From the Guidelines
Foley catheters should be placed for surgery in specific situations, such as urologic surgery, prolonged surgeries, or when intraoperative monitoring of urine output is necessary, as indicated by the most recent guidelines 1. When considering the placement of Foley catheters for surgery, it's essential to weigh the benefits against the risks of catheter-associated urinary tract infections (CAUTIs). The decision to place a Foley catheter should be based on specific indications, such as:
- Urologic surgery or procedures involving contiguous structures of the genitourinary tract
- Prolonged surgeries
- Large-volume infusions or diuretics during surgery
- Intraoperative monitoring of urine output
- Management of acute urinary retention
- Aiding in the healing process of open pressure ulcers or skin grafts
- Palliative and/or comfort care, if catheter use aligns with specific patient goals The most recent guidelines 1 emphasize the importance of removing catheters placed solely due to the duration of surgery or for decompression after the surgical case. Additionally, catheters should be removed as soon as clinically appropriate, ideally within 24-48 hours postoperatively, to reduce the risk of CAUTIs 1. Some key points to consider when placing Foley catheters for surgery include:
- Catheter size: typically ranges from 14-18 French for adults, with smaller sizes for pediatric patients
- Placement: should occur after induction of anesthesia but before surgical positioning to minimize patient discomfort
- Monitoring: urine output should be closely monitored during procedures with potential hemodynamic instability
- Removal: catheters should be removed as soon as clinically appropriate to reduce the risk of CAUTIs It's crucial to prioritize the single most recent and highest quality study, which in this case is 1, to ensure that the decision to place a Foley catheter is based on the most up-to-date and evidence-based guidelines.
From the Research
Placement of Foley Catheters for Surgery
- Foley catheter placement is often advised in surgeries anticipated to exceed 3 hours 2
- However, the type of surgery is also an important consideration, and some surgeries may not require Foley catheter placement even if they exceed 3 hours 2
- For example, patients undergoing unilateral and bilateral mastectomies with or without reconstruction may avoid Foley catheter placement without increased risk of urinary retention, even if the case is anticipated to exceed 3 hours 2
Indications for Foley Catheter Use
- Foley catheters are appropriate for measuring and collecting urine only when fluid status or urine cannot be assessed by other means 3
- Patients in the intensive care unit (ICU) need specific medical indications for catheters, as ICU location alone is not an appropriate indication 3
- Foley catheters may be pragmatically appropriate to manage urinary incontinence in select patients 3
Alternative Uses and Techniques
- A self-retaining intraurethral device may be used as an alternative to indwelling catheter and prostatectomy in patients with urinary retention due to benign prostatic hyperplasia 4
- A new endourologic technique using a Peel-Away sheath can facilitate accurate insertion of a Foley catheter without trauma to the urethra, particularly after transurethral resection of prostate (TURP), prostatectomy, and difficult urethroscopy 5