21.4 Inserting and Managing Indwelling Urinary Catheters

Safely and accurately placing an indwelling urinary catheter poses several challenges that require the nurse to use clinical judgment. Challenges can include anatomical variations in a specific patient, medical conditions affecting patient positioning, and maintaining sterility of the procedure with confused or agitated patients. See the checklists on Foley Catheter Insertion (Male) and Foley Catheter Insertion (Female) for detailed instructions.

Nursing interventions to prevent the development of a catheter-associated urinary tract infection (CAUTI) on insertion include the following^[1]:

• Determine if insertion of an indwelling catheter meets CDC guidelines.
• Select the smallest-sized catheter that is appropriate for the patient, typically a 14 French.
• Obtain assistance as needed to facilitate patient positioning, visualization, and insertion. Many agencies require two nurses for the insertion of indwelling catheters.
• Perform perineal care before inserting a urinary catheter and regularly thereafter.
• Perform hand hygiene before and after insertion, as well as during any manipulation of the device or site.
• Maintain strict aseptic technique during insertion and use sterile gloves and equipment.
• Inflate the balloon after insertion per manufacturer instructions. It is not recommended to preinflate the balloon prior to insertion.
• Properly secure the catheter after insertion to prevent tissue damage.
• Keep the drainage bag below the bladder but not resting on the floor.
• Check the system to ensure there are no kinks or obstructions to urine flow.
• Provide routine hygiene of the urinary meatus during daily bathing, and cleanse the perineal area after every bowel movement. In uncircumcised males, gently retract the foreskin, cleanse the meatus, and then return the foreskin to the original position. Do not cleanse the periurethral area with antiseptics after the catheter is in place.^[2] To avoid contaminating the urinary tract, always clean by wiping away from the urinary meatus.
• Empty the collection bag regularly using a separate, clean collecting container for each patient. Avoid splashing and prevent contact of the drainage spigot with the nonsterile collecting container or other surfaces. Never allow the bag to touch the floor.^[3],[4]