An indwelling urinary catheter, often called a Foley catheter, is a flexible tube passed through the urethra into the bladder to drain urine continuously. A small balloon inflated at the tip inside the bladder keeps the device securely in place. Common clinical indications include acute urinary retention, bladder outlet obstruction, precise monitoring of hourly urine output in critically ill patients, and healing support after urological surgeries. In Nigerian healthcare settings, they are also frequently managed for patients with severe pelvic trauma or immobility ulcers where urine contact impairs wound healing. Unlike intermittent catheters that are removed immediately after drainage, indwelling systems remain in place for extended periods, carrying a correspondingly higher risk of ascending bacterial colonization.
Successful catheter insertion requires a clear understanding of male and female pelvic anatomy.
A common misconception is that the female meatus is easily visualized in all patients; anatomical distortion from childbirth, age, or obesity often requires alternative positioning like the lateral Sims position to improve visibility.
Selecting the correct catheter size and material minimizes urethral trauma and prevents complications like encrustation. Sizing is measured on the French (Fr) scale, where each unit equals 0.33 millimeters in diameter.
| Material / Type | Characteristics & Common Uses |
|---|---|
| Latex | Flexible and economical, but prone to bacterial adherence and latex allergy risks. Suitable for short-term use. |
| Silicone | Rigid, durable, and hypoallergenic. Ideal for long-term indwelling use because it resists mineral encrustation. |
| Hydrophilic | Coated with a slippery layer when activated with water, reducing friction during insertion. |
| Coude Tip | Features a curved, slightly rounded tip designed to navigate around an enlarged prostate in male patients. |
Standard adult sizes typically range from 14Fr to 16Fr. Using excessively large catheters can cause pressure necrosis of the urethral mucosa.
Before inserting an indwelling catheter, nurses must perform a comprehensive patient assessment. Verify the clinical order, check for known allergies to latex, iodine, or local anesthetic lubricants, and assess the patient's baseline bladder fullness via palpation or bladder scanning. Explain the procedure thoroughly to secure informed consent and reduce anxiety. Gather all necessary equipment, including a sterile catheterization tray, appropriate catheter size, sterile gloves, antiseptic solution, water-soluble lubricant, and a securement device. Ensure adequate lighting and privacy at the bedside. Failing to check for latex allergies can trigger severe anaphylactic reactions, making this safety check non-negotiable.
Maintaining strict sterile technique throughout insertion is critical to prevent introducing pathogens into the bladder.
Routine maintenance preserves the closed drainage system and prevents ascending infection. Clean the perineal area and meatal junction daily using mild soap and water during routine bathing; avoid applying antiseptic ointments or powders to the insertion site, as they promote bacterial growth. Maintain the drainage bag below the level of the bladder at all times to prevent backflow of contaminated urine. Ensure the tubing remains free of kinks, loops, or tension that could impede flow. Empty the collection bag regularly using a clean, dedicated measuring container for each patient, avoiding contact between the spigot and the container rim.
Catheter-associated urinary tract infections represent one of the most common hospital-acquired infections. Prevention centers on strict adherence to aseptic insertion, maintaining a closed drainage system, and prompt catheter removal when no longer clinically indicated. Nurses should never disconnect the catheter from the tubing unless irrigation is specifically ordered for obstruction. Routine bladder irrigation to prevent infection is discouraged because opening the system introduces pathogens. Hand hygiene must be performed before and after handling any component of the drainage circuit. Minimizing catheter days remains the single most effective preventive intervention.
When urine stops flowing into the collection bag, the nurse must systematically troubleshoot the cause before assuming the patient is anuric. First, check the tubing for obvious kinks, patient sitting weight on the line, or external compression. Inspect the lower abdomen for bladder distension and discomfort. If no mechanical blockage is found in the external tubing, gentle flushing with sterile saline may be required if an order is present and obstruction is suspected from sediment or clots. Bladder spasms can also cause urine to leak around the catheter; these are often managed with antispasmodic medications like oxybutynin rather than replacing the catheter prematurely.
Catheter removal should occur as soon as the clinical indication resolves. Explain the procedure to the patient; removal is generally quick and causes only mild discomfort. Perform hand hygiene, don clean gloves, and place a protective pad underneath the patient. Attach a syringe to the inflation port and aspirate all fluid to completely deflate the balloon, ensuring no residual volume remains that could traumatize the urethra. Gently withdraw the catheter in a smooth, continuous motion. Document the time of removal and monitor the patient's first spontaneous voiding, typically expected within 6 to 8 hours. Assess for post-removal complications such as urinary retention, burning, frequency, or hematuria.