How to Insert an Indwelling Foley Catheter on a Male Patient

Hello everyone, Nurse Sarah here! In this detailed guide, I’ll walk you through the entire process of inserting an indwelling Foley catheter on a male patient, step by step. This procedure requires precision and care, so take your time to understand each step thoroughly before you begin. Let’s dive into the process.

Step 1: Pre-Procedure Preparation

1.1 Confirm the Order Before initiating any procedure, it’s essential to verify that there is a legitimate medical order for inserting the Foley catheter. This ensures that the procedure is necessary and appropriate for the patient’s condition.

1.2 Patient Identification and Rights Next, perform the patient identification and rights checks to confirm that you have the correct patient and that the procedure is what was ordered. This involves:

• Checking the patient’s ID band against the order.
• Ensuring that you have the correct procedure listed.
• Verifying the patient’s consent if required.

1.3 Educate the Patient Take a moment to explain the procedure to the patient in simple, understandable terms. Inform them about what to expect during the catheter insertion and address any concerns or questions they may have. This is a critical step in ensuring patient cooperation and reducing anxiety.

1.4 Allergy Check During this discussion, confirm any known allergies the patient may have. Pay particular attention to iodine and latex, as these are commonly used in the procedure. If the patient has allergies, ensure that alternative, non-allergenic supplies are available. For example, if the patient is allergic to iodine, use a chlorhexidine-based solution instead.

1.5 Gather Supplies and Assistance Having a second person to assist with the procedure can be invaluable, especially in maintaining a sterile field or providing additional support if needed. Gather all necessary supplies, including:

• Sterile Foley catheter kit (appropriate size for the patient, typically 14-16 French for adults)
• Sterile gloves (ensure you have an extra pair if the provided ones don’t fit)
• Sterile drapes
• Lubricant (and potentially lidocaine gel if ordered)
• Waterproof pad
• Drainage bag and tubing
• Skin prep and securing devices (e.g., StatLock)
• Waste disposal bags
• Hand hygiene supplies

Having everything prepared and within reach helps maintain the flow of the procedure and reduces the risk of contamination.

Step 2: Initial Setup and Patient Positioning

2.1 Hand Hygiene and Gloves Begin by performing hand hygiene thoroughly, using soap and water or an alcohol-based hand sanitizer. Once your hands are clean, put on a pair of clean, non-sterile gloves.

2.2 Bed Height and Patient Positioning Adjust the bed to a comfortable working height to prevent back strain. This is important as the procedure might take some time, and maintaining good ergonomics will help you avoid injury.

Position the patient on their back with their legs extended and slightly apart. This position provides easy access to the genital area and facilitates proper catheter insertion. Ensure that the patient is comfortable and that their privacy is respected throughout the procedure.

2.3 Protecting the Bed with a Waterproof Pad Place a waterproof pad under the patient’s hips and genital area. This step helps to protect the linens from any spills during the procedure, making cleanup more manageable and maintaining a clean working environment.

2.4 Glove Change and Hand Hygiene After positioning the patient and placing the waterproof pad, remove your gloves, perform hand hygiene again, and put on a new pair of clean gloves. This ensures that you maintain a high level of hygiene before proceeding to the next steps.

Step 3: Perineal Care

3.1 Setting Up the Foley Catheter Kit Open the Foley catheter kit by carefully peeling back the outer packaging and laying out the contents on a clean, dry surface. Be mindful of maintaining the sterility of the items within the kit. The kit typically includes sterile gloves, antiseptic solution (iodine or chlorhexidine), lubricant, sterile drapes, and the catheter itself.

If the sterile gloves provided in the kit do not fit, have an extra pair of sterile gloves ready. This preparation will save time and maintain the sterile field if you need to switch gloves.

3.2 Assessing the Penis Before cleaning, assess whether the patient is circumcised or uncircumcised. This step is crucial as it determines how you will approach the cleaning process:

• Circumcised: The glans (head) of the penis is fully exposed.
• Uncircumcised: The foreskin covers the glans and must be gently retracted to expose the urinary meatus (the opening at the tip of the penis) for cleaning and catheter insertion.

