Foley Catheters and CAUTI on the NCLEX
Sterile insertion, the CAUTI bundle, removal criteria, and patient teaching.
The best CAUTI prevention is a catheter that never goes in. Every question flows from that idea.
Insertion
Surgical asepsis. Sterile gloves, sterile field, sterile catheter. Use the smallest effective size (commonly 14 to 16 Fr in adults). Clean the meatus with antiseptic front to back (female) or in a circular motion from the meatus outward (male). If the catheter tip touches anything unsterile, start over with a new kit. Insert until urine returns, then advance a bit more before inflating the balloon; a balloon inflated in the urethra causes trauma.
The CAUTI bundle
Insert only for an approved indication: retention, accurate output in critical illness, perioperative need, sacral or perineal wound with incontinence, comfort at end of life. Incontinence alone is not an indication. Maintain a closed system. Keep the bag below the bladder and off the floor at all times, including transport. Secure the catheter to the thigh to stop urethral traction. Daily peri care with soap and water. Sample urine from the needleless port, never the bag. Review necessity daily and remove early.
Removal and after
Many units run nurse-driven removal protocols: if no qualifying indication remains, the catheter comes out without a new order. Deflate the balloon completely before withdrawing. Expect the patient to void within 6 to 8 hours of removal; if not, bladder scan and follow the retention protocol. Burning and small frequent voids for the first day are common; fever, flank pain, or foul cloudy urine are not.
Teaching
For a patient going home with a catheter: keep the bag below the bladder, empty when two-thirds full, wash hands before and after handling, daily soap-and-water cleansing at the meatus, and report fever, pain, leaking, or no drainage. Fluids as allowed by other conditions.
Frequently asked
Urine specimen from a Foley?
Clamp briefly below the port, scrub the needleless port, aspirate fresh urine. Never take a specimen from the bag.
The catheter tip brushed the labia during insertion?
Contaminated. Get a new sterile catheter. This exact scenario is a favorite NCLEX question.
Who can perform Foley insertion?
It is a sterile invasive procedure: RN or LPN per state rules, never assistive personnel. AP can empty the bag and record output.
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