Removing Indwelling Urinary Catheters: Nursing Procedure and Post-Removal Care

Removing an indwelling (Foley) catheter is a common nursing skill that, when done correctly, reduces the risk of catheter-associated urinary tract infection (CAUTI) and urethral trauma. This guide reviews indications, the step-by-step procedure, post-removal monitoring, and the high-yield exam points students should master.

Definition

• Removing an indwelling catheter involves deflating the balloon and withdrawing the catheter from the urethra and bladder.
• Removal should occur as soon as the catheter is no longer medically necessary.
• Early removal reduces the risk of CAUTI and urethral trauma.

Indications for Removal

• Patient is able to void spontaneously.
• The original indication has resolved (e.g., post-operative diuresis completed).
• Catheter is malfunctioning or causing significant discomfort.
• Patient has a CAUTI and the catheter is no longer needed.
• Remove within 24 hours of no longer meeting criteria; perform a daily review of catheter necessity.

Preparation

• Explain the procedure to the patient — expect a brief tugging sensation; reduces anxiety.
• Encourage fluid intake (unless contraindicated) — a full bladder stimulates the urge to void after removal.
• Gather supplies: clean gloves, 10–12 mL syringe, waterproof pad, specimen container, basin or disposable bag.
• Verify balloon size in the patient's record — most Foley catheters have a 5 mL, 10 mL, or 30 mL balloon.

Step-by-Step Removal Procedure

1. Perform hand hygiene and apply clean gloves. Place a waterproof pad under the patient's buttocks.
2. Insert the syringe into the balloon port (not the drainage port). Withdraw all fluid from the balloon.
3. Never cut the catheter or pull without deflating first.
4. Once the balloon is fully deflated, gently pull the catheter straight out in a smooth, steady motion. Do not use force.
5. If resistance is met, stop and notify the provider — the balloon may not be fully deflated.
6. Inspect the catheter for intactness; ensure the balloon is fully deflated and no pieces remain in the bladder.

Post-Removal Care

• Assess voiding status — most patients should void within 6 to 8 hours after removal.
• Assess for urinary retention: suprapubic discomfort, inability to void, distended bladder.
• Assess for UTI symptoms: burning, frequency, urgency, fever, or new confusion in older adults.
• Perform a bladder scan if the patient has not voided within 6 hours or reports discomfort.
• Post-void residual (PVR):
  • < 100 mL is normal.
  • > 200 mL may require straight catheterization.
• The first void may cause burning or stinging — this is normal and should resolve within 24 hours.

Complications and Nursing Actions

• Urinary retention — No voiding within 6–8 hours, distended bladder → Perform bladder scan; notify provider; straight catheterize if ordered. Do not reinsert an indwelling catheter without an order.
• Bladder spasms — Sudden urgency, suprapubic pain, urine leakage → Administer anticholinergics (e.g., oxybutynin, tolterodine) as ordered.
• Mild hematuria — Pink-tinged urine → Reassure patient; monitor; usually resolves within 24–48 hours.
• Severe hematuria — Bright red blood or clots → Notify provider immediately.
• CAUTI — Fever, confusion in older adults, foul-smelling urine → Obtain a urine culture before antibiotics; notify provider.

Documentation

• Date and time of removal, balloon volume withdrawn, and whether the catheter was intact.
• Patient's tolerance, any pain, resistance, or complications.
• First voided urine: time, volume, color, clarity, and any symptoms.
• Bladder scan results if performed, including pre-void and post-void volumes.

Patient Education

• Drink fluids (unless contraindicated) — encourage water, not caffeinated or sugary drinks.
• Void as soon as the urge is felt; do not delay urination.
• Mild burning or stinging for the first 1–2 voids is normal; report if it persists.
• Report fever, chills, severe pain, inability to void, or blood in the urine.

Common Exam Traps

• Do not cut the catheter or pull without deflating the balloon first — causes urethral trauma.
• Do not pull forcefully if resistance is met — the balloon may not be fully deflated.
• Do not forget to assess voiding within 6–8 hours after removal — retention is common.
• Do not reinsert an indwelling catheter without a provider order — use a straight catheter if retention occurs.
• Do not ignore new confusion in an older adult — this may indicate a UTI.
• Do not discharge a patient who has not voided after removal without notifying the provider.

Key Takeaways

• Deflate the balloon completely via the balloon port before removal — never cut or forcefully pull the catheter.
• Pull the catheter straight out in a smooth motion; stop and notify the provider if resistance occurs.
• Assess for voiding within 6–8 hours; perform a bladder scan if the patient has not voided.
• PVR < 100 mL is normal; > 200 mL may require straight catheterization.
• Watch for CAUTI signs — including new confusion in older adults — and obtain a urine culture before antibiotics.
• Do not reinsert an indwelling catheter for retention without a provider order.