Hey everyone, it's Nurse Sarah with RegisteredNurseRN.com and in this video I'm going to demonstrate how to insert an indwelling Foley catheter on a female patient. So let's get started. Before you insert an indwelling catheter, you want to make sure that you have a doctor's order. Then you want to make sure you confirm everything. So you want to do those rights.
For instance, do you have the right patient? And are we doing the right procedure? Did the physician order an indwelling catheter or did the physician order an in and out catheter? You want to definitely confirm that. You also want to make sure you have the right supplies and your facility will have different supplies.
So here we have a kit. I've read everything that my kit includes, which is everything I need to do the procedure, but you want to make sure you're familiar with what's in your kit and what you have available to you. And then another important step you want to take is you want to assess your patient's allergies. There's two big things you want to be looking for.
You want to make sure your patient's not allergic to latex because some of these catheters are made out of latex and you want to make sure that your patient is not allergic to iodine. because the cleaning solution we're going to be using to clean the labia before we actually insert contains betadine which is a type of iodine so you'd want to use a different type of cleaner per your facilities protocol then after we have confirmed everything we want to go to our patient and we want to explain what the doctor has ordered and what we're going to be doing We want to go into detail about it so this patient knows exactly what to expect, answer all your patients questions, and then get their consent for this procedure. So we've explained the procedure to our patient, the patient is agreeable, now it's time for me to gather my supplies and perform hand hygiene. So let me touch on supplies for a minute. I talked about getting your kit, so again, read what's in the kit so you know exactly what you need.
This kit right here has everything I need, but a lot of kits like I've worked with in the past, they don't have the peri care supplies. because you want to provide peri care before you actually insert the Foley. So you'll need to get some washcloths so everything for that.
Then you want to grab some other things like extra pair of sterile gloves in case yours break or they don't fit because that does happen. You'll need some clean gloves as well. Any PPE that you may need if your patient has some type of contact precautions or something else. You're going to need some alcohol prep. This is used to secure the stat lock securement device and if that's what you're going to be using.
And you're going to need someone else to help you. This could be a nursing assistant, but some facilities are now requiring that this is done as a two-person catheter insertion technique. Now what we're going to do is we are going to position the patient.
So there's two positions you can use for the female. It really depends on the patient's mobility. The first one is called the dorsal recumbent position and this is where you lay the patient back with the legs flexed and apart exposing the genital area. Or if your patient has mobility issues or joint issues, they're not really good at moving around. A better choice is the SIMS position.
And then after positioning them, put a waterproof pad under the patient. This is going to help. protect that linen and help you have easy cleanup and you want to cover the patient to make them feel comfortable and less exposed but be careful that you keep that sheet out of the way so it's not going to contaminate your sterile field it's now time to open up our foley kit particularly that clear plastic part so we're just going to bring it up lift these sides up and then pull the tray out and then put this back to the side so i'm going to take this off and then look at what's in our kit here we have cleanser to cleanse the periurethral area first we will do this first before we do anything else and then it has directions to use some other little education pieces in a different language Spanish and then these are stickers that we're going to be putting in the chart and on our drainage tubing we'll put that to the side so let's prep for this so I've washed my hands and I've done clean gloves so I'm going to take this out in here And in this little package, we have the soap towelettes to clean the area.
And then afterwards, we have this to wash our hands with. So when you go to perform peri care, this is a great time to get a good visualization of the anatomy of the patient and where the location of the urethral meatus is. This is the opening to the bladder, and that's where we're wanting to go. And what we're going to do is you want to tell the patient before you even touch them in this area that you're going to touch the labia.
and that you're going to spread them. So we've said that, and you're going to take your non-dominant hand. You want to be on the side of your patient where your non-dominant hand is going to be towards the patient. So I'm right-handed, so this is my left hand.
And you're going to take your index finger and thumb, and you're just going to spread the labia out. And in the female, there's three openings. You have a top opening, which is the urethral meatus. That's where we're going. We're going for that top opening.