3.3 Cleaning the Genital Area The Foley catheter kit should include antiseptic wipes or swabs, often soaked in iodine (or another antiseptic). Here’s how to clean the area:

• Step 1: Using your non-dominant hand, hold the penis at the shaft. If the patient is uncircumcised, gently retract the foreskin to expose the glans.
• Step 2: Take the first antiseptic wipe and clean the urinary meatus in a circular motion, starting at the center and moving outward. Discard the wipe after use.
• Step 3: Use the second wipe to clean the shaft of the penis, starting from the top and moving down towards the base in a circular motion. Discard the wipe after use.
• Step 4: Use the third wipe to clean the groin area and scrotum, extending the wipe from the front of the scrotum back towards the anus. This ensures thorough cleaning of the entire area.

3.4 Post-Cleaning Glove Change After completing the cleaning process, remove your gloves, perform hand hygiene, and don a new pair of sterile gloves. This step is critical to maintaining sterility as you move on to catheter insertion.

Step 4: Preparing the Foley Tray and Catheter

4.1 Positioning the Foley Tray Place the Foley tray between the patient’s legs, ensuring it is oriented correctly with the arrow pointing towards the insertion site. This positioning facilitates easy access to the tray’s contents and helps maintain a sterile field.

4.2 Opening the Sterile Wrap Carefully open the sterile wrap, also known as the CSR (Central Sterile Reprocessing) wrap. Start by peeling back the top tab, then the side tabs, and finally the bottom tab. Be mindful not to touch the inside of the wrap to avoid contamination.

If the wrap doesn’t fully extend, you can gently pull on the edges (maintaining a 1-inch border) to ensure it lies flat. This gives you a larger working area and reduces the risk of touching non-sterile surfaces.

4.3 Donning Sterile Gloves The first item you’ll retrieve from the tray is the sterile gloves. Place them on a clean surface and open the packaging carefully. When putting on the gloves:

• Glove the Dominant Hand First: Pick up the first glove by its inside cuff, ensuring that you only touch the inside. Insert your dominant hand into the glove.
• Glove the Non-Dominant Hand: Using your sterile gloved hand, pick up the second glove under its cuff and carefully insert your non-dominant hand. Adjust the gloves as needed to ensure a comfortable fit.

4.4 Draping the Patient The Foley catheter kit includes two sterile drapes to help maintain a sterile field:

• Underpad Drape: This drape has a dull side and a shiny side. The shiny side should face downwards towards the patient. Drape it over your gloved hands and, with the help of your assistant, slide it under the patient’s hips and genital area.
• Fenestrated Drape: This drape has a hole in the center, designed to fit around the penis. The shiny side should face down. Carefully position the drape so that the penis is centered within the hole, allowing you to proceed with the catheter insertion while maintaining sterility.

Step 5: Catheter Preparation

5.1 Preparing the Iodine Swabs Open the iodine packet and pour it over the swabs in the tray. These swabs will be used for cleansing the urinary meatus before insertion.

5.2 Attaching the Water Syringe to the Foley Catheter Attach the pre-filled water syringe to the catheter’s inflation port. Note the size of the catheter (e.g., 14 French) and the volume of water needed to inflate the balloon (typically 10 mL). These details will be important for documentation.

Do not test the balloon at this stage, as inflating and deflating it can alter the shape of the balloon and potentially damage the urethra during insertion.

5.3 Lubricating the Catheter Use the lubricant provided in the kit to generously coat the first 5 to 7 inches of the catheter, or as specified by your facility’s protocol. This step ensures smooth insertion through the urethra, minimizing discomfort for the patient.

5.4 Instilling Lubricant into the Urethra (If Ordered) In some cases, especially for male patients, the healthcare provider may order the instillation of a lubricant directly into the urinary meatus. This lubricant often contains lidocaine, which numbs the area and helps ease the catheter insertion. Here’s how to do it:

• Hold the Penis at a 90-Degree Angle: Using your non-dominant hand, hold the penis up at a 90-degree angle.

the Lubricant: Slowly insert the nozzle of the lubricant syringe into the urethral opening, ensuring you don’t touch the surrounding skin. Gently instill the lubricant as ordered, usually 10 mL. This helps in numbing the urethral canal and facilitating smoother catheter passage.

