FOLEY CATHETERIZATION

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1 FOLEY CATHETERIZATION

2 WHAT IS A FOLEY CATHETER? They seem simple enough: soft tube, goes into the bladder, drains the urine, with a little balloon towards the end, inflated inside the bladder to keep it from slipping out. Foley catheterization is a sterile procedure

3 WHAT IS A FOLEY CATHETER USED FOR? Retention of urine leading to urinary hesitancy, straining to urinate, decrease in size and force of the urinary stream, interruption of urinary stream, and sensation of incomplete emptying Obstruction of the urethra by an anatomical condition that makes it difficult for one to urinate including: prostate hypertrophy, prostate cancer or narrowing of the urethra

4 CHOOSING THE RIGHT SIZE FOLEY CATHETER Catheters are graded on the French (F)scale according to size of the lumen (8F-30F). 1 F is equivalent to 0.33 mm=0.13=1/77 of diameter. Catheter s will also have the balloon size (10-30cc) which indicates the amount of sterile water that keeps the catheter from slipping out of the bladder. Example: 14/5cc; 18/5cc; 20/10cc Most common adult size used: 16/5cc

5 FOLEY CATHETER

6 Inflated Foley Catheter

7 WHAT IS THE BALLOON FOR? The inflated balloon lies up against the neck of the urethra, and keeps the tube from just sliding out.

8 WHAT IS A 3-WAY CATHETER AND WHY IS IT USED? The three-way foley catheter has three separate lumens which are incorporated within the round shaft of the catheter for drainage of urine, inflation, and introduction of irrigating solutions into the bladder.

9 WHAT IS A SUPRAPUBIC CATHETER AND WHY IS IT USED? There are many reasons why a foley catheter may be surgically inserted through the abdominal wall, and drain the bladder in that manner. INCLUDING: Urethral injuries Urethral obstruction Bladder neck masses Benign prosthetic hyperplasia(bph) Prostate cancer

10 WHAT IS A COUDE CATHETER? Little curve in the end of the catheter, a bit stiffer, lets it slip past urethral obstruction Urologists put these in for us.

11 A FOLEY CATHETER IS USED WHEN: Monitoring urinary output in a critically ill or injured person Collection of a sterile urine specimen is needed for diagnostic purposes Nerve-related bladder dysfunction, such as after spinal trauma (Catheter inserted on a scheduled basis to empty the bladder Imaging study of the lower urinary tract After surgery (short term)

12 WHAT IS A URINARY CATHETERIZATION KIT? Urinary catheterization kits are sterile. They contain a Foley catheter, water-soluble lubricant jelly, a 10cc syringe with sterile water for the Foley balloon, a sterile drainage bag with sample port and tubing, sterile drapes, sterile gloves, iodine, sterile gauze, sterile specimen cup, and forceps.

13 IS THE FOLEY CATHETER STERILE? The foley catheter is sterile The whole urinary path is sterile With normal urine flow, it stays sterile The kidneys make urine, it collects in the bladder. It is drained out promptly, and nothing backs up in through urethra.

14 PROCEDURE FOR FEMALE CATHETERIZATION Female catheterization: The female urethra is short compared to the male urethra. It is located above the vagina in the pelvis. Insertion of the catheter is facilitated by having the patient lie down on his or her back with the buttocks at the edge of the examination table. Adequate exposure of the urethra is obtained by elevating and supporting the legs by stirrups or placing them in a frog-legged position. Finally, the labia are separated to expose the urethra.

15 HOW FAR IS THE CATHETER INSERTED INTO A FEMALE PATIENT? Placing foley catheters in women takes some practice Insert the foley until you obtain urine and then go in another inch or two. Inflate the balloon slowly and ask the patient if they feel any pain or discomfort with the inflation. If so..deflate the balloon and push the catheter in another inch or two and try to inflate again. DO NOT FORCE THE CATHETER!

