From the Guidelines
A Foley catheter should be placed for urinary retention when the postvoid residual bladder volume exceeds 500 cm3 in asymptomatic patients or 300 cm3 in symptomatic patients. This recommendation is based on the most recent guidelines from the International Society for Infectious Diseases, updated in 2024 1. The guidelines emphasize the importance of appropriate indications for catheter placement, including management of acute urinary retention. Symptoms of urinary retention may include bladder pain or fullness, persistent urge to void, new incontinence or leaking, or being only able to have frequent small voids.
Key considerations for catheter placement include:
- The volume of retained urine, as detected by a bladder scanner
- The patient's clinical presentation, including symptoms of urinary retention
- The potential risks and benefits of catheterization, including the risk of catheter-associated urinary tract infections
Before catheterization, non-invasive measures like encouraging voiding in a comfortable position or using warm water stimulation may be attempted for smaller volumes. Once placed, the catheter should be connected to a closed drainage system and secured properly to prevent trauma. The duration of catheterization should be minimized to reduce infection risk, with removal as soon as clinically appropriate, as recommended by the guidelines 1.
In clinical practice, it is essential to weigh the benefits of catheterization against the potential risks, particularly in patients with limited mobility or those who are at high risk of developing catheter-associated urinary tract infections. The guidelines provide a framework for making informed decisions about catheter placement, emphasizing the importance of individualized patient care and careful consideration of the potential benefits and risks of catheterization 1.
From the Research
Urinary Retention and Foley Catheter Placement
- The decision to place a Foley catheter in patients with urinary retention depends on various factors, including the volume of retained urine and the patient's overall clinical condition 2, 3.
- According to the American Urological Association, chronic urinary retention is defined as a post-void residual (PVR) volume greater than 300 mL measured on two separate occasions and persisting for at least six months 3.
- A study published in the American Journal of Medicine found that PVR volumes of ≥150 mL were common in geriatric hospitalized patients, but the need for indwelling catheters was not predicted by PVR volumes alone 2.
- Another study published in the Journal of Urology compared two techniques for predicting voiding efficiency after inpatient urogynecologic surgery and found that a back fill technique, where the bladder is filled with 300 cc saline before removing the Foley catheter, correlated better with successful voiding trials than an auto fill technique 4.
Post-Void Residual Urine Volume Measurement
- The accuracy of post-void residual urine volume measurement using an ultrasound bladder scanner has been evaluated in several studies, with one study finding a high correlation between scan volume and catheter volume (r = 0.89, p < 0.001) 5.
- The use of ultrasound bladder scanners has been shown to be quick, safe, non-invasive, and comfortable for patients, making it a potential alternative to catheterization for measuring PVR volumes 5.
Clinical Guidelines for Foley Catheter Placement
- The American Urological Association recommends that patients with chronic urinary retention be defined as having a PVR volume greater than 300 mL measured on two separate occasions and persisting for at least six months 3.
- In clinical practice, the decision to place a Foley catheter should be based on individual patient factors, including the volume of retained urine, the presence of symptoms such as lower abdominal pain, and the patient's overall clinical condition 2, 3, 6.