INDWELLING
FOLEY CATHETER
INSERTION
Sir Abe
Invasive Procedure
Is one where purposeful/deliberate
access to the body is gained via an
incision, percutaneous puncture, where
instrumentation is used in addition to the
puncture needle, or instrumentation via a
natural orifice.
Is any medical process which involves
making a physical entry into a patient's
body, often through the skin or a body
cavity, to diagnose, treat, or prevent a
medical condition. 2
Key components:
(1) method of access to the body
(2) instrumentation
(3) requirement for operator skill.
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Different routes of injection
Nasogastric tube insertion
Surgical operations
IVF insertion
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● Urine Formation
The heart pumps about 5 L/min of blood
under resting conditions.
Approximately 20% or 1L enters the kidneys to
be filtered
Ave. → about 125 mL/min filtrate
produced in men
→ 105 mL/min filtrate produced in women
1296 ml/day
Stretch Receptors → 200–300 ml
↓
Send signal to the Spinal cord
↓
Pontine Micturition Center (PMC) 5
Pontine Micturition Center (PMC)
Bladder is full, the stretch receptors (+) Prevent detrusor contraction (-)
↓ ↓
Sensation of urinary urge Multitude of inhibitory signals
*At the same time, an individual may actively contract the levator muscles to
keep the external sphincter closed or initiate distracting techniques to
suppress urination
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The urethra transports urine that’s
stored in the bladder out of the body
External urethral orifice is the
opening of the urethra
It is located about 2.5 cm (0.98 in)
behind the clitoris and immediately in
front of the vagina
Clitoral-Urinary Meatus Distance
(CUMD)
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Indications For Urinary Catheterization
Relieve urinary retention
Empty the bladder → Before, During, or
After Surgery
Allows accurate measurement of urine
output (UO)
Measure Residual urine
Obtain a sterile urine specimen from a
female Px.
For patients needing end-of-life care
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A urinary catheter is a hollow, partially
flexible tube that collects urine from
the bladder and leads to a drainage bag.
It is an aseptic procedure for which
sterile equipment is required
They can be made of:
● rubber
● plastic (PVC)
● Silicone
There are three main types of catheters:
Indwelling catheters, External catheters,
and Short-term catheters 9
Indwelling Foley Catheters (IFC)
Is a catheter that resides in the bladder
It is also known as a Foley catheter
This type can be useful for short and
long periods of time.
A tiny balloon at the end of the catheter
is inflated with water to prevent the
tube from sliding out of the body
The balloon can then deflate when the
catheter needs to be removed
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External Catheters (condom catheters)
Is a catheter placed outside the body
It’s typically necessary for men who don’t have
urinary retention problems but have serious
functional or mental disabilities, such as
dementia.
A device that looks like a condom covers the penis
head
A tube leads from the condom device to a
drainage bag
Usually need to be changed daily
These catheters are generally more comfortable
and carry a lower risk of infection than indwelling
catheter
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Short-term Catheters (Intermittent catheters)
A person may only need a catheter for a short
period of time after surgery until the bladder
empties
Healthcare providers refer to this as an in-and-
out catheter
Is the insertion and removal of a catheter several
times a day to empty the bladder
The purpose of catheterization is to drain urine
from a bladder that is not emptying adequately or
from a surgically created channel that connects
the bladder (5-10 mins.)
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Suprapubic Catheters
This type of catheter is inserted into the bladder
through a small incision above the pubic area
It is use for continuous drainage
An SPC is inserted a couple of inches below your
navel, directly into your bladder, just above your
pubic bone
Are usually more comfortable than regular
catheters because they aren’t inserted through
your urethra, which is full of sensitive tissue
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Urinary Catheter Size
The French size (Fr) is used to denote the size of
the catheters
1 Fr. → 0.33 mm in diameter (Fr. 18 = 6 mm)
The smaller the Fr. size (number), the smaller
the catheter
A large size catheter is used for a male because
it is stiffer, thus easier to insert (push) the
distance of the male urethra
Fr 8-10 → are used for children
Fr 14 & 16 → are used for female adults
Fr 20 & 22 → are used for male adults
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A catheter should be used only when absolutely
necessary.
