Amanda Lorenzetti Dr. Albert Farr Enc1101 5 October 2012 How to insert a Foley Catheter Catheter insertion is a medical procedure that empties the bladder of urine. First off, I should mention that there are three different types of catheters. The most common and the one I will be explaining in this paper is the Foley catheter or indwelling catheter. Which is a flexible latex tube inserted through the urethra and into the bladder. The tubing can also be made of Teflon, non-latex and silicone.
Next, we have the Texas Catheter or external catheter. This has a stretchy latex cap that fits over the head of the penis, like a condom and the urine drains through a tube connected to the cap. This is used mostly for incontinent people who have no bladder retention problems. Finally, we have the Suprapubic catheter this one is for very long term use, possibly life, since a tube has to be surgically implanted into your bladder through a small hole in your lower abdomen. There are many reasons why a catheter would be needed.
Some of the most common reasons are prior and post-surgery, morbidly obese individuals who cannot ambulate, spinal injury, wounds that are not healing in an incontinent person and before and during childbirth and after childbirth if an epidural was given. Catheters vary in size, measuring in French units (12FR-48FR). The smallest size is usually recommended, but the larger sizes are used when leakage occurs or to allow urine thick with mucous or blood clots to drain through easily. Before you begin you must have un-opened sterile equipment and an understanding of the anatomy.
You do not have to be licensed to catheterize yourself or if you are the caregiver of a loved one. You do need a state certification to catheterize patients in a nursing home or hospital setting. Before I begin explaining the how to, let me go over the equipment that comes in a “Cath kit”. You will have a sterile drape with a hole in the center to expose the perineum area and an absorbent pad for under the buttocks , three large cotton swabs or cotton balls, betadine (antiseptic cleanser),tubing, a syringe pre-filled with sterile water, lubricant, plastic tray and sterile gloves.
The large plastic bag the package comes in is kept at the foot of the bed for trash disposal during procedure. The catheter drainage bag that connects to the tubing comes separate. Also, for patients who remain in bed most of the time, you would use a bed side drainage bag. This is a large bag that hangs on the bed frame and can hold 2,000-5,000 cc of urine. For people who are able to ambulate, you would use a leg bag. This is a smaller bag that holds 500cc of urine and is attached to the leg with elastic straps this bag is more discrete, providing privacy.
Finally, let me explain the tubing it’s long, thin, flexible and 12 inches in lenght . It has a slightly pointed end, this is the end that gets inserted into the patients urethral opening. Close to the tip is a small slit, inside the tube is a small balloon, when filled with water the balloon inflates out of the slit. This is what keeps the tube in place. 10 inches down is a side arm, a small portal where the water is inserted via syringe. Finally at the end on the tube is the opening where the tubing to the catheter bag connects. First, you always check the doctors order, you cannot catheterizes someone without one.
You then check the patient armband, (if providing care in an institution) and ask their name, if they are able to answer. Next, you want to ensure privacy by asking guests to step out for a few minutes or by pulling the privacy curtain if they are in a double room and then closing the door. Explain the procedure and answer any questions they might have. After you’ve gathered all the equipment you are ready to begin. You’re going to want to start by raising the bed up all the way (if it’s a hospital style one) then ask the patient to lay flat on their back and raise the knees up and open as wide as they comfortably can.
As they are getting in position you’re going to want to wash your hands. And by that I mean was your hands hospital style. First, run water as hot as you can stand. Second, use an antibacterial soap and lather up. Scrub between fingers, palms, wrists, forearms and under nails for at least 20 seconds. Third, rinse, don’t let the water run down your arms. Use several paper towels to dry off. Finally, use the paper towels to turn water off. Now, you are ready to begin. The best way, I feel to explain this is in steps.
Step one, pull out the absorbent pad, using only the corners of the pad, place just under patients buttock, the rest of the pad extents down to become your ‘sterile field’. It’s very important to keep your sterile field intact you don’t transport any germs inside your patient. Step two, remove and put on your sterile gloves, by holding only the cuff and slipping your hands in carefully as not to contaminate the gloves. Step three, pull out the plastic tray and place on the pad between the patients legs in your sterile field. Step four, lay out your cotton swabs on the tray.
Step five, open your package of antiseptic and pour generously over the tips of the cotton swabs. Also, open your package of lubrication and squeeze in one of the corners. Step six, open sterile drape and place over patients genitalia, making sure the hole in the center of the drape matches up properly. Step seven, with your non-dominate hand spread open the patients labia. With dominate hand pick up a cotton swab and cleanse the patients urethral meatus with one downward stroke. The urethral meatus is the small hole right above the vaginal opening, where urine comes out.
One downward stroke per swab and always wipe top to bottom. When finish with the first swab discard it in the plastic bag at the foot of the bed. Bring the swab around the sterile field and not over the field. These steps are important as to not contaminate the sterile field. Repeat these steps with the remaining two cotton swabs. For men, you would hold the shaft of the penis with the non- dominate hand and with the dominate hand you would hold the cotton swab. You start from the urethral opening and work your way out and around the head in a circular motion.
Repeat this same motion with the remaining swabs. Discard each one in the same manner as described above. Step eight, remove plastic sleeve covering catheter tube and dip tube into lubrication, make sure the tip and several inches down are thoroughly lubed. Set tube down on pad in sterile field. Connect the end of tubing to drainage bag and hang bag on the bed frame. Step nine, take out pre-filled syringe insert into the side arm, fill with just enough water to test that the balloon is intact. Step ten, with non-dominate hand reopen the labia.
Pick up lubricated tubing with dominated hand insert catheter into urethra at a slightly upward angle about2-3 inches. Urine will start to flow through tube when you are in the bladder. Once this occurs you want to continue to thread the tube deeper in about 2-3more inches. Procedure about the same with a male, hold shaft upward with non-dominate hand, with dominate hand insert tubing straight down instead of 2-3 inches, it’s about 6 inches until urine flows. Step eleven, insert pre-filled syringe into side arm and fill balloon. It will take between 10-30cc of the sterile water to fill balloon.
Give tube a light tug to ensure proper insertion. Watch for leakage around the meatus, if leakage occurs add a little more water. Step twelve, wrap up absorbent pad and drape and throw away, remove gloves, wash hands and then tape tubing to upper, inner thigh. This helps prevent the catheter from being snagged or pulled out. This procedure does cause discomfort. Mild to moderate, depending on your pain tolerance. Empty drainage bag as needed and replace bag once a week. The indwelling tubing should be replaced every 4-6weeks with a new one.