Urinary tract infections, restricted mobility, and increased risk of delirium in elderly patients are widely recognized complications.
Approximately two thirds of the anterior urethral injuries are related to urinary catheterizations, and 25% ultimately require surgical intervention.
Approximately 3.2 foley catheterization associated injuries per 1000 male hospitalizations.
Refers to a flexible tube passed through the urethra and into the bladder to drain urine.
It is the most common type of indwelling urinary catheter.
The Foley catheter has two separated lumens, running down its length.
One lumen is open at both ends, and drains urine into a collection bag.
The other lumen has a valve on the outside end and connects to a balloon at the tip.
The balloon is inflated with sterile water when it lies inside the bladder to stop it from slipping out.
Foley catheter is retained by means of a balloon at the tip that is inflated with sterile water.
Foley catheter balloons typically come in two different sizes: 5 cm3 and 30 cm3.
Commonly made from silicone rubber or natural rubber.
Used only when indicated, as use increases the risk of catheter-associated urinary tract infection and other adverse effects.
In EDs indwelling urinary catheters are most commonly used to assist persons who have urinary retention.
Indications: urinary retention, monitoring urine output for critically ill persons, managing urination during surgery, and providing end-of-life care.
Foley catheters are used:
On patients who are anesthesized or sedated for surgery or other medical care
On comatose patients
On some incontinent patients
On patients whose prostate is enlarged to the point that urine flow from the bladder is cut off.
The catheter is kept in until the problem is resolved:
On patients with acute urinary retention.
In patients who are unable due to paralysis or physical injury to use either standard toilet facilities or urinals.
Following urethral surgery
On patients with kidney disease whose urine output must be constantly and accurately measured
Before and after cesarean sections
Before and after hysterectomies
On patients who had genital injury
On patients unable use standard toilets due to physical weakness and whose urine output must be constantly measured.
On who cannot control their bladder.
Can also be used to ripen the cervix during induction of labor as part of an extra-amniotic saline infusion.
To ripen the cervix the balloon is inserted behind the cervical wall and inflated, with the remaining length of the catheter pulled slightly taut, and taped to the inside of the woman’s leg.
The inflated balloon applies pressure to the cervix, as the baby’s head would prior to labour, causing it to dilate.
As the cervix dilates over time, the catheter is readjusted to be slightly taut, and re-taped to maintain pressure on the cervix.
When the cervix has dilated sufficiently, the catheter simply drops out.
Can be used in cases of severe epistaxis to block blood from freely flowing down the nasal passage into the mouth.
Indwelling urinary catheters should not be used to monitor stable people who are able to urinate or for the convenience of the patient or hospital staff.
Catheter-associated urinary tract infection is the most common type of hospital-acquired infection.
Indwelling catheters should be avoided when there are alternatives.
Tend to contribute to urinary tract infections because bacteria can travel up the catheter to the bladder, where the urine can become infected.
Antiseptic coated catheters have not completely solved this major problem.
Foley catheters tend to become coated over time with a biofilm that can obstruct the drainage, increasing the amount of stagnant urine left in the bladder, which further contributes to the problem of urinary tract infections.
Clogged Foley catheters must be flushed or replaced.
Risks factors include:
The balloon can break.
The balloon might not inflate after it is in place.
The risk of bladder or urinary tract infection increases with the number of days the catheter is in place.
If the balloon is opened before the Foley catheter is completely inserted into the bladder, bleeding, damage and even rupture of the urethra can occur, and could lead to scarring and strictures of the urethra.
The most common sizes are 10 F to 28 F.
1 F is equivalent to 0.33 mm = .013″ = 1/77″ of diameter.
Foley catheters come in several types:
Coudé (French for elbowed) catheters have a 45° bend at the tip that facilitates easier passage through an enlarged prostate.
Councill tip catheters have a small hole at the tip so they can be passed over a wire.
Three way, or triple lumen catheters have a third channel used to infuse sterile saline or another irrigating solution.
These are used primarily after surgery on the bladder or prostate, to wash away blood and blood clots.