Foley Comp

Step 1

verify the order for catheterization and assess the catheter size needed

Step 2

ask pt to spell their last name and birthdate, ask if they have any allergies to iodine and latex

Step 3

explain the procedure to the pt without medical terminology and maintain privacy throughout the entire procedure (pull the curtain)

Step 4

State that you would wash the perineal area with soap and water, washing from front to back on a vagina model and utilizing a different part of the washcloth each time. For a penis model, clean in a circular motion
beginning at the meatus and going down the shaft of the penis If present, retract the foreskin prior to cleansing

step 5

unpack the foley kit and place it on a table that has been sterilized

step 6

open the white inner liner to make a sterile field, open wrap away from you, side, side, then towards you

step 7

place waterproof pad down in between the pts legs

step 8

take off your clean gloves and apply your sterile gloves correctly

step 9

discard the diamond drape

step 10

loosen swabs from the packaging so that they are easily accessible later

step 11

open the lubricant, find catheter, lubricate the catheter without breaking sterile technique

step 12

move your sterile field in between your pt legs

step 13

clean the private area

• vaginal model: use left hand to separate the labia, cleanse from top to bottom going side, side, middle

• penis model: hold the penis up using your left hand, and cleanse in a circular motion

step 14

move the sterile box with the catheter inside and move it in between the pts legs, insert the catheter

• vaginal model: insert the catheter 2-3 inches and then put it in about 1-2 inches

• penis model: insert the catheter about 7 inches, then slowly insert it closer to the bifurcation

step 15

inflate the ballon with sterile water using syringe

step 16

gently pull the catheter until it is secured against the bladder neck

step 17

place the drainage bag below the level of the bladder and secure the catheter with a catheter stabilizing apparatus

step 18

verbalize the documentation of the procedure

• characteristics of urine: 0.5ml/kg, clear to pale yellow, no blood, should be clear with no sediment

• size of catheter: 14 Fr

• pain tolerance of procedure: insertion can be uncomfortable but otherwise should not be painful

step 19

removing a foley

• teach the pt that removing the foley doesn’t hurt but may feel a little uncomfortable

• ask pt to take a deep breath and exhale while you are removing it

• let pt know the next time they have to void so you can assess the output

what do you check before removing a foley catheter?

check ID, check the order, check if a culture is needed, and check the balloon size for the water volume to be retrieved before the catheter is taken out

do you passively deflate the balloon?

yes

Your patient tells you he has had a catheterization in the past, and the catheter came out when the nurse was done. He says, “It didn’t hurt, if you have to put this back in, I will just take it out myself if it bothers me too much.” What might you reply appropriately?

“I appreciate you sharing your experience—it’s helpful to know how you felt about the procedure before. It’s great to hear that the catheterization didn’t hurt last time. What you had before was probably a straight catheter, which is designed to drain the bladder temporarily and is removed right after it’s done.

A Foley catheter, which we might need to use, is a little different. It stays in place for a longer time to continuously drain your bladder. It has a small balloon at the end that holds it securely in place, so it can’t just slide out like a straight catheter.

We don’t want the bladder to get too full because it can become overstretched and cause discomfort or even damage. Keeping it drained helps everything work properly and prevents other complications, like infections.

If we need to place a Foley catheter, I’ll make sure you’re as comfortable as possible, and we’ll check on it regularly to avoid any problems. I understand this might feel a bit intimidating, but I’ll walk you through the process and be here to answer any questions or concerns. You’re in good hands.”

Your patient has a Foley removed. After how long (at the most) after removal would you assess his or her ability to void, and how would you do this?

measure the amount of output, the frequency of output with each void, feel the abdomen, bladder scan, ask pt to describe how they feel

Explain how and why you would use a urimeter

urimeters are used to precisely monitor a patient’s urine output, specifically in intensive care units, when you use a urimeter, you can easily detect low or high urine output that may indicate underlying issues that the pt might have