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

00:04 Let's take a look at male indwelling catheter insertion. Now, let's take a look at what we're going to need.

00:11 Don't forget that absorbent pad and of course, your Foley insertion kit.

00:15 Now, let's take a look inside this kit. Luckily, this is all packaged for you.

00:21 But man, there are a lot of components. So, let's take a look at these.

00:24 So, don't forget your sterile gloves because this is a sterile procedure.

00:29 Now, one good tip in trach is that sometimes, during the donning of those gloves, we may rip it or contaminate our gloves. It's a great idea to bring you an extra pair.

00:40 Also, sizes can differ. So, make sure you grab a pair that's going to work for you.

00:45 Next, you're going to have some sort of antiseptic or cleaner swabs inside the kit.

00:51 You're also going to have lubrication for the catheter.

00:54 Also, there's the sterile water syringe to later inflate the balloon.

00:59 We also have our drape, a sterile under pad, and that securement device to attach it to the patient's leg.

01:06 We also have, of course, the indwelling catheter itself and the urine collection bag.

01:11 So, again, look at all these components that are in this kit. Luckily, we don't have to go finding these.

01:17 These come in an exclusive kit that's sterile for you to use.

01:22 So, once we get started, we of course, need to open that sterile insertion kit wrapper.

01:27 Now, remember, once we open this, don't leave your sterile field. You need to keep an eye on it.

01:33 We need to maintain sterility here and we also have the one-inch border forgiveness that's allowed for us for movement, for proper placement for our patient.

01:47 Now that I've done my hand hygiene, I've donned just standard gloves.

01:52 Now, this really is a personal preference here but I like to ensure that I protect myself as well as the patient.

01:59 So, now, we're going to start by opening the sterile insertion kit.

02:03 And of course, make sure that you thoroughly explain the procedure to the patient first.

02:08 This can be a little uncomfortable, so make sure that you answer all of their questions before you get started.

02:15 So, I'm going to go ahead and open this and this is a pretty standard kit.

02:19 So, these are usually encased in plastic. So, I'm just going to open this up and take out my kit.

02:28 I don't need this or this top either. This usually tells you the contents of your package.

02:35 Okay. So, when I open up my kit, you've got your sterile flap.

02:40 So, you want to ensure that when you start, you take the first flap and open it away from you.

02:46 So, I'm going to pinch here and we're going to open this away and don't forget to kind of fold these corners down.

02:53 They like to kind of creep up on you.

02:55 So, I like to kind of curl them so they don't come back into your sterile field.

03:00 Then, I like to take the wings. And again, you see me just pinching here and opening this up.

03:07 Now, the beauty of a sterile field just like you've seen me do, you have a one-inch border that is non-sterile that you can use to manipulate your package wherever you need to do that.

03:19 Now, the last step is to take this last wing and I'm going to pinch and then, open it towards myself.

03:26 And again, as you can see, you just want to make sure that you fold down these edges so they don't come back in your sterile field.

03:34 So, now, that I've got this laid out, you have that one-inch border.

03:38 I like to kind of align mine with my patient. The other thing I'd like to note, you may see a nurse open the sterile kit on a bedside table or in between here closest to the patient.

03:52 It is fine either way as long as you maintain sterility that is really key.

03:57 So, you kind of have to judge and assess your patient as well.

04:00 So, now, that I've done this, I'm going to go ahead and take off my gloves.

04:09 Now's the time to done our sterile gloves.

04:12 Now, important to place the sterile under pad beneath the patient.

04:16 We can place the sterile drape over the patient and for the perineal area as well.

04:21 Now, we can open our antiseptic swabs at this time.

04:25 So, one thing to remember is once you put on those sterile gloves, we can touch anything inside that sterile kit.

04:32 Now, attach the sterile water syringe to the balloon inflation port.

04:37 This is going to help us save time and maintain sterility later in the procedure.

04:43 Also, we can open the lubricant and squeeze that into the insertion tray to prepare that for a catheter.

04:48 Now, it's a good time to remove that catheter cover.