You have a bottom opening that is the opening and then you have a third opening which is the anus. So how can you find this urethral meatus? Well use some landmarks. On the female we have two labia. We have the labia majora which are the larger outer folds.
This usually in most women has pubic hair on it and then we have the labia minora. These right here and these are the smaller folds. And then where these smaller folds meet together, as you can see right here where they come together, that is known as the frenulum. And about a few centimeters below the frenulum is going to be the urethral meatus. Now let's say you're having trouble finding that top opening, the urethral meatus.
Well, one thing you could do is you could have the patient bear down or try to act like they're urinating. And that sometimes will relax that urethral. meatus and it'll make it more prominent.
It really depends on the anatomy of the female. Sometimes they're a little hard to find and you really have to work at finding it. So this is where your helper comes in to help. You can get a flashlight or a pin light to illuminate this area so you can find it.
So now what we're going to do is we're going to provide the periurethral care before we actually insert. And periurethral care is a type of peri care. And what we're doing is we're cleaning around this urethra area.
So we're really concentrating. on the labia minora and that urethral meatus. It came with three toilets for the care.
So take your non-dominant hand, warn the patient you're going to be spreading the labia minora. And here I have a mannequin. The mannequin's tissue is very hard.
In a normal clinical setting on a real patient, it's very easy to move the labia around. But here these labia are very stiff. But you'll get the idea.
and we really need to spread these open. And we're going to take one of our towelettes, it came with three, and we're gonna start with the labia minora that's the furthest away from us. We're gonna go from top to bottom.
So we're gonna go from top, get up here at the top, and then go down all the way to anus and then discard. Then we're gonna go to the labia closest to us from top to bottom, same way, all the way to the anus and then discard. And then we're going to take our last tileette and we're going to go into the middle and we're really going to concentrate getting over that meatus because we want that to be clean for insertion. So we're going to go in the middle and we're going to wipe from top.
to bottom and discard. Then we're going to doff our gloves and perform hand hygiene. We're going to take our wrap kit.
We can touch this part right now because this is the shiny side and the shiny side is going to go on your surrounding surfaces. Remember, shiny go on surrounding surfaces. It's not sterile, so we can touch this.
So we're going to move this and we're going to orient it toward the insertion side. So it's going to go on the bed. in between the patient's legs. Now we're going to open our CSR wrap. So you have to do this in a specific way because we don't want to reach over our kit with our hand, which could contaminate the sterile field.
So what we're going to do is we're going to peel this to open it, that part off, and we are going to take this top tab off and pull it this way away from us. You have one inch on this dull side that is considered non-sterile. So it's like a one inch border that you could touch or you could just grab the shiny side and pull it's whatever you prefer pull that then we're going to do our side tabs remember you have one inch like that and then we're going to do the inside one pull it like that next what we're going to do is we're going to don the sterile gloves now you never want to turn your back on this whole sterile field because if you do you're going to have to start over once the sterile gloves are on you can't touch anything outside of the kit you can only touch things that are inside the kit because everything is sterile so we're going to don these sterile gloves outside the sterile field so now let's open up our gloves Turning the package around and always read the little words on the packaging to help you orient it We're going to take the tabs stick our hands underneath the tabs and pull it out You have about a one to two inch border to work with so that paper folds out nice and neat so you can get in there to those gloves. I'm going to glove my dominant hand.
So I'm going to take my non-dominant, grab this cuff and I'm going to slide it over like so. Okay, this is now sterile. We cannot touch anything outside of our sterile field.
And then I'm going to go under this cuff right here to glove my dominant hand. Okay, now we're sterile. Now we're going to drape the patient and we're going to be placing two different pads.
The first pad we're going to place is called the under pad. And the reason we're placing all of these pads is because we want to extend our sterile field. So we are going to get the under pad. It should be the top pad and we're just going to grab it here. I want you to see both of these sides.
