PBA Foley

Question 1

What should be done outside the patient’s room before inserting a urinary catheter?

insertion

Answer 1

Check EHR for legal order to insert urinary catheter and verbalize one indication for placement.
Check EHR for allergies, specifically iodine, shellfish, and latex.
Gather supplies (kit, chuck, graduated, washcloth.

Question 2

What are the expected and unexpected outcomes to identify before catheter insertion?

insertion

Answer 2

Expect: 500ml, yellow/clear urine, no pain
Unexpected: anuria, hematuria, painful

Question 3

What are the initial steps upon entering the patient’s room for catheter insertion?

insertion

Answer 3

Introduce self, identify patient using two client identifiers, confirm physician orders, ask about allergies.
Adjust bed to appropriate height, adjust side rails, provide privacy, perform hand hygiene, and apply clean gloves.
Assess bladder for pain and fullness and explain the procedure to obtain verbal consent.

Question 4

How should the patient be positioned and prepped for catheter insertion?

insertion

Answer 4

Assist patient to the appropriate position, drape to expose only the perineum, and place a waterproof pad under the client.
Inspect the perineal region and demonstrate perineal care, verbalizing foreskin retraction for an uncircumcised male.

Question 5

What are the steps to prepare equipment using sterile technique?

insertion

Answer 5

Open catheter kit and “square” outer wrap on the table, apply sterile gloves, and place sterile drape.
Separate top and bottom trays, prepare antiseptic, apply lubricant to catheter, and attach syringe to balloon inflation port.
Restack trays and move kit contents onto sterile drape between patient’s legs, maintaining sterility.

Question 6

Male catheter insertion - Hand commitment and cleaning method

insertion

Answer 6

Commit non-dominant hand. Hold penis firmly behind the glans with non-dominant hand at a 60-to-90-degree angle.
With dominant hand, using forceps and saturated cotton ball/swab stick, start from the meatus, circle the entire glans x 3 and discard. Repeat the same procedure x 3.

Question 7

Male catheter insertion - Technique

insertion

Answer 7

Maintain sterile technique, pick up catheter with dominant hand, lubricate if necessary.
Slowly insert catheter tip into the urinary meatus, ask patient to bear down gently, and breathe slowly and deeply.
Advance 7-9 inches, state presence of urine, continue to the catheter bifurcation.

Question 8

M/F catheter insertion - Securing the catheter

insertion

Answer 8

Inflate the balloon using the sterile water-filled syringe, ask patient about discomfort. Keep positive pressure, remove and discard syringe. Gently pull catheter until balloon is snug against bladder neck.
Change gloves, hand hygiene, secure catheter to a holding device on the leg.

Question 9

Female catheter insertion - Hand commitment and cleaning method

insertion

Answer 9

Commit non-dominant hand. Separate labia majora and minora with the thumb, middle, and index fingers of non-dominant hand.
Keep labia separated throughout the procedure. Re-swab if necessary.

Question 10

Female catheter insertion - Technique

insertion

Answer 10

With dominant hand, using forceps and saturated cotton ball/swab stick, clean labia minora furthest from you with a downward stroke, and discard. Repeat same for labia minora closest to you, and straight down the urinary meatus.
Insert catheter tip into urinary meatus, bear down gently, and breathe slowly and deeply.
Advance 2-3 inches, state presence of urine, insert an additional 1-2 inches.

Question 11

Post catheter insertion - Final steps

insertion

Answer 11

Keep catheter and tubing free from kinking, avoid dependent loops, hang drainage bag below patient’s bladder level on an immovable part of the bed, not allowing it to rest on the floor.
Clip tubing to bottom sheet.
Remove fenestrated drape, verbalize need for peri-care, replace foreskin if retracted.
Dispose of supplies, remove gloves, perform hand hygiene.
Assess patient comfort, answer questions. Lower bed, raise bed rails, place call light within reach.
Outside room, verbalize documentation of procedure including date, time, size of Foley, volume of balloon, urine returned, and patient tolerance.

Question 12

First steps before urinary catheter removal

removal

Answer 12

Outside room, check EHR for legal order for removal of urinary catheter.

Question 13

Patient identification and explanation of catheter removal

removal

Answer 13

Introduce self, identify patient using two client identifiers, compare physician orders to wristband, ask for allergies. Explain purpose and procedure in understandable terms.

Question 14

Ensuring privacy and cleanliness

removal

Answer 14

Provide privacy, perform hand hygiene, and apply clean gloves.

Question 15

Setting up for urinary catheter removal

removal

Answer 15

Place waterproof pad under client. Verbalize need to empty drain bag/tubing, measure total volume, and dispose in toilet.

Question 16

Detaching the urinary catheter

removal

Answer 16

Remove urinary catheter from catheter holding device.

Question 17

Deflating the urinary catheter balloon

removal

Answer 17

Deflate the urinary catheter balloon by inserting a 10 mL slip tip syringe into the balloon valve, allow water to flow back into syringe, note amount returned.

Question 18

Removing the urinary catheter

removal

Answer 18

Gently tug to remove catheter, wrap in waterproof pad, dispose of per hospital policy.

Question 19

Providing care after catheter removal

removal

Answer 19

Verbalize the need to provide peri-care.

Question 20

Final steps after removing the urinary catheter

removal

Answer 20

Remove gloves, perform hand hygiene. Assess client comfort level, ask if there are any questions. Lower bed, raise bed rails, place call light within reach.

Question 21

Documentation after urinary catheter removal

removal

Answer 21

Verbalize documentation of procedure date, time, size of Foley, volume of balloon emptied, total volume emptied, color/clarity of urine, and patient tolerance.