Female Foley Catheter Placement Preoperatively

CHAPTER 1

Hi, I'm Dr. Joseph Clark, professor of urology here at Milton S. Hershey Medical Center. Today we are going to demonstrate placing a Foley catheter. This patient is under general anesthesia and about to undergo a major surgery, and typically we place Foley catheters for long cases. So we're about to place a Foley catheter in a patient who has been just placed under general anesthesia. Typically, we place these catheters for long cases or for cases where it's important to monitor the urine output. One of our interns, a PGY1 urology intern, will be placing the catheter. You will see that she first has the kit, which has everything one needs to place the Foley catheter. After she's under anesthesia, her legs are placed in the frog leg position. She opens up the kit and there's the catheter that's preconnected to the tubing and the bag. There will be a 10-cc syringe with sterile water. There's a syringe with lubricant. There are swabs that we can use to clean the meatal area. So once the kit is open, you will see her donning her gloves. These are sterile gloves. Then she will be putting the drape around the perineum. And once that is done, she will take one hand and spread the labia to expose the meatus. Now, sometimes in very obese women or older women, the introitus is quite small, and sometimes it's difficult to find that meatus. Sometimes with the help of light or better retraction, we can actually find the meatus. This patient's meatus was just a little bit recessed, but you'll see that once she uses her hand to spread the meatus, that hand is considered contaminated. So she would do everything with her other hand. She will take the swab stick, dip it in the Betadine, and swab the meatus before inserting the catheter. Once she swabs the meatus, she will take that Foley catheter that she's already lubricated and just pass it into the meatus. She'll push it slowly in, and there was a little bit of difficulty you can see, but once it was in, you can see yellow urine through the tubing. The female urethra is only about four centimeters long. And so once we see urine, we push the catheter maybe about another inch, and there is a balloon port. She takes the sterile water and blows up the balloon. That balloon keeps the catheter in place. Because everything is preconnected, we'll see urine coming down the tubing, and her urine output can be measured. So once the catheter is in place, she use a special device to secure the catheter in place so that it's less likely to be pulled or dislodged. And this is a StatLock device, and you can see how it's applied. So once the catheter is in place and secured, she will be placed in the position for the actual surgery that she's to undergo.

CHAPTER 2

So we have a patient that we're gonna do a percutaneous nephrolithotomy, but before we do that, we're gonna put a Foley catheter in. So we're gonna just open up the - actually, let me get her colostomy out of the way, and we're just gonna frog leg her. Okay. And sometimes having light in the area will be helpful. So Dr. Guan is using a standard Foley tray to put in the Foley catheter. And it usually has all the things that you need to put in a Foley catheter under sterile technique. So the kits usually contain a little cleaning pad before starting the sterile case. So she's wiping the area. So typically Foley catheters are put in for long cases where they need to monitor the urine output and to prevent distention of the bladder. They're usually put in also during laparoscopic cases. So right now, Dr. Guan is sanitizing her hands and she'll open up this tray. It will contain sterile gloves. Sometimes the sterile gloves aren't a proper fit, so sometimes you can get separate sterile gloves that will fit you better. All right, so we have the sterile gloves there that she's gonna pick up and she'll put on. And as you can see, everything is here. There is a separate pad to put down. There's another pad with a hole in it. And here's the catheter system. This is a 16 French Foley catheter, which is all preconnected to the drainage bag. There's also two things here. One is a syringe that is filled with sterile water to blow up the balloon for the Foley catheter. And there, at least in this packet, there's a syringe with a lubricant, which we can use to lubricate the tip of the Foley catheter before insertion. So this is the sterile drape. And then there's again another drape with a hole in it, typically. And she will put the opening where the perineum is. Okay. Like that. So here you can see this kit contains three swab sticks, and she's gonna be putting the iodine solution. And she's taking the syringe that has the lubricant, and she's gonna squirt it someplace. There's the lubricant. And again, she has the 10-cc syringe with the sterile water to blow up the balloon. So here's the Foley catheter. It's got this special sheath on that she's gonna take out. She's gonna lubricate the tip of the Foley catheter with the lubricant.

CHAPTER 3

And now once she uses her left hand to spread the labia, that left hand is not considered sterile. She will take the swab sticks to clean the meatus area.

CHAPTER 4

All right, and then she will take the Foley catheter. The female urethra is typically just four centimeters long, and so she will insert the Foley catheter. And then we will have some return of urine. Do we need help retracting, or we can get some sterile gloves if we need help retracting. Are we... Ah, okay, so now we have return of urine, so we know she's in. Once we get the urine, she'll put it in maybe, you know, an inch further in, and she will inflate the balloon on the inside of the bladder. And the balloon prevents the catheter from slipping out.

CHAPTER 5

In some patients who are obese or who have a recessed urethra or the introitus is very narrow, sometimes it is very difficult to place these Foley catheters. Sometimes you need to have additional sets of hands to help retract the labia. So she is now going to secure the catheter with a StatLock. So this positions the Y-portion of the catheter to the thigh. And once it's in place, it's just important that the Foley catheter drainage bag is below the level of the bladder because it drains by gravity. We can put it more on the medial aspect rather than anterior since she'll be in the prone position. Yeah, go ahead. Yeah, that'll be fine. All right, and so that is the Foley container. Now this has an aspiration port, so if you want to draw urine for a sample, it can be taken from the aspiration port. This is connected so that you cannot disconnect the tubing from the actual catheter. But sometimes if you need to irrigate the bladder, we'll take this covering off and put a syringe to irrigate the bladder. All right, and then we're putting the catheter below the level of the bladder, and we'll put her legs back together. And again, there's a little label to, you know, label when the catheter was put in by whom. But that's basically insertion of a Foley catheter.