04:51 And then, we're going to take our sterile dominant hand, pick that catheter up, dip the catheter tip into the lubricant to make sure it's lubricated and ready to go.

05:03 Now, here's the thing that's tricky. Make sure when you're inserting a catheter, you maintain with your non-dominant hand, you're going to touch the patient here.

05:13 Once you've touched the patient, you're no longer sterile.

05:16 So, use your non-dominant hand, hold the patient's penis at about a 60 to 90 degree angle and if the patient needs, we may need to retract the foreskin here for better visualization of the urethra.

05:29 Now, with our dominant hand, remember, we have our non-dominant holding our patient.

05:34 With the dominant hand that's going to stay sterile, use an antiseptic swab to make sure you clean the glands in a circular motion from inside outward.

05:45 Now, we need to repeat this with a new swab for a total of three times.

05:51 Once we've cleaned our patient, we can gather our lubricated catheter and insert this catheter into the urethra itself.

06:00 Now, here's where it's a little bit different for a male patient that you need to consider.

06:04 So, you want to make sure you hold on to your patient's penis apart from the body and as you advance the catheter, you're going to see that urine begin to flow and you're going to see that urine return.

06:16 Now, here's where the difference is between male and female. The male has a longer urethra.

06:22 So, it's recommended that when you advance the catheter, you're going to go all the way to that Y site.

06:28 I know it seems really long but you want to make sure that that catheter tip where the balloon is going to be inflated is all the way into the patient's bladder. This ensures you to do so.

06:40 So, make sure all the way to the Y site on the catheter. Now, once we're all the way to that Y site, this is when we can inflate that balloon using a sterile water syringe.

06:51 This is going to help seat it in the patient's bladder like you see in the picture here.

07:00 Now, that I've performed my hand hygiene and my sterile insertion kit is open, I'm going to pinch in the middle and remove my sterile gloves from the kit.

07:10 So, it's very important you pinch in the middle here and we kind of treat this as almost like a second sterile field.

07:18 And this is why I like to have my bedside table close because I'm going to utilize this later and you'll see what I'm talking about.

07:25 So, now that I have this done, don't forget to explain to your patient.

07:30 So I may say, "Hey, Mr. Jones, I've got everything ready. I'm going to go ahead and pull back your blanket now.

07:37 Now, I know it's going to expose you but it will only be the time for the procedure and I'll try to maintain privacy as quick as I can afterwards.

07:45 So, now, I'm going to go ahead and pull back Mr. Jones' blanket, make sure it stays out of our way and now that we've done this, I can go ahead and don my sterile gloves.

07:57 So, when you're taking a look at your sterile gloves, it's very helpful for you.

08:01 You can open this up. So, don't forget. Yes. This is like a separate sterile field.

08:06 The outside of the glove package is totally fine for you to touch because it's inside, the sterile gloves is what's important.

08:13 So, I'm going to open this up like a book. I also kind of like to open this up like I did my sterile field and opened down the corners or pushed down the corners.

08:23 And it will also tell you which side that your gloves are on. So, thumb on the right, thumb on the left.

08:29 So, it tells you kind of slide in like a pizza. So, you see these little cuffs, this is what you want to use. Sometimes, it's hard to get in there.

08:39 Take these and you're going to open these up as well.

08:42 So, again, you want to make sure you're treating this like a sterile field.

08:46 So, I take these and I'm going to fold in those corners so they don't flop back into my sterile field.

08:53 So, when you don sterile gloves, it's up to you. You can go right, left. It's totally up which is ever your preference.

09:00 So, now that I get my gloves, don't forget to pinch in the middle of the cuff.

09:05 This is the part that's going to be closest to your skin. So, this part's not sterile.

09:10 So, I'm going to open this up and I'm going to slide in my hand like a pizza and you don't want your sterile gloves dragging on the surface.

09:18 So, make sure you pick these up and if you kind of keep and take your time.

09:23 This is not a rush. You want to create some tension to help pull these down.

09:29 And again, you see I'm on the inner part of the cuff and I let go.

09:33 So, now that I have a sterile glove, you can touch sterile to sterile.

