Female Indwelling (Foley) Urinary Catheterization (IUC) (Nursing)

00:04 So, now, let's take a look at female catheter insertion.

00:07 So, just note there's differences between female and male catheter insertion and we're going to talk about these both.

00:14 So, now, let's talk about the female specifically. So, what are we going to need? The absorbent pads a great idea to put under your patient's buttocks to catch maybe extra fluid or cleaning solution and to keep those linens clean.

00:28 And of course, our Foley insertion kit. So, let's take a closer look at that insertion kit.

00:34 So, thank goodness, inside that kit is everything you're going to need.

00:38 So, let's talk about what's actually in the kit itself.

00:41 So, sterile gloves are important because this is a sterile procedure.

00:46 Now, you may want to grab a pair of backup gloves just in case they rip during insertion.

00:52 So, sterile gloves is key. Next, don't forget, you have antiseptic swabs or some sort of cleaning material to help clean the perineal area.

01:02 You're going to need lubrication.

01:05 Also, there's a sterile water syringe in the kit for you as well for the balloon.

01:09 You're going to have a drape, another sterile under pad.

01:14 You're also going to have a securement device once that's inserted to affix to the patient's leg.

01:20 Also, there's going to be the catheter itself, of course, and the urinary collection bag.

01:25 So, look at all of this stuff on this slide. So, the good thing is this typically always comes in a sterile kit for you, so, you don't have to worry about grabbing all these materials.

01:38 Now, before we get started, open the sterile catheter kit. So, make sure you maintain sterility while you're doing this.

01:45 So, don't forget. You have a one-inch border around that kit.

01:53 Now, that I've done my hand hygiene and I've done my standard gloves.

01:58 Now, this is just personal preference here but I like to ensure that I protect myself and the patient as well.

02:05 Now, before you get started, of course, make sure you're talking to the right patient and the right procedure and ensure that with Ms. Jones here today that we're going to explain thoroughly all of the steps of the female catheterization insertion.

02:20 So, once we've explained this to our patient, we can go ahead and get started.

02:24 So, now, I'm going to go ahead and open up my sterile catheter kit.

02:29 So, with this kit, it usually comes very, very similar to this.

02:34 Just going to open up the plastic. I'm going to take this out.

02:47 And I don't need this. So, this is just personal preference here.

02:52 You can either use a bedside table which is very common or you can use the bed.

02:58 Now, the main thing to remember is whatever method you use, you have to maintain sterility.

03:04 So, now that I've got my catheter kit open, I'm going to go ahead and position this on the edge of my bed.

03:11 Now, when we open up the catheter kit, don't forget that you have to start with the first flap and it's got to go away from your body.

03:19 So, I'm going to pinch here and I'm going to open this away. Now, don't forget.

03:28 With a sterile drape, you have a one-inch border that is not sterile.

03:34 So, you can use this to manipulate your package. I like to kind of curl down these corners.

03:40 As you can see, they like to flap back into your sterile feel to help me protect that.

03:46 Now, once I open that flap, I can then go to my wings. I'm going to pinch with my wings and open this up.

03:56 And again, you have that one-inch border to play with. And again, I like to just kind of curl those under.

04:03 Then, once those are down, I'm going to take a last flap and open it closest to my body, making sure I don't hover over the sterile field.

04:12 And you can already see how these like to curl up.

04:15 I like to use this one inch, straighten this out so this doesn't become a problem for me later.

04:21 All right. So, now, that I've got this, with this one-inch border, I don't love mine like this.

04:26 So, I like to align it with the patient. So, I'm just going to scoot this straight here.

04:32 So, now that I've done this, I'm going to go ahead and remove my gloves and perform my hand hygiene.

04:43 Now's the time to don our sterile gloves. Now, important to place the sterile under pad beneath the patient.

04:49 Now, we can use a sterile drape over the perineal area. This just helps maintain a sterile environment.

04:56 Now, I'll just be honest. Sometimes, nurses will use this and sometimes, they don't.

05:00 So, you may see that difference. Now, we can open our antiseptic swabs at this time.

05:06 Then, we want to attach that sterile water syringe to the balloon inflation port.

05:12 So, it's nice to have this ready, so, you don't have to attach this later.

05:17 Now, we can open our lubricant, squeeze it into the tray. Then, we can remove that catheter cover.

05:24 And then, we can take that with our sterile dominant hand, dip that into the tray where the lubricant is to lubricate our catheter.

05:33 Now, we're going to take our non-dominant hand.

05:37 So, once we touch our patient with our non-dominant hand, this is no longer sterile.

05:42 We're going to separate the labia minora here. And then, we're going to take our dominant hand.

05:48 We're going to be able to grab in that tray and then, we're going to clean our patient.

05:52 So, it's important to note. We're going to take this swab.

05:55 We're going to go one on one side, take a new swab, one on the other side, and then, one down the middle.

06:02 Now, use a new swab for each swipe.

06:06 Now, once we cleaned, we want to slowly insert the lubricated catheter into the urethra.

06:12 Now, here, we want to continue to hold the labia apart so we can see much better as we advance the catheter inward and then, the urine begins to flow.

