Can a Foley catheter be removed for comfort in a patient with generalized edema who is now comfort measures only (CMO)?

Foley Catheter Removal in a CMO Patient with Generalized Edema

Yes, the Foley catheter should be removed if a patient with generalized edema who is on comfort measures only (CMO) requests it for comfort. 1

Rationale for Removal

Primary Considerations

• For patients on comfort measures only (CMO), the primary goal shifts to maximizing comfort and quality of life rather than medical necessity
• The Geriatric Emergency Department Guidelines explicitly state that indwelling catheters should be removed as soon as feasibly possible 1
• Urinary catheters are associated with significant discomfort, including:
  • Bladder spasms
  • Urethral irritation
  • Restricted mobility
  • Psychological distress

Balancing Edema Management with Comfort

While generalized edema typically requires fluid management that might benefit from a Foley catheter, in the CMO setting:

• The patient's comfort preferences take precedence over fluid monitoring
• Strict fluid balance monitoring becomes less critical when the focus shifts to palliation
• The risks of catheter-associated urinary tract infections (CAUTIs) outweigh the benefits in end-of-life care 1

Implementation Approach

1. Assess for specific contraindications:

   • Urinary retention with bladder distention causing pain
   • Open wounds in the sacral or perineal area that could be contaminated 1

2. Consider alternatives if needed:

   • External collection devices
   • Absorbent pads
   • Scheduled toileting assistance 2

3. Monitor for complications after removal:

   • Urinary retention (if it occurs and causes discomfort, intermittent catheterization may be preferable to reinsertion of an indwelling catheter)
   • Skin breakdown from potential incontinence

Special Considerations for Edematous Patients

In patients with generalized edema:

• Monitor for increased urinary output as edema resolves
• Ensure adequate absorbent materials if incontinence occurs
• Position changes may need to be more frequent if mobility is limited

Common Pitfalls to Avoid

1. Maintaining a catheter solely for:

   • Staff convenience
   • Urine output monitoring when not clinically necessary for comfort
   • Managing incontinence without trying alternatives 2

2. Failing to reassess the need for catheterization daily 1

3. Overlooking patient preferences in end-of-life care decisions

In conclusion, when a patient is on comfort measures only, their comfort preferences should guide care decisions. If the patient requests removal of the Foley catheter, this request should be honored unless there are specific contraindications where the catheter is actually providing comfort rather than causing discomfort.