Foley catheter insertion
Formal Definition
A bedside procedure for sterile placement of a urinary catheter — typically a Foley catheter with a small inflatable balloon at its tip — through the urethra into the bladder for continuous urine drainage; performed for both clinical monitoring (strict I&O in ICU, perioperative, post-op) and therapeutic purposes (acute urinary retention unresponsive to bladder scan intermittent decompression, neurogenic bladder with retention, severe symptomatic BPH with obstruction, bladder outlet obstruction from prostate, accurate measurement when voluntary voiding insufficient); standard sterile technique with sterile drape, sterile gloves, antiseptic cleansing of urethral meatus, and sterile catheter kit.
How It's Used on the Ward
"Foley" or "place a Foley" — the patient needs an indwelling urinary catheter; very common procedure for ICU patients, post-op patients, patients in retention, and patients who need strict I&O monitoring; always a sterile procedure to prevent CAUTI (catheter-associated UTI).
Example
""Post-op patient with benign prostatic hypertrophy has not voided in 12 hours since surgery. Bladder scan shows 800 mL retained. Patient symptomatic with lower abdominal pressure. Bedside team attempts bladder drainage but unable to pass straight catheter past prostate. Resident placed Foley without difficulty, 850 mL returned over 30 minutes. Foley left in place for postoperative bladder management, planned for removal once return of spontaneous voiding pattern.'""
Clinical Context
Indications for indwelling Foley: (1) Accurate output monitoring in ICU, post-op, during active resuscitation. (2) Acute urinary retention unresponsive to intermittent catheterization. (3) Perioperative use for surgical cases >3 hours or requiring bladder decompression (urologic, pelvic, abdominal cases). (4) Chronic neurogenic bladder (though intermittent self-catheterization is preferred when feasible to reduce CAUTI). (5) Hospice/comfort for end-of-life urinary retention. Contraindications: urethral trauma (suspected), recent urethral surgery, severe urethral stricture — urology may need to place suprapubic catheter. Insertion: female — separate labia, identify urethral meatus above vagina; male — retract foreskin if uncircumcised, hold penis at 90 degrees to body during insertion, slight resistance at external sphincter — gentle pressure. Inflation: inflate balloon with 10 mL sterile water after urine return confirms placement. Risks: CAUTI (most common HAI in US — risk increases ~3-7% per day of catheterization), urethral trauma, hematuria, retention of catheter fragments, balloon rupture. Daily necessity review is required: every day, the team must ask "does this patient still need this Foley?" — remove as soon as not needed.