7 Critical Steps To Safely Flush A Foley Catheter And Prevent Dangerous Blockages

Dealing with a blocked Foley catheter can be a stressful and potentially dangerous situation, but understanding the correct flushing procedure is a vital skill for patient safety and comfort. As of December 2025, the latest clinical guidelines emphasize that catheter irrigation, or "flushing," should only be performed when a blockage is suspected or as part of a specific, physician-ordered treatment plan—it is not recommended for routine care to prevent infection. This in-depth guide provides the current, evidence-based, step-by-step instructions for performing an open-system Foley catheter flush, a procedure used to clear debris, blood clots, or sediment from the indwelling catheter and restore proper urine drainage.

The primary goal of catheter flushing is to maintain the patency of the urinary catheter, ensuring the continuous flow of urine from the bladder into the drainage system. Blockages can lead to painful bladder spasms, urine backflow, and a significantly increased risk of Catheter-Associated Urinary Tract Infection (CAUTI). By following a strict sterile technique and using the correct supplies, you can perform this critical intervention safely and effectively, restoring the patient's comfort and health.

Essential Supplies and Preparation for Catheter Irrigation

Before beginning the procedure, preparation is key to maintaining a sterile environment and preventing the introduction of pathogens into the urinary tract. The procedure described here is the "open-system irrigation" method, which is typically used to clear an acute blockage.

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Required Supplies List:

• Sterile Flushing Solution: Usually sterile normal saline (0.9% NaCl) or sterile water. Specialized solutions, like those containing citric acid (e.g., Uro-Tainer® Twin SUBY G), may be ordered by a physician to dissolve encrustations.
• Sterile Syringe: A 60 mL piston syringe (often called a Toomey syringe or catheter tip syringe) is most commonly used for its large volume and specialized tip.
• Sterile Gloves: Essential for maintaining sterile technique.
• Antiseptic Wipes: Such as alcohol or ChloraPrep wipes, to clean the catheter port.
• Sterile Collection Tray/Basin: To hold the supplies and collect the return fluid.
• Clean Towel or Underpad: To place under the catheter/port area to protect the bedding.

Crucial Entity Checklist: Always ensure you have a physician's order before performing a bladder washout or catheter flush. Explain the procedure to the patient, as they may experience a brief feeling of fullness or pressure in their bladder.

The 7-Step Procedure for Flushing a Foley Catheter (Open System)

The open-system method requires temporarily disconnecting the catheter from the drainage system, which slightly increases the risk of infection compared to a closed system. Therefore, meticulous attention to sterility is paramount.

Step 1: Hand Hygiene and Preparation

Wash your hands thoroughly with soap and water or use an alcohol-based hand sanitizer. Open the sterile irrigation kit and set up a sterile field. Put on your sterile gloves. Pour the required amount of normal saline solution (usually 30–60 mL per flush) into the sterile basin.

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Step 2: Disconnecting the Drainage System

Place the clean towel or underpad beneath the connection point of the Foley catheter and the drainage tubing. Clamp or pinch the catheter tubing just below the connection point to prevent urine backflow. Carefully disconnect the catheter drainage system from the catheter port (the irrigation port, if present, or the main drainage port). Keep the end of the drainage tubing sterile, perhaps by placing a sterile cap on it or keeping it wrapped in a sterile gauze pad, to prevent contamination.

Step 3: Cleaning and Attaching the Syringe

Use an antiseptic wipe to thoroughly clean the catheter's access port where the syringe will be attached. Allow it to air dry. Draw the ordered amount of sterile flushing solution (e.g., 30 mL) into the Toomey syringe. Expel any air bubbles. Insert the tip of the syringe firmly into the cleaned catheter port.

Step 4: Gentle Injection of the Solution

Gently and slowly inject the irrigation solution into the bladder through the catheter. Do not use force. If you meet resistance, stop immediately. Forcing the fluid can cause trauma or painful bladder spasms. If the patient reports pain, slow the injection or stop and notify the healthcare provider. The goal is to instill the fluid to dislodge the debris or blood clot causing the obstruction.

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Step 5: Aspirating the Irrigant and Debris

Once the fluid is instilled, gently pull back on the plunger of the syringe to aspirate the fluid back out of the bladder. The fluid that returns is called the 'return irrigant.' Note the color and consistency of the return—it should ideally be clear or contain the debris that was causing the blockage. If the fluid does not return, reposition the patient slightly and try again. Do not repeat the injection/aspiration more than a few times without a specific order. If the blockage persists, the catheter may need to be replaced.

Step 6: Repeat and Monitor

Repeat the irrigation process (Steps 3–5) using a fresh syringe of sterile normal saline until the return fluid is clear or the blockage is resolved and urine begins to drain freely. Keep track of the total amount of fluid instilled and the amount of fluid returned to ensure a safe fluid balance. A common sign of a successful flush is the resumption of a steady flow of urine into the drainage bag.

Step 7: Reconnecting the Drainage System

Once the flush is complete, clean the catheter port one final time with a new antiseptic wipe. Remove the clamp/pinch and immediately and securely reconnect the catheter to the original, sterile drainage system. Dispose of all used supplies appropriately and perform final hand hygiene. Document the procedure, the amount of fluid used, the amount of fluid returned, and the appearance of the return fluid.

Why Catheter Blockages Occur and How to Prevent Them

Understanding the root causes of a blocked indwelling catheter is crucial for long-term care and prevention. Flushing is a treatment, but prevention is always the best strategy for managing a urinary catheter.

Common Causes of Obstruction:

• Encrustation: This is the buildup of mineral deposits (like calcium and magnesium phosphate) from the urine, which forms a rough, crystalline material on the catheter surface. It is a major cause of recurrent catheter blockage in long-term users.
• Biofilm Formation: Bacteria naturally colonize the catheter surface, forming a protective layer of biofilm that narrows the lumen and can lead to CAUTI.
• Blood Clots: Common following urological surgery or in cases of gross hematuria. These clots can quickly occlude the catheter.
• Mucus and Sediment: The bladder naturally produces mucus, which, when combined with sediment, can create thick debris.
• Kinks or Mechanical Obstruction: Simple kinks in the tubing or the patient lying on the drainage tube can stop the flow.

Prevention Strategies (LSI Keywords):

The best way to avoid having to perform an emergency catheter irrigation is through diligent urinary catheter care. This includes ensuring adequate fluid intake to maintain a good urine output and keep the urine dilute. Regularly checking the tubing for kinks or loops is a simple but effective measure. For patients prone to recurrent encrustation, a physician may order specialized catheter maintenance solutions or the use of silicone catheters, which are less prone to buildup than latex. Finally, always keep the drainage bag below the level of the bladder to prevent backflow and ensure the system remains a closed system as much as possible.