06:22 So, one key note here is once we get urine return, you do want to go ahead and advance the catheter maybe just a few more inches.

06:30 We want to make sure that catheter is secure in the bladder.

06:34 Now, just to make sure we secured in the bladder, we have that balloon to help us out.

06:38 You want to inflate the balloon using the sterile water syringe.

06:42 That's why it was so helpful to go ahead and attach the syringe earlier when we prepared our equipment.

06:52 So, this is the ideal time. You want to let Ms. Jones know, "Okay, Ms. Jones, we're getting our supplies ready.

06:58 We're going to go ahead and have to expose you here so we can insert the Foley catheter." We will do our best to maintain privacy but just during the procedure, we've got to pull back your blanket and as soon as we're done, we can maintain privacy again.

07:14 So, now that I've got that pulled back, now, we've got to look at our sterile field.

07:18 So, once I've got - once I take a look at this, the first thing I notice is my sterile gloves and this is very common.

07:25 So, I'm going to pinch in the middle. And I like to treat this almost like a separate sterile field.

07:31 So, this is why I like my bedside table and I'm going to move this to the side.

07:36 So, just note when you're talking about a sterile field, you can't touch anything inside of that until you're sterile.

07:42 So, remember, sterile to sterile. So, now, let's take a look at our gloves.

07:46 So, I'm going to open these up. And yes, I'm touching the outside of the package but remember, the inside gloves is what's sterile. So, I'm going to open this up kind of like a book.

07:58 Now, with most gloves, it's super helpful because it'll tell you, this glove is thumb on the right.

08:03 This glove is thumb on the left. So, I'm going to take these little flaps and use these to open, kind of like my sterile field and I like to fold these down as well.

08:15 So, now, that this is open, this is considered my sterile field. My gloves are also sterile.

08:22 So, it doesn't matter which hand you like to use.

08:25 You can start with your right, start with your left, it's whatever your preference is.

08:29 So, I like to start with my left. So, when I do this, I'm going to pinch the inside cuff of the glove.

08:36 This is the piece that's touching my skin, so, this is not the sterile part of the glove.

08:41 So, I'm going to open this up carefully. Then, I'm going to slide my hand in kind of like a pizza.

08:47 Now, it's important to take your time here.

08:49 Don't rush and you notice, I like to lift this up so my glove is not dragging all over.

08:56 So, I'm going to maintain sterility and just take my time and wiggle my fingers.

09:02 And notice, I'm touching the inside of the glove and maintain some tension.

09:06 It'll help you pull it on. But don't get in a rush here.

09:09 So, you see, once I'm done and I've donned my glove, I can let go.

09:13 Now, because we're sterile to sterile, I can take this glove and go on the inside cuff of my other glove.

09:22 Again, don't get in a rush here.

09:25 Not a bad idea as well that you bring an extra set of sterile gloves in case you break yours because that can happen.

09:31 So, I've got the inside of my cuff. I'm going to slide this hand in like a pizza as well.

09:38 And again, take your time and notice, I'm on the inside of the cuff.

09:42 I keep my thumb out just to make sure I don't touching anything like my hand, wiggle these on.

09:49 Again, take your time, maintain tension but not too hard.

09:53 And then, just kind of manipulate that down and let go.

09:56 So, now that I've got both on, I'm sterile to sterile.

09:59 If you want to, I just like to use my elbow and move this out of the way.

10:04 So, now, that I've got this on, you notice inside, I've got this blue sterile drape.

10:10 So, when we touch this, I'm going to touch the corner of this and let this unfold.

10:21 Be careful not to drag this all over the place.

10:24 So, when I do this, I want to maintain the sterility of the drape.

10:31 It gets kind of wild here but I like to take my gloves and I'm going to curl this inside to where when I drop it for my patient, I'm protecting my gloves as well.

10:41 So, I'm going to take this and then, just let that go. So, however you need to do to maintain sterility.

10:48 So, once that drape is down, I want to show you the next drape as well.

10:51 So, this one, we can touch anything inside the box now, now that we're sterile.

10:57 This one's a little unique. There's a hole cutout and this is on all catheter kits.

11:03 A lot of the times, nurses will use this to drape over the patient for another sterile field.

11:08 It's totally up to you. I typically find this bothersome. It'll flap back and forth in my field.

11:15 I don't particularly like to use it, so, I get rid of it. But again, you might see a nurse do this.

11:20 Now, during this time, as you've seen, I've opened this.

11:23 It's really important that you maintain the sterile field in front of you and you don't turn your back on it.

11:29 You also want to make sure you're not hovering over your field.

11:32 All right. So, now, that we've got this set up, I like to move my kit closer to my patient for when I'm ready to cath. So, because we're sterile to sterile.

11:42 And remember, that one-inch border is not, I'm going to slide this a little closer to my patient.

11:48 The other thing I like to do is I like to position this towards ease for catheterization.

11:55 So, I'm going to take off this top and we're going to put this side by side.

12:00 So, now, that I've done that, I'm going to go ahead and prep my equipment.

12:04 I'm going to get my swabs and open this up.