We have a shiny side and we have a dull side. Remember, the shiny side is the side that's going to go on the surrounding surfaces. It's going to go down. So we're going to place this under the patient's bottom. And the key with this is you got to be careful because whenever you go to place this under the patient's bottom, you don't want to contaminate your sterile gloves.
If so, you'll have to start all over. So you sort of want to grab it on this dull side in here and then this is where your assistant comes in handy. They're going to help the patient lift their bottom. and we're just going to place it and let it fall and go underneath the patient like so.
Then we're going to take our finished straighted drape and put it over the patient's genital. It's going to have a hole that gives us an area to work. So we're going to grab this and let this unfold itself, and then we're going to take the shiny side, put it on the patient, and again being careful as we drape.
So we're just going to put it over the patient like this. Now we're going to set up our kit, and this kit is really cool because it labels Every step for us. So here we have our Foley with the drainage bag We have the securement device a stat lock device that we're going to be applying later So the very first thing that we need to do is we need to open the iodine So we're going to open this iodine and we are going to put it on these swabs right here Step two is pour on the swabs.
So tear here Then we're going to just put it on our swabs right here because this is what's going to be used to clean our Labia and we're going to discard this then what we're going to do is we're going to attach the water syringe So we're going to just connect it to this port here We no longer test the balloon prior to insertion because doing that they have found Changes the shape of that balloon prior to inserting it up through the urethra when we change the shape it could damage the urethra which could cause a urinary tract infection and we don't want to do that. So here's our water syringe and this Foley that we are dealing with it tells us it's a 14 French and to inflate with 10 mLs of water you always want to pay attention to that because that's really important whenever you go to remove it. So this is the port that we're going to be instilling that water in whenever we're ready to after insertion but right now we're just going to connect it there and set it aside because we're going to be using that when we're done inserting. The next what we're going to do is we are going to dispense the lubricant here so we can lubricate the tip of our catheter prior to insertion. This is really important so this is a comfortable procedure as much as it can be for your patient.
So we're going to take that we're going to just put it in here and discard this. Then we are going to remove the catheter very carefully from this plastic sheathing you definitely want to let it coil like that because if you just pull this thing out it's going to go Flying off your sterile field and then you're gonna have to start all over so for females We want to lubricate at least two inches of this tip. So we're going to put it in there Okay, so we've prepped everything that we need now next up We here in a moment are going to clean the area prior to insertion But also in some kits you have a urine sample collection cup if you needed that with some labeling and then you have your drainage bag. You always want to make sure your kit came with the drainage bag because if not you would need that.
Now we're going to prep the site before we actually insert the Foley with those betadine swabs that we just prepped. So in order to do this we are going to take our non-dominant hand and we're going to warn the patient that we're going to be spreading the labia and once this hand goes here to spread the labia it must stay here the whole time because it's no longer sterile. until we're done inserting.
So we've told the patient and we're going to really spread the labia minora because that is where we're going. Again, this is a stiff mannequin. These labia do not spread like they would normally. So we're going to take our first swab and we're going to go to that labia furthest away.
We're going to go from top to bottom and then we're going to discard this. Then we're going to take our next swab and we're going to go to the labia that is closest to us and go from top to bottom. then discard that.
Then we're going to take our last swab and we're going to go in the middle. So we're going to go from top to bottom, really concentrate on that meatus, and then discard. Now before you actually go to insert the Foley, you want to tell the patient to concentrate on their breathing.
So tell them to slowly breathe in and out and to bear down. because with that breathing, it's going to help relax that urethra along with bearing down, which is what we want. So the patient is breathing in and out.
Whenever I hear an exhale, that is when I'm going to insert into the urethra and I'm going to go about two to three inches until I see urine return. And we do have urine return in our tubing. So now that we have urine return we're going to insert another two inches since we are inserting on a female just to make sure that that is nice and in the bladder. So we have done that now we need to instill water in the balloon. So I'm going to have to take my dominant hand to actually push on that plunger to get that balloon inflated.
