Urethral (Foley) Catheterization Procedure Video

Indications for Foley catheter:

  1. Monitoring of urinary output to assess volume status and renal perfusion
  2. To collect uncontaminated urine specimen
  3. Instilling contrast material into the bladder for cystourethrography
  1. Acute or Chronic urinary retention
  2. To increase the space in pelvic cavity to prevent damage to bladder during abdominal or pelvic surgery
  3. Incontinence
  4. Chronically bed-ridden patient for hygiene

Contraindications for Foley catheter:
  • Urethral injury: Trauma patients with blood at meatus or abnormal prostate location on rectal exam. 

Equipments required:
  1. Foley catheter (Size: 16-18 F for adults, 5-12 F for children). Coudé catheter (with curved tip that makes it easier to pass through the curvature of the prostatic urethra) must be used in cases of enlarged prostate.
  2. Dressing/catheter pack containing drapes
  3. Cleansing solution (Povidone)
  4. Gloves
  5. Lignocaine gel
  6. Gauze swabs
  7. Drainage bag
  8. 50mL bladder syringe

Preparation for catheterization:
  1. Position: Male (Supine position) and Female (Dorsal recumbent position - supine with knees flexed and heels held apart or Sims position - side lying with upper leg flexed at knee and hip)
  2. Expose the genital area, prepare sterile field, drape the patient
  3. Apply sterile gloves after cleaning the hands
  4. Apply the lubricant to distal portion of catheter

Male Catheterization:
  1. Pick up the glans penis with your non-dominant hand "dirty hand", through the hole in the drape: the other hand will be your "clean hand".
  2. Holding a swab soaked in sterile saline with your clean hand retract the foreskin and clean the urethral orifice and glans thoroughly, so that your gloved fingers only touch the swab not the glans penis.
  3. Without letting go of the penis, discard the swab and pick up the sterile lignocaine gel with your clean hand and inject into the urethra.
  4. Still holding the penis in a vertical position (right angle) introduce the catheter with the clean hand and advance gently for approximately 10cm.
  5. Lower the penis to lie horizontally and advance the catheter fully (through the prostatic urethra) up to the hilt.
  6. Inflate the balloon now in the bladder via the smaller catheter channel with the 10mL sterile water.

Female Catheterization:
  1. A similar technique is employed here to male catheterization, but note:
  2. Separate the labia minora with the left hand and ensure the whole genital area is adequately cleaned using the right hand.
  3. Identify the external urethral orifice. If this proves difficult in obese patients, an assistant may help by retracting the dependent fat from the pubic area.
  4. Lubricate the tip of the catheter with sterile water or lignocaine gel and pass gently into the urethra.
Tips and problems 
No urine immediately: The bladder has just been emptied: insert a 2mL syringe into the end of the catheter and aspirate any residual urine.The catheter tip may be blocked with lignocaine gel-try gently instilling 15-20mL of sterile water and gently aspirating. 
Still no urine: The patient may be anuric or a false passage may have been created. Palpate to see if the bladder is empty or if you can feel the catheter balloon (which should not normally be palpable). Treat anuria appropriately. Consult a senior colleague if a false passage may have been created. 
Inability to insert: Try a smaller catheter or a silastic (firmer). If unsuccessful, ask a senior for help; suprapubic catheterization may be needed. 
Decompression of grossly distended bladder:  Rapid decompression of a distended bladder (e.g. from chronic retention) may result in mucosal haemorrhage. Empty the bladder by 250-500mL every 30min until empty. Then monitor urine output closely, as a brisk diuresis and dehydration may follow. 
Bypassing catheter: Usually due to catheter blockage. Check urine output, flush the catheter, and observe. If urine is flowing down the catheter and bypassing it, the catheter may be too small-try a slightly larger size.  
Catheter stops draining: The catheter may be blocked. Flush as above. If unsuccessful, try inserting a new catheter. Is the patient oliguric or anuric? Treat appropriately. 
Tips specific for Males: Never inflate the balloon until the catheter is fully inserted as this risks inflating the balloon within the prostatic urethera, causing urethral rupture: ideally you should see urine before inflating the balloon. Replace the foreskin to avoid paraphimosis. 
Tips specific for Females: Difficulty identifying urethral orifice. After warning the patient, place an index finger in the vagina to elevate the anterior vulva. Guide the catheter along the finger into the urethra.

Complications of Urethral catheterization:
  1. Damage to the lining of urethra. Repeated trauma may lead to urethral stricture.
  2. Rupture of urethra and Bleeding from urethra, prostate or bladder.
  3. Urinary tract infection (UTI) and Septicemia.
  4. Epididymitis.
  5. Obstruction of catheter leading to backflow of urine which may cause renal damage

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