09:38 So, I'm going to take this hand and I'm going to go inside the cuff to help me don my right hand.

09:44 We want to be very careful here. We're going to pick up that cuff. It's going to open it up.

09:49 And I'm going to slide this one in like a pizza as well. So, I'm going to slide this in and take your time.

09:55 There's no rush here. And you see, I keep my thumb out as well, so, I'm not touching anything else and you don't want that dragging and just work your thumb in, create tension.

10:06 And then, you can let go. So, now that I've got these donned, sterile to sterile is totally fine.

10:13 If you want to move this off, that's fine. I just use my elbows.

10:16 Okay. So, now, that we've donned our sterile gloves, now, we can get into our kit.

10:21 The first thing you're going to see in your kit is this drape.

10:25 So, I'm going to grab the corners and this sterile drape just kind of helps extend our sterile field.

10:32 And don't forget with the sterile drape, you have corners here and that one-inch corner, we're going to kind of fold across.

10:41 I'm going to open this up and I'm going to kind of wrap here to protect my sterile gloves and I'm going to stick this underneath the patient and let go.

10:52 So, now that I've got that sterile drape down, here's another sterile drape we've got in our kit.

10:57 So, I'm going to pinch this as well. Now, this is a personal preference. Let me show you this drape.

11:05 This drape has that hole in the middle. Many times, we use this to create another sterile field.

11:13 However, as a nurse, honestly, this moves around, it kind of flaps back and forth across your sterile field.

11:20 It's very possible that you could possibly interrupt your sterile field with this, so, it's not my preference.

11:26 You won't see a lot of nurses using it but you can. So, I'm going to go ahead and get rid of this.

11:33 Okay. So, the other thing you've noticed is during this time, I'm not turning my back to the sterile field.

11:39 That's very important, so, don't forget that as well.

11:42 So, once I've done this and I've got everything sterile, I'm going to personally pull this a little bit closer to where when I'm ready to insert, I can do that.

11:51 So, I'm going to pinch inside the sterile field and pull this a little closer to my patient.

11:57 So, now, that we're sterile to sterile, I'm going to manipulate the box to where it's helpful for me.

12:02 So, I kind of like to open this up and set this side by side. Again, totally up to you.

12:09 So, now, that I've done this, I may get my antiseptic swabs. And again, notice, I can touch all in here.

12:15 It's sterile to sterile. I'm going to open this up. It's up to you. You can either leave it in the kit or not.

12:26 Let me get rid of my trash. Then, after I open that up, I'm going to take my sterile water syringe.

12:33 See this here. I'm going to undo the cap. Okay. Let me get rid of that extra pressure.

12:41 Then, I'm going to attach it to the balloon inflation port. So, you see this orange port right here.

12:49 This fits very nicely. This is very helpful to go ahead and attach it, so, when you need to inflate it later, it's already done. So, this is a great tip.

12:59 So, go ahead and keep this on there. And again, be really careful this stuff doesn't flop outside your sterile field. Now, I've got my swabs ready.

13:08 I've got my sterile water syringe ready. Now, I've got my lubricant.

13:16 So, I'm going to take this off as well.

13:17 However you want to do this, I like to just squirt this down the side of my kit.

13:23 Some people do it on the catheter. Either way, it's up to you.

13:26 So, let me get rid of that. So, now that I've got this, I'm going to go ahead and lubricate my catheter and I'm going to take my cover off.

13:36 Notice I'm kind of choking up on the catheter, so, it doesn't flop outside my sterile field.

13:41 Okay? So, now that I've got this, I'm going to lubricate the catheter.

13:46 Again, this can happen a lot.

13:48 Be very careful that you're not letting your catheter flop outside your sterile field.

13:53 So, mine's behaving, so, we're good to go.

13:56 So, now that we've done this, you have to decide which is the dominant hand that you are going to cath with.

14:02 So, if you're left-handed, you may have to be on the other side of the table but I'm right-handed.

14:07 So, once you've done this, you want to talk to your patient.

14:10 Okay, Mr. Jones, everything's ready. I'm going to go ahead and get a hold of you.

