Foleys Catheterization in Hyderabad

Introduction Insertion of an indwelling urethral catheter (IDC) is an invasive procedure that should only be carried out using aseptic technique, Insertion of an indwelling urethral catheter (IDC) is an invasive procedure that should only be carried using aseptic technique, either by a nurse, or doctor if complications or difficulties with insertion are anticipated. Catheterization of the urinary tract should only be done when there is a specific and adequate clinical indication, as it carries a risk of infection Indications:

• To drain the bladder ventillatory and bed bound patients prior to, during, or after surgery
• For investigations
• To accurately measure the urine output
• To relieve retention of urine
• To relieve urinary incontinence when no other means is practical

Procedure For Insertion Of Urinary Catheter

• The need for an IDC should be discussed with the patients’ medical team prior to insertion. Medical approval for IDC insertion should be ordered and/or documented.

The Following Should Be Completed In Line With The RCH Aseptic Technique Procedure. Female:

• Perform hand hygiene
• Place in supine position with knees bent and hips flexed
• If soiling evident, clean genital area with soap and water first
• Perform hand hygiene
• Open dressing pack (aseptic field) and prepare equipment needed using aseptic technique
• Pour sterile normal saline onto tray
• Perform aseptic hand wash and don sterile gloves
• Apply sterile drapes/towel
• Separate labia with one hand and expose urethral opening. In neonates, the urethral meatus is immediately above the hymeneal fringes.
• Using swabs held in forceps in the other hand clean the labial folds and the urethral opening. Move swab from above the urethral opening down towards the rectum. Discard swab after each urethral stroke into waste bag or designated waste area.
• Remove catheter wire if a 6Fr catheter is used
• Lubricate catheter
• Insert catheter into the urethral opening, upward at approximately 30 degree angle until urine begins to flow.
• Inflate the balloon slowly using sterile water to the volume recommended on the catheter. Check that child feels no pain. If there is pain, it could indicate the catheter is not in the bladder. Deflate the balloon and insert the catheter further into the bladder. ALWAYS ensure urine is flowing before inflating the balloon. Note that in a under 6 months a balloon is not typically used. In this case be especially mindful that strapping is secure.
• Withdraw the catheter slightly until resistance is felt and attach to drainage system
• Remove gloves and perform hand hygiene
• Secure the catheter to the thigh with either a catheter securement device or tape
• Clean trolley and dispose of used articles into yellow biohazard bag
• Perform hand hygiene

Male:

• Perform hand hygiene
• Place in supine position
• If soiling evident, clean genital area with soap and water first
• Perform hand hygiene
• Open catheter pack (aseptic field) and prepare equipment needed using aseptic technique
• Pour sterile saline onto tray
• Perform aseptic hand wash and don sterile gloves
• Lift the penis and retract the foreskin if non-circumcised. Do not force the foreskin back, especially in infants. A sterile gauze swab can be used to hold the penis.
• Using other hand, clean the urethral opening with swabs held in forceps. Use a circular motion from the urethral opening to the base of the penis. Discard swab into waste bag or designated waste area.
• For boys older than 3 years insert the Xylocaine gel into the urethra. Gently hold the urethra opening closed and wait 2 – 3 minutes to give the gel time to work. For infants apply sterile lubricant to catheter before insertion. Post urology surgery consider using two syringes of xylocaine gel to increase lubrication of the urethra and decrease risk of trauma.
• Remove the wire if using a 6Fr catheter
• Hold the penis with slight upward tension and perpendicular to the body. Insert the catheter.
• When the first sphincter is reached (at level of pelvic floor muscles) gently bring the penis down to face the toes, apply constant gentle pressure. If resistance is felt the following strategies should be considered:
• Remove the catheter and utilise a 2nd tube of lubricant
• Increase traction on penis and apply gentle pressure on the catheter
• Ask to take a deep breath
• Ask to cough and bear down e.g. try to pass urine
• Gently rotate the catheter.
• If unable to pass the catheter seek assistance from treating medical team or Urology registrar. DO NOT use force as you may damage the urethra.
• Advance the catheter and gently insert it completely into the urethra until the connection portion.
• ALWAYS ensure urine is flowing before inflating the balloon.
• Inflate the balloon slowly using sterile water to the volume recommended on the catheter. Check that feels no pain. If there is pain, it could indicate the catheter is not in the bladder. Deflate the balloon and insert the catheter further into the bladder. Withdraw the catheter slightly till resistance is felt and attach to drainage system
• Reposition the foreskin if applicable
• Remove gloves and perform hand hygiene
• Secure the catheter to the thigh with either catheter securement device or tape
• Clean trolley and dispose of used articles into yellow biohazard bag
• Perform hand hygiene