Step 6: Inserting the Catheter

6.1 Positioning the Penis for Insertion

• Holding the Penis: With your non-dominant hand, continue holding the penis at a 90-degree angle to the body. This angle straightens the urethra and makes insertion easier.
• Gentle Traction: Apply gentle traction by slightly pulling upward on the penis, which helps to straighten out any natural curvatures of the urethra.

6.2 Inserting the Catheter

• Starting Insertion: With your dominant hand, carefully insert the lubricated catheter tip into the urinary meatus. Ask the patient to take deep breaths to relax the muscles and reduce discomfort.
• Advancing the Catheter: Slowly and steadily advance the catheter along the urethra. If you encounter resistance, stop and ask the patient to take another deep breath. Sometimes, asking the patient to cough or bear down as if trying to urinate can help pass the catheter past the prostatic urethra.
• Continuing Until Urine Flow: Continue advancing the catheter until you see urine begin to flow through the catheter tubing. This indicates that the catheter tip has reached the bladder.
• Advancing Further: Once urine flow is observed, advance the catheter another 1 to 2 inches to ensure that the balloon portion is fully inside the bladder before inflation.

6.3 Inflating the Balloon

• Inflating the Balloon: With your dominant hand still holding the catheter in place, use your non-dominant hand to inflate the balloon by slowly injecting the sterile water from the pre-filled syringe into the balloon port.
• Verifying Placement: After inflation, gently tug on the catheter to ensure it’s securely seated at the bladder neck. This slight tension will prevent the catheter from slipping out.

6.4 Securing the Catheter

• Repositioning the Foreskin: If the patient is uncircumcised, gently pull the foreskin back over the glans after the catheter is in place. This step is crucial to prevent paraphimosis, a condition where the foreskin becomes trapped behind the glans and can lead to swelling and discomfort.
• Securing the Catheter: Use a securement device, such as a StatLock, to anchor the catheter to the patient’s thigh. This minimizes movement and reduces the risk of urethral trauma. The catheter should be secured with enough slack to allow the patient some movement without pulling on the catheter.
• Positioning the Drainage Bag: Ensure that the drainage bag is positioned lower than the bladder to allow gravity drainage. Avoid placing the bag on the floor to maintain hygiene and reduce the risk of contamination.

Step 7: Post-Procedure Care

7.1 Clean-Up

• Removing Drapes: Carefully remove the sterile drapes from the patient, taking care not to dislodge the catheter.
• Disposing of Supplies: Dispose of all used materials, including gloves and the Foley kit, in a biohazard bag. Follow your facility’s protocols for waste disposal.

7.2 Documentation

• Recording the Procedure: Document the date and time of the catheter insertion, the size and type of catheter used, the volume of water used to inflate the balloon, the amount of urine drained immediately after insertion, and any complications or difficulties encountered during the procedure.
• Patient Response: Note the patient’s response to the procedure, including any reports of discomfort or pain. This is important for ongoing care and monitoring.

7.3 Patient Education

• Providing Education: Inform the patient about the care of the catheter, including how to avoid pulling on it, signs of infection to watch for (e.g., fever, foul-smelling urine, discomfort around the catheter site), and how to manage the drainage bag.
• Encouraging Mobility: Advise the patient to remain as mobile as possible to prevent complications such as urinary stasis or catheter blockage. Ensure that the drainage bag is always positioned below the bladder level.

7.4 Monitoring and Follow-Up

• Monitoring Output: Monitor the patient’s urine output closely for the first few hours after insertion. Report any significant changes, such as a drastic decrease in output or the presence of blood in the urine.
• Assessing for Complications: Regularly check the catheter site for signs of infection or irritation. Make sure the catheter remains securely in place and that the drainage system is functioning properly.

Conclusion

Inserting a Foley catheter in a male patient is a delicate procedure that requires attention to detail and adherence to sterile technique to prevent complications. By following these detailed steps, you can ensure a safe and effective catheterization process, promoting the patient’s comfort and well-being throughout the procedure.

Remember to always follow your facility’s specific protocols and guidelines, and don’t hesitate to ask for assistance if you encounter any challenges during the procedure. As always, the patient’s safety and comfort are your top priorities.