14:15 And when I do, I'm going to be sliding in the catheter. Try to take deep breaths and try to relax as much as possible.

14:22 So, with my non-dominant hand, as soon as I touch the patient, you see, this is not sterile anymore.

14:29 So, I've hold on to my patient. Then, I've got my catheter and it's very important here that you create a firm grip and if there's any foreskin, you want to retract that before you get started.

14:41 So, now that I've got a hold of my patient, I'm going to go ahead and lubricate my catheter very well.

14:48 And then, don't forget, actually, you gotta clean first. So, let me go back.

14:52 So, now, that I've got my swab sticks, I've got a hold of my patient.

14:56 And when you're taking your cleaning for your patient, you want to swab on one side in like a clockwise motion and get rid of that.

15:05 Now, with your other, you're going to go down the other side and clean your patient.

15:14 This step is really important because this will help reduce our risk of infection.

15:19 Then, I'm going to go down the middle as well. So, now that this is clean, let me get rid of that.

15:25 Now the patient's clean and then, we can get our catheter going.

15:28 Now, that I've just cleaned, okay, I'm going to take my catheter.

15:32 "Mr. Jones, I'm lubricating my catheter and I'm going to slowly insert this.

15:37 Just try to deep breath and relax as much as possible.

15:40 You may feel a little pressure but it should not be painful. So, if it is, let me know." So, you want to make sure you get a firm grasp of your patient.

15:49 Then, when I'm taking my catheter, I kind of choke up here.

15:53 And then, we're going to thread this as much, as smooth and as quickly as we possibly can as long as it's safe and comfortable for your patient.

16:02 Now, here's what's different. With a male patient, you want to go all the way to the Y.

16:08 Now, obviously, with this, we have a mannequin, so, there's some restrictions but I want to hold this in here and then, with my other hand, I'm going to go ahead and inflate the balloon.

16:20 This is what's going to seat this inside the bladder, so, it doesn't slip out.

16:26 So, I can make sure you hold pressure, get rid of this. So, let's stop for a minute.

16:32 When we're talking about a male patient, there's a reason why we go all the way to the Y of the catheter.

16:38 Now, this will be much easier on a human patient but this way, we are ensuring that the catheter and the balloon when it's inflated goes all the way to the bladder and we do not inflate that in the urethra of the patient.

16:52 So, now, that we've got this inflated, I'm going to take a very small tug and make sure that this is seated correctly in the patient.

17:01 Obviously, don't pull hard but just a small, gentle pull to make sure that is seated correctly in the bladder of your patient.

17:09 Now, that we've done this, we want to make sure that we open this up, take our drainage bag.

17:18 This is just a little key tip that when you get the drainage bag, a lot of the time, these are vacuum sealed.

17:24 So, kind of break that vacuum. That way, urine will flow into the drainage bag.

17:30 The another important step is that most of the time that you will have a catheter securement device in your Foley catheter kit.

17:38 This is really important to help prevent infection rates with a catheter.

17:43 It also helps with pain in positioning with the catheter itself.

17:48 So, if we had a catheter securement device, we would place that here in the Y and attach this to the patient's thigh which as you can see, this patient doesn't particularly have a thigh but don't forget that Foley catheter securement device.

18:04 So, once that's affixed to the patient's thigh.

18:06 And then, once you do that, make sure you've got a little bit of slack as well.

18:10 So, once that's affixed, you want to take your drainage bag and make sure that the collection bag is at the lowest level of the patient's bladder.

18:19 So, it's below the level of the bladder. So, when you do that, don't forget.

18:26 When you place the collection bag, do not place it on a moving part of the patient's bed.

18:32 This could tug. For example, like a side rail, when we move it, it will pull on the patient very uncomfortable.

18:39 So, once we've done this, we want to thank our patient.

18:42 Thank you, Mr. Jones. I want to make sure that I go ahead and cover you up here.

18:45 I'm going to clean out my supplies and don't forget to return the bed to the lowest position.

18:51 Dispose of all your used supplies. We can remove our gloves and also perform hand hygiene. Thanks for watching.