16 MALE CATHETERIZATION INSERTION COMPLETION

17 PROCEDURE FOR MALE CATHETERIZATION The urethra and the surrounding areas are cleansed with a cotton-ball dipped in antiseptic solution. Beginning at the urethra, the cleansing is performed in a circular motion, moving outward to the surrounding areas. A foley catheter, lubricated with water-soluble jelly, is inserted into the bladder through the urethra. When the catheter is in the bladder, the balloon is then slowly inflated with about cc of water (depending on size of catheter chosen)using a syringe. Inflating the balloon should not be painful. At this time, if urine is present in the bladder, it should flow back through the catheter and into the sterile drainage bag.

18 HOW DO I KNOW THE CATHETER IN THE RIGHT PLACE, AND I CAN INFLATE THE BALLOON? There are a couple of basic clues: The catheter has gone in smoothly. Urine starts draining through the tube.

19 WHAT IF THE CATHETER WILL NOT GO IN? Don t force it! The Great Nursing Supervisor created urologists for a good reason! A foley catheter that won t pass is NOT a job for a student nurse, an instructor, or even a seasoned RN. Let the experts deal with it!

20 WHAT IF THERE IS RESISTANCE IN INSERTING A CATHETER IN A MALE PATIENT? Just be careful! If the catheter doesn t want to go, don t force it to go! A little steady forward pressure, may allow the catheter to sort of wriggle it s way into the bladder past a swollen prostate Don t ever force it! You could do internal damage!

21 How do I attach the outside part of the catheter to the patient? You don t want the catheter getting pulled on by accident urethral injuries are not trivial, and your patient can be experience pain. Attach the foley catheter to the patient s leg using a catheter leg strap.

22 How long can a Foley catheter stay in? That will depend on the reason it was placed and why: Surgery (short term) Incontinence

23 FOLEY CATHETER-BASED INFECTION AND HOW PREVENT IT? Urinary catheter-based infections are common and can lead to serious illness and death. An infection can be caused by bacteria (germs) that get inside the catheter or tubing when the drainage system is opened. Not washing your hands before a urine bag is changed, a urine sample is collected, catheter equipment cared for, or sterile technique not used when inserting the catheter. You are putting the patient at risk for infection!

24 DO S & DON TS IN THE CARE OF THE URINARY DRAINAGE BAG Position the drainage bag and tubing to allow gravity drainage. Do not loop or kink the tubing so urine can flow back or out. Position the drainage bag properly. Keep the drainage bag below the level of the waist. This helps stop urine from moving back up the tubing and into the bladder.

25 DO S & DON TS IN THE CARE OF THE URINARY DRAINAGE BAG Keep the bag off the floor. Do not let the drainage bag touch or lie on the floor. Empty the drainage bag when needed. The weight of a full drainage bag can pull on and hurt the urethra. Empty the drainage bag every 3 to 6 hours or when it is ½ to ⅔ full.

26 PROBLEMS ENCOUNTERED WITH A FOLEY CATHETER No urine is draining into the bag: Check for kinks in the tubing and straighten them out. Check the tape or device used to secure the catheter tube to the skin. Make sure it is not blocking the tube. Make sure the patient is not sitting or lying on the tubing. Make sure the urine bag is hanging or secured below the level of the bladder or waist.

27 WHAT OTHER PROBLEMS MIGHT OCCUR WITH A FOLEY CATHETER? Leaking urine: Check if the closed drainage system has accidently come open or apart. If it has, clean the catheter and tubing ends with a new alcohol pad and reconnect them.

28 REMOVAL OF CATHETER AND DRAINAGE BAG The catheter balloon is deflated by inserting a syringe into the catheter valve and pulling back on the syringe. The pressure in the balloon will cause the water to flow into the syringe. Once the balloon is empty, the foley catheter can be pulled out

29 BLADDER SCAN Bladder ultrasound is used in the acute care, rehabilitation, and long-term care environments. It is a noninvasive alternative to bladder palpation and intermittent catheterization used to assess bladder volume.

30 WHAT TO DOCUMENT Type and size of foley and balloon inserted Amount of fluid used to inflate the balloon (5-30cc) Patient tolerance of the procedure Record the amount of urine obtained through the catheter, color, any unusual characteristics of the urine, and if specimen obtained

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