12:09 Most of the time, you'll see these as iodine or something like this, like a brown liquid to clean your patient.

12:16 So, I'm going to open these up, just lay these in here and get rid of these.

12:21 Once I've done that, then, I'm going to take my sterile balloon inflate - or my sterile saline.

12:27 I'm going to take off my cap. Then, I'm going to go ahead and release that pressure.

12:34 Okay. So, once I've got my sterile saline ready, this is what we use to inflate the balloon inflation port or the balloon on the Foley catheter.

12:43 That's what's going to see in the bladder of your patient.

12:46 So, when you take a look at your catheter, you see this orange port, this is where the sterile saline port is going to - sterile saline syringe is going to attach to the port.

12:59 Now, some people may not do this until later, but I promise you, it's way easier to do it now.

13:05 That way, once you insert the catheter, you'll be ready to go.

13:08 So, I'm going to carefully place that back down and be sure stuff doesn't flop outside your sterile field.

13:15 So, now that we've got that going, I'm going to go ahead and open up my lubricant.

13:19 I just like to prep everything ahead of time. Everybody's different with the lubricant.

13:24 I like to squirt this in a line. Some people like to do it on the catheter. It's totally up to you.

13:30 Okay. So, now that we've done this, I'm going to go ahead and prep my catheter as well.

13:37 So, notice when I take out this catheter cover, I'm not letting the catheter flop all around, choke up a little bit so it doesn't flop outside your sterile field.

13:49 Okay. You can see it gets a little wily here. So, now that I've got my catheter, I'm going to make sure I lubricate this and it's very important that you want to make sure this doesn't go outside your sterile field, so, mine's behaving.

14:05 Okay. So, now that we've got all of our supplies ready, we're ready to clean.

14:10 So, this is a good time to say, "Okay, Ms. Jones. We've got all of our supplies ready.

14:15 You're going to feel me clean you. And then, we're going to insert the catheter." So, when you start with this, you have a dominant and a non-dominant hand.

14:24 Make sure you choose this before you start. I'm right-handed, so, I'm going to cath with my right hand.

14:30 Now, with my non-dominant hand, this is where I'm touching the patient and I'm going to separate the labia minora.

14:36 So, once I do this and I get good visualization of my patient, this is where I'm going to clean.

14:41 I'm going to take my swab and I'm going to go down the side and get rid of it.

14:49 I'm going to take my swab and go to the other side. Then, I'm going to take my last swab and go down the middle.

15:00 And it's important that you use a new swab for each swipe. So, now that we've cleaned our patient, this is a great time to go ahead and slowly insert the catheter.

15:12 Okay, Ms. Jones. Now, that we've cleaned, I'm going to go ahead and slowly insert the catheter.

15:17 If you feel any pain or discomfort, let me know. You may feel a little pressure though." So, I'm going to choke up a little bit on my catheter. We want to continue to hold the labia apart.

15:28 Then, I'm going to advance the catheter. Now, with a female patient, it's a great idea to shoot up at the top rather than down below.

15:36 So, I'm going to start at the top and slowly insert my catheter.

15:44 And now, with our mannequin, I want to make - just a little bit stiff, so, we're going to slowly insert this.

15:52 Now, with a female patient, when we're inserting the catheter, you go until you see urine return into the tube.

16:00 Now, once you've done that, it's a great idea just to go a few more inches.

16:04 You just want to make sure you're passed the urethra. So, once that - this is in, I've got urine return.

16:10 I've advanced a bit. I'm going to hold on to this. Then, I'm going to go ahead inflate my balloon.

16:18 So, maintain pressure and if at any point when you're inflating the balloon, the patient feels like it's uncomfortable, you need to stop. You're probably not far enough with your catheter.

16:29 So, keep a hold of your syringe. And then, unscrew this, and then, you can get rid of it.

16:35 Now, now that we've got our catheter placed, we're going to go ahead and secure it to the patient's thigh.

16:41 Now, this patient obviously doesn't have a thigh to secure it to But that catheter securement device is very important.

16:48 This is going to help reduce infection rates in your patient and it's going to be much better for positioning and comfort as well.

16:55 So, if you have a catheter securement device which most facilities do, it will seat right here at the Y and you'll attach it to the patient's thigh.

17:04 Now, very important that you give them a little slack once you secure that.

17:09 Now, once that's done, we want to take our bag. Here's the other thing with these bags.

17:15 Notice how thin they are. They're kind of vacuum sealed.

17:20 So, this was a pro tip a catheter tech showed me one time that make sure you break the seal of this vacuum, so, once it's placed, the urine will drain down into the bag.

17:33 So, I've broken that seal and once we've done that, we're going to go ahead and make sure we lower it to the level below the bladder.

17:42 Now, when you affix the collection bag to the bed, it's got to be to a non-moving part.

17:49 You don't want to place a collection bag on the side reel for example and move it.

17:53 It will tug on your patient. Then, don't forget. We've got our securement clip as well that you can use.

18:00 Then, you're going to return the bed to the lowest position, maintain privacy for your patient, get rid of all your supplies.

18:07 And of course, take off your gloves and perform hand hygiene. Thanks for watching.