Use the narrowest tube size (Fr.) possible
Patients who are unable to void naturally
Remove as soon as possible.
Infection is a major risk of urinary catheterization.
Ensure that no kinks or blockages occur in the
tubing.
Provide daily cleansing of the urethral meatus with
soap and water or perineal cleanser.
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Identify the patient.
Explain the procedure, its necessity, and its potential
complications to the patient and/or family.
Explain the purpose/ rationale of the procedure.
Confirm order, to include catheter and balloon size;
use the smallest effective catheter size.
Assemble and verify supplies.
*Consider bringing a second catheter to use if the
first one is accidentally contaminated
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PROCEDURE
Equipment's needed:
IFC
10 cc syringe
Sterile water
Cotton balls soaked with povidone iodine
Lubricant
Sterile gloves
Pen light
Urine bag
Anchoring tape
Disposal bag
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Ensure privacy and good lighting.
Position the patient correctly for the procedure;
consider using an assistant to help patient stay
in position and decrease potential
contamination of sterile catheter.
Perform hand hygiene, don clean gloves, and
cleanse the perineal area with a washcloth, skin
cleanser, and warm water, moving from front to
back.
Prepare the antiseptic solution; ensure the
patient is not allergic to iodine. 19
Open the sterile catheterization kit on a clean
bedside table, using sterile technique. Ensure
all supplies are conveniently positioned
Apply sterile lubricant to the catheter tip.
Consider attaching catheter to drainage system
now, if not already attached, and ensure the
drainage bag emptying port is clamped
With non-dominant hand, identify meatus, and
be prepared to keep this hand in this position
until after the urine is flowing.
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Apply lubricant to the tip of the
catheter.
Coat the distal portion of the catheter
(2-5 cm) portion at the tip) with a
generous amount of lubricant.
This is the end you will insert into the
urethral opening.
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With dominant (sterile) hand, clean the meatus
opening with the antiseptic solution, moving from
top to bottom.
Use a new wipe/swab each time. Allow the
antiseptic to dry.
With the dominant (sterile) hand, insert the
catheter slowly into the urethra until there is a
return of urine.
Then advance the catheter 2-3 inches more.
(Do not force the catheter through the urethra).
Leave the catheter in the vagina, if accidentally
inserted, until after the new sterile urinary
catheter is inserted into the bladder.
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If the patient is male:
Hold the penis and insert the catheter into the
urethral opening.
Hold the penis in your non-dominant hand and
gently pull upward, perpendicular to the
patient's body.
Insert the tip of the catheter into the patient's
urethra with your dominant hand.
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Hold the catheter with the non-dominant hand;
use the dominant hand to fully inflate the
catheter balloon with the entire volume of
supplied sterile water in the prefilled syringe.
Gently pull on catheter after balloon inflation to
feel resistance.
Remove used equipment and dispose of used
supplies in trash per facility policy.
Place syringe in sharps container.
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Secure catheter to the patient’s leg with
securement device.
Remove gloves and perform hand hygiene
Cover the px. with linens and assist to a
comfortable position.
*Ensure the tubing in not kinked and the drainage
bag is below the level of the bladder.
Place a cover over the drainage bag to maintain
px dignity.
Perform hand hygiene.
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Document
a. Type and size of catheter and balloon
b. Amount of fluid inserted in the balloon
c. How the patient tolerated the procedure
d. Amount of urine obtained and its
characteristics
e. Name of person performing the insertion and
the date it was completed.
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Bladder Training
Restoration of normal pattern of voiding.
Patients must be mentally & physically
capable of toileting themselves, &
motivated to do so.
This lead: To a larger bladder capacity
and improved bladder control.
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“
“Many of life’s failures are people
who did not realize how close
they were to success when they
gave up.” – Thomas A. Edison
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