Editing Nursing Skills and Procedures (section)

=== Insertion sequence ===
# Explain the procedure, provide privacy, and position: female dorsal recumbent with knees flexed, male supine with legs slightly apart.
# Perform hand hygiene, set up the sterile field, and don sterile gloves. Test the balloon only if manufacturer instructions direct it, since repeated testing can create creases.
# Lubricate the catheter generously. Men benefit from instilled lidocaine lubricant when policy allows.
# Clean with the nondominant hand, which is now contaminated and does not leave the field. For the female patient, separate the labia and maintain that separation until the catheter is in, cleaning front to back from the far labium, then the near labium, then the meatus, using a new swab each stroke. For the male patient, retract the foreskin if uncircumcised and clean in a circular motion from the meatus outward.
# Insert with the sterile dominant hand: about 5 to 7.5 cm, roughly 2 to 3 inches, in the female patient and about 17 to 22.5 cm, roughly 7 to 9 inches, in the male patient, or until urine returns.
# When urine returns, advance an additional 2.5 to 5 cm in the female patient, or to the bifurcation of the catheter in the male patient, before inflating the balloon. Never inflate a balloon before urine return, because inflating in the urethra causes trauma and can rupture the urethra.
# Inflate the balloon with the prefilled sterile water syringe using the full stated volume. Never use saline, which can crystallize.
# Gently pull back until resistance is felt, secure the tubing to the thigh or abdomen with a securement device to prevent traction, and reduce the foreskin in the uncircumcised male patient. Failing to reduce the foreskin can cause paraphimosis.
# Hang the bag below bladder level, off the floor, and keep the tubing free of dependent loops.

If resistance is met, the nurse stops, does not force, and notifies the provider. Forcing risks urethral false passage. If the catheter is contaminated during insertion, it is discarded and a new sterile catheter is used.