Female Foley Catheter Placement Preoperatively

Urinary catheterization is a standard procedure performed in the perioperative setting. Foley catheters are routinely placed before many surgical procedures for several purposes.^1–3 Primary indications include maintaining bladder decompression during lengthy operations, enabling precise measurement of urinary output as a critical indicator of hemodynamic status and renal perfusion, and providing access for bladder drainage when the surgical field involves the pelvic region or when postoperative urinary retention is anticipated.^4–7

Despite the relative simplicity of the procedure, several challenges may be encountered during female urethral catheterization. These include difficulty in visualizing the urethral meatus in patients with obesity, anatomical variations, or age-related changes to the introitus. Furthermore, maintaining a strict sterile technique is essential to minimize the risk of catheter-associated urinary tract infections, which represent a significant source of nosocomial infection.^8–11

In this video, the procedure is initiated after the patient has been placed under anesthesia, and the lower extremities are positioned in a frog-leg configuration to provide optimal access to the perineum. A standard Foley catheter tray is utilized, which contains all necessary components for the procedure under sterile conditions. The tray typically includes:

• A preconnected catheter system with drainage tubing and collection bag.
• Sterile gloves.
• Sterile drapes, including a fenestrated drape.
• Antiseptic solution (commonly povidone-iodine).
• Applicator swabs for cleansing.
• A syringe prefilled with sterile water for balloon inflation.
• A syringe containing lubricant.
• A Foley stabilization device.
  

The procedural sequence for female Foley catheter placement is performed as follows:

1. The operator's hands are first sanitized, after which sterile gloves are donned to maintain asepsis throughout the procedure.
2. A sterile field is established by placing the provided sterile drape beneath the patient, then positioning the fenestrated drape over the perineal area, with the opening aligned to expose the urethral meatus.
3. The antiseptic solution is applied to the cleansing swabs, which are then used to decontaminate the urethral meatus and surrounding tissues. Using a sterile technique and the dominant hand, cleansing should proceed from the clitoris to the anus, as well as from the labia to the folds of the inner labia and the urethral opening. It should be noted that once one hand is used to retract the labia, that hand is considered contaminated and should not contact sterile components.
4. The Foley catheter is removed from its protective sheath, and lubricant is applied to the distal portion to facilitate atraumatic passage through the urethra.
5. Using the non-dominant hand, the labia are separated to expose the urethral meatus. The meatus may be recessed or difficult to visualize in certain patients, necessitating adequate lighting and sometimes additional assistance for retraction.
6. With the dominant hand, the lubricated catheter is inserted into the urethral meatus and advanced slowly. The female urethra is approximately 4 cm in length, and the catheter is advanced until urine is observed in the tubing.
7. Upon confirmation of proper placement by the return of urine, the catheter is advanced an additional 2–3 cm to ensure that the balloon portion is positioned within the bladder.
8. The balloon is inflated with the prescribed volume of sterile water (typically 10 mL) to anchor the catheter within the bladder and prevent accidental dislodgement.
9. The catheter is then secured to the patient's thigh using a dedicated securing device to minimize movement and potential urethral trauma during the surgical procedure.
10. The drainage bag is positioned below the level of the bladder to facilitate gravity-dependent drainage and prevent retrograde flow of urine.
    

In cases where anatomical challenges are encountered, such as in patients with obesity or a narrow introitus, additional techniques may be required. These might include enhanced lighting to improve visualization, additional personnel to assist with retraction, alternative patient positioning, and in rare cases, consideration of different catheter types or sizes.

The placement of a Foley catheter in female patients preoperatively represents a fundamental yet critical procedure in perioperative care. Though technically straightforward, its proper execution demands meticulous attention to anatomical detail, strict sterile technique, and awareness of potential challenges. Furthermore, technical proficiency in catheter placement contributes to improved patient outcomes by reducing the risk of urethral trauma and catheter-associated infections.

The clinical significance of proper Foley catheter placement extends beyond the operating room, as these devices are often maintained postoperatively for ongoing monitoring and urinary management. Therefore, competency in initial catheter placement impacts the patient's entire perioperative course and recovery.

The patient referred to in this video article has given her informed consent to be filmed and is aware that information and images will be published online.