Description
Foley catheter placement in a female patient is a fundamental skill in gynecologic surgery. Decompression of the bladder allows surgeons to operate safely in the surrounding organs.
Skills training in Foley catheter placement requires prior knowledge of:
- Female anatomy
- Assembly of the catheter
- Use of sterile technique
NOTE: This entire module is also available in PDF Format.
Learning Outcomes
This clinical skills module provides a standardized framework for teaching learners how to place a Foley catheter in a female patient. Following participation in this module, students should demonstrate the following learning outcomes:
- Understand indications for a Foley catheter
- Understand the normal female vulvar and perineal anatomy
- Prepare the urethra for Foley catheter insertion
- Insert the Foley catheter
- Inflate the balloon
- Attach the Foley to the patient’s leg without excessive traction
Best Practices
Without a structured program to teach female urinary Foley catheter placement, many students learn from the standard medical education paradigm of “see one,” “do one,” and then “teach one.” Peadar Waters and colleagues found that students who participated in interactive learning (didactic and practice with high-fidelity urinary catheter simulator) significantly outperformed the groups with didactics only and didactic with observation of the procedure. Medical students who participated in simulation training also retained these skills longer and maintained comfort with these skills at 18 months.1, 2
Foley catheter placement is commonly performed during the ob-gyn rotation. Students can gain ample experience during the rotation. With prior preparation, this is a skill that can be learned during the clinical experience while under direct observation.
Multiple teaching modalities have been described to teach Foley catheter insertion.
- Didactic (lecture, video, assigned reading for flipped classroom)
- Simulation practice with task trainer
Checklist
The following checklist may be used as a component of the training session and/or as a component of a performance assessment as part of an objective structured clinical examination.
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Done |
Not
Done |
Confirm patient meets Indications for Indwelling Urethral Catheter Use:
- Patient has acute urinary retention or bladder outlet obstruction
- Need for accurate urine output measurements
- Use for selected surgical procedures
- To assist in healing of open sacral or perineal wounds
- Patient requires prolonged immobilization
- To improve comfort for end-of life-care
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| Select the appropriately Foley catheter size |
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| Review patient record for any latex or iodine allergy |
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| Explain the procedure to the patient while maintaining privacy |
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| Wash hands |
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| Position the patient properly: Supine position with knees flexed and separated; feet flat on the bed |
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| Put on non-sterile gloves |
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| Create an area for the sterile field and open packaging |
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| Perform periurethral scrub |
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| Take off non-sterile gloves |
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| Wash hands with antibacterial gel |
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| Open inner kit using sterile technique |
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| Put on gloves using sterile technique |
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| Place drape under buttocks |
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| Place fenestrated drape over perineum |
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| Prepare betadine swabs |
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| Attach fluid syringe to open port on Foley |
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| Prepare lubricant |
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| Lubricate catheter tip |
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| Identify normal anatomy by separating the labia with non-dominant hand and keep open during entire cleansing process |
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| With dominant hand, cleanse with iodine-soaked cotton balls, using a single downward motion; outer edges first, then the center over the meatus itself |
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| Insert Catheter: If the catheter is inadvertently inserted into the vagina, leave the catheter in place until another insertion kit can be obtained |
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| Insert catheter 6-8 cm |
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| Attach the saline-filled syringe and inflate the balloon with 10 cc water if indwelling catheter is being used |
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| Gently pull back on catheter to fix catheter against bladder wall |
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| Secure the catheter drainage tubing to the patient’s thigh or use a leg band with Velcro closure to prevent pressure on the urethra. Cover patient to restore privacy |
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| Remove equipment and dispose of used supplies |
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Practical Tips
We recommend introduction of Foley catheter placement at the end of second year in preparation for the clinical clerkships. Collaboration between undergraduate medical education and nursing leadership could assist in creating interprofessional protocols to teach and assist medical students in maintaining this important skill.
Resources
Models may be hand-made or purchased from commercial vendors. Some of the available models are listed below.
| Model Name |
Manufacturer |
Approximate cost |
| Advanced Female Catheterization Trainer |
Limbs & Things |
>$2,000 |
| Interchangeable Catheterization and Enema Task Trainer |
Laerdal Medical |
$500-600 |
| Advanced Patient Care Female Catheter |
Pocket Nurse |
>$300-400 |
| Catheterization Simulator, Female |
3B Scientific |
>$600 |
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- Waters PS, McVeigh T, Kelly BD, Flaherty GT, Devitt D, Barry K, Kerin MJ. The acquisition and retention of urinary catheterization skills using surgical simulator devices: teaching method or student traits. BMC Medical Education. 2014 Dec; 14:264
- Kaplan, A. G., Abdelshehid, C. S., Alipanah, N., Zamansani, T., Lee, J., Kolla, S., Sountoulides PG, et al (2012). Genitourinary exam skills training curriculum for medical students: a follow-up study of comfort and skill utilization. Journal of Endourology, 2012; 26(10), 1350-1355.
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