with a water-soluble gel.
Holding the catheter a few inches from the tip with the sterile dominant hand, gently insert it into the meatus. The patient may be asked to take a slow, deep breath or bear down slightly to help relax the pelvic floor muscles. Advance the catheter steadily until urine begins to flow into the drainage tubing, confirming the tip has entered the bladder. After urine flow is established, advance the catheter an additional 2.5 to 5 centimeters to ensure the balloon portion is fully inside the bladder cavity.
Post-Insertion Confirmation and Stabilization
With the catheter positioned correctly, the retention balloon is inflated with the sterile water volume specified on the packaging, usually 5 to 10 milliliters. Inflation should not meet resistance, and the patient should not report pain or discomfort. Pain or resistance suggests the balloon is incorrectly inflated within the urethra. If this occurs, immediately deflate the balloon, advance the catheter further, and re-attempt inflation.
After successful inflation, gently retract the catheter until a slight resistance is felt, indicating the balloon is resting against the bladder neck. This secures the catheter within the bladder and prevents accidental displacement. Finally, the catheter tubing is secured to the patient’s inner thigh using a securement device, allowing slack to avoid traction injury to the meatus. The drainage bag is positioned below the level of the bladder to ensure continuous, gravity-fed flow.