But this catheter cannot be left to itself because the bladder or the urethra could contract the Foley out and we'd have to start all over. So now that we're done inserting, we are going to take this non-dominant hand and it's going to just hold our catheter like this while we actually inflate our balloon. So I'm going to take my dominant hand and I'm going to depress this plunger.
As I am instilling the water in the balloon, it should be very easy. Patients shouldn't be complaining of any pain or anything like that. And if they do complain of pain, you may be in the urethra.
So you may have to advance the catheter a little bit more. Now I have inflated the balloon. I'm going to let go. It should stay in place. And I'm just going to detach this and discard.
Then what I want to do is I want to gently tap. hug on this and make sure I have a little bit of resistance because that tells me that balloon is where it's supposed to be. It's right above that bladder neck setting nice and firmly. So now that we have done that, What we want to do is we want to clean up the patient and get them covered up and then we're going to secure the device. So we're just going to take this off and then we are going to discard all of this per our facility's protocol.
We're going to cover up our patient and we're going to keep the thigh exposed because that is where we're going to secure the device. So here's the actual device itself. This is going to go on the inner thigh of the female and then there's a skin protectant pad.
which is going to be applied prior to actually putting it on. So let's put it on. So the first step of what you want to do before you place this on the patient is that you want to put this actual catheter in the retainer. because we don't want to put this on the patient's skin and then clamp it shut.
It's not going to feel too good to the patient. So we have the arrow. See this arrow here? It's pointing towards the insertion site.
That is where we want to go. So we have the arrow pointing. We're going to take the bifurcation of the catheter, and there's this little part right here hanging off this white part.
It's going to just set in between. this catheter right here see like that it's right there and then we're going to close it shut by pressing these little lines right here we're not going to press in the middle we're going to press those lines and it's nice and in place now we want to find a spot to put our stout lock. So make sure the patient's leg is completely extended and we're going to go on the inner thigh of the female and we want to go about right here but we want some slack in this catheter line.
We don't want too much or too little. So according to the manufacturer they say pick your spot and then go back about an inch. and that is about where you want to go so you want to keep note of this because this is the area you're going to clean we're going to clean this whole area with alcohol prep and then with skin prep so i'm going to put my fingers here just to remind me i'm taking my alcohol prep and i'm cleaning this area i'm going to clean an area that's even bigger than that stat lock device we want to remove any dirt and grime that is on this skin And then we're going to let that dry completely.
Now that that has dried completely, I'm going to take the skin prep and I'm going to clean that whole area again. But this is just protectant to protect the patient's skin because these stat locks stay on the skin for a while, especially if they're going to be having an indwelling catheter. And you want to change these stat locks out according to your facility's protocol. It's usually about every seven days. And while you're waiting for your site to dry, you want to put your initials and the date for when you inserted this so the person behind you will know when to change this out.
Now that it is dry we're ready to place the stat lock on the skin. So to do that we are going to pull back one side of the adhesive and just place that on the skin rub that down. Then we're going to pull the other back off put that on the skin and then Just put it down.
And again, confirm your arrow is pointing towards the insertion site. Now that we've done that, we want to position the drainage bag. There's two things we want to remember about this drainage bag and tubing. First thing is that this bag needs to be kept below the patient's bladder. at all times, never on the floor, and never position it on the part of the bed that's a movable part because we don't want that catheter to come out.
Plus, this tubing doesn't need to have any kinks or loops in it. It really needs to be a straight line and we want to make sure we position the bag so it does have a straight line so gravity can easily drain that urine. So we will put this drainage bag at the foot of the bed on a designated hanging spot where it should go.
And we're going to use this part. This is called a sheet clip. We will connect this to the sheet, some spot, to help keep the tubing in that straight line. And then once you get that taken care of, you can take the stickers that came with your tray, put them wherever your facility wants you to put them.
Once we have all of that done, we're going to finish cleaning up our supplies, make our patient comfortable, doff our gloves, perform hand hygiene, and then we are going to document.