How to Master the Foley Catheter Insertion
Foley catheter insertion is one of the core procedures you'll learn in nursing school — and you'll place a lot of them as a bedside nurse. This guide covers everything from indications and catheter types to the full step-by-step procedure, plus advanced tips and tricks.
What Is a Foley Catheter?
A catheter is simply a flexible tube inserted into part of the body — examples include the intravenous catheter (IV), cardiac catheterization, and urinary catheters. A Foley catheter, also called an indwelling urinary catheter, is a tube inserted into the bladder to allow urine to drain into a bag instead of staying in the bladder. It's intended for both short- and long-term use, inside and outside the hospital.
Foley Catheter Indications
Foleys are ordered when a patient can't effectively drain their bladder — or when that's anticipated, like with surgery.
Not for Incontinence
Foley catheters should not be used to manage urinary incontinence. It's an inappropriate use — the complication risk and longer hospital stay outweigh any benefit.
When to NOT Place a Foley
There's really only one absolute contraindication: trauma with hematuria, which should be managed by a urologist. Relative contraindications include urethral strictures, recent UTIs, or artificial sphincters. As always, weigh benefits against risks — anything invasive raises the risk of infection, which is very common and can be lethal.
Types of Urinary Catheters
This article focuses on Foley insertion, but several other urinary catheters work similarly for different scenarios.
Choosing a Catheter Size
Like IV gauges, Foley catheters are sized — in French (Fr) units, where each French unit increases the catheter's diameter by 0.33 mm. For most adults, a 14–16 Fr catheter is standard. If you're worried about obstruction from sediment, go larger; if worried about clotting, consider a three-way.
Catheterizing Infants
Some units use purple Kangaroo PVC nasogastric tubing to catheterize infants and toddlers — also sized in French (a 5 Fr is common). Always follow facility and unit protocols.
The Foley Catheter Insertion Procedure
Gather everything you'll need:
- Foley insertion tray (catheter connected to tubing & bag, lubricant, Betadine swabs or solution/cotton swabs/forceps, sterile gloves)
- Cath-secure device or tape
- An extra pair of sterile gloves in your size
Explain the procedure, obtain verbal consent, and verify an order exists. Help the patient undress from the waist down and position supine. Females extend their legs in a "frog" position; males keep relaxed legs. Pre-clean and pre-locate: cleaning the peri-area first (soap and water or bath wipes) lets you visually inspect and locate the urethra — "if you can find it clean, you won't miss it sterile." Also ensure proper lighting — an adjustable overhead light is ideal.
Wash your hands and open the kit, best placed between the patient's legs. Open the sterile drapes so you can access the sterile contents once gloved.
This is a sterile procedure — sterile gloves minimize the risk of introducing pathogens into the bladder. The kit gloves are often small and tear easily, so a personal pair in your size (stretchier, easier to maneuver) is worth having.
With gloves on, place the sterile drape under the patient's buttocks and the fenestrated drape over the genital area. Don't touch the patient or bed with your sterile gloves.
Remove the catheter from its covering and seat it in a sterile lube package (this also keeps it from flopping around). If your kit has a pre-filled lube syringe, squirt it onto the tray and rest the catheter tip in it.
Attach the 10 mL pre-filled syringe to the balloon port. Don't pre-test the balloon — inflating and deflating it beforehand is no longer recommended, as it can stretch and distort the catheter and cause more trauma during insertion.
Using Betadine swabs (or Betadine with cotton swabs/forceps), cleanse around the urethra. Females: swab front to back, one direction — left, then right, then down the middle. Males: swab one direction around the left of the glans, then right, then down the middle.
Females: spread the labia with your non-dominant hand to visualize the urethra. Males: retract any foreskin and stabilize the penis in your rounded hand.
Insert into the urethra with steady force, advancing until you see urine in the tube — then advance a little more before inflating the balloon.
Steadily push the 10 mL syringe to inflate the balloon, anchoring the catheter inside the bladder.
Gently pull back until you meet light resistance — this seats the balloon at the bladder neck.
Secure the Foley to the thigh with a cath-secure, StatLock, or tape so it can't catch on anything and cause urethral trauma.
Hang the bag below the level of the bladder but off the floor to prevent backflow and infection.
Collect any sample needed and send to lab, otherwise measure, empty, and document.
If at First You Don't Succeed
Never force past resistance. Remove the catheter and consult the provider/urology — the prostate may be enlarged or there may be tracts or strictures. In women, if you see no urine within ~5–6 cm, you're likely in the vagina: leave that catheter in place as a landmark, grab a new sterile kit, and aim superior to it. Do not reuse the misplaced catheter (infection risk).
How to Remove a Foley
Removal should be quick and easy. Verify the order first — or if the patient insists (and isn't confused), remove it regardless.
You really only need an empty 10 mL syringe.
Remove any cath-secure, StatLock, or tape holding it to the leg.
Hook the empty syringe to the balloon port and draw the full 10 mL back out, then remove the syringe.
Gently pull the catheter out — there should be no resistance.
Dispose of the catheter, tubing, and collection bag in a biohazard bag if possible.
Foley Catheter Assessment & Monitoring
Assess the catheter each shift with your head-to-toe assessment, and more often if new symptoms or discomfort arise. The biggest thing to watch for is signs of a UTI, since Foleys raise that risk.
No Routine Foley Changes
There's no reason to change a Foley based on time alone — neither the IDSA nor the CDC recommends routine changes. Change it for obstruction, malfunction, infection, or discontinuation.
Foley Catheter Complications
During and after insertion, watch for these complications.
Clinical Pearls
Related Guides
References
- Complications of urinary bladder catheters and preventive strategies. UpToDate.
- Placement and management of urinary bladder catheters in adults. UpToDate.
- Urethral Catheterization. FP Notebook.
- Lister S, et al. The Royal Marsden Manual of Clinical Nursing Procedures, Professional Edition. 10th ed.
Hello
Dear William
I,m read this weblog and always so useful for me and share good information with my collaborators in ward.
Best
I find it helpful to have an assistant using sterile 4x4s to help spread open the labia so I can see my target better.
Yes, having an assistant can make a big difference!
Very helpful and informative! Great for my urology rotation!
Very entertaining and helpful 🙏🙏
perfect tutorial. Thank you!