What are the proper care and management techniques for a patient with a Foley catheter?

Proper Care and Management of Foley Catheters

Foley catheters should be removed within 24-48 hours after insertion whenever clinically feasible to minimize the risk of catheter-associated urinary tract infections (CAUTIs), and silver alloy-coated catheters should be used when prolonged catheterization is necessary. 1, 2

Indications for Foley Catheter Use

Foley catheters should only be used when absolutely necessary for:

• Acute urinary retention or obstruction
• Precise monitoring of urine output in critically ill patients
• Open wounds in sacral/perineal areas with urinary incontinence
• Patients too ill or incapacitated to use alternative collection methods
• Post-surgical management when required
• Neurogenic bladder management
• Emergent pelvic ultrasound or surgery
• Hospice/palliative care 1

Insertion Technique

• Use strict aseptic technique with proper hand hygiene
• Use appropriate lubricant during insertion to minimize urethral trauma
• Ensure proper catheter size selection (typically 14-16 Fr for adults)
• Secure catheter properly to prevent movement and urethral trauma
• Document procedure including time, date, and catheter size 2

Daily Catheter Care

1. Maintain closed drainage system at all times to prevent bacterial entry
2. Secure catheter properly to prevent movement and urethral trauma:
   • Use leg strap or securement device
   • Prevent tension on catheter
3. Perineal hygiene:
   • Clean the perineal area and catheter entry site daily with mild soap and water
   • No need for antiseptic solutions for routine cleaning after initial healing
4. Collection bag management:
   • Keep collection bag below bladder level to prevent reflux
   • Empty regularly to prevent overfilling
   • Avoid touching drainage spout to non-sterile surfaces 2

Preventing Complications

Catheter-Associated UTIs (CAUTIs)

• Daily assessment of continued need for catheterization
• Remove catheter as soon as possible, ideally within 24-48 hours 1
• Use silver alloy-coated catheters when prolonged catheterization is necessary 1, 3
• Maintain adequate hydration to ensure good urine flow
• Never disconnect the closed drainage system unless absolutely necessary 2

Pain Management

• Use oral analgesics like acetaminophen and NSAIDs for discomfort
• Apply local cool packs for perineal discomfort
• Consider topical anesthetic sprays or ointments for insertion site discomfort
• Avoid opiates for catheter-related pain due to potential complications 2

Mechanical Issues

• Obstruction: If decreased output, assess for kinks in tubing, patient position, or blockage
• Leakage: Check for proper balloon inflation and catheter position
• Bladder spasms: Consider anticholinergics if severe and persistent 2

Special Situations

Catheter Replacement

• For inadvertent removal after 4 weeks (mature tract):
  • Direct replacement can be safely attempted before tract closes
  • If no similar diameter catheter is available, a balloon-tipped Foley of same size can be used temporarily
  • Confirm proper position after blind replacement 1

Newly Placed Gastrostomy Site Care

• Monitor PEG exit site daily for first week
• Keep site clean and dry using aseptic wound care
• Consider glycerin hydrogel or glycogel dressing as alternative 1

Monitoring and Documentation

• Document daily assessment of continued catheter need
• Monitor for signs of infection (fever, suprapubic pain, cloudy urine)
• Track catheter days and set reminders for timely removal
• Document urine characteristics, output, and any complications 1

Key Pitfalls to Avoid

1. Prolonged catheterization: The risk of CAUTI increases approximately 5% per day 1
2. Breaking the closed system: Increases infection risk significantly
3. Improper securing: Can cause urethral trauma and pain
4. Blind catheter manipulation in patients with suspected urethral trauma 2
5. Routine urine cultures in asymptomatic patients: Can lead to unnecessary antibiotic use 1
6. Inadequate training: Improper insertion technique significantly increases CAUTI risk 4

Remember that despite technological advances, the basic Foley catheter design has remained largely unchanged for nearly 80 years and continues to be associated with significant complications including bacterial colonization, recurrent infections, and tissue damage 5. Therefore, the most important intervention is to remove the catheter as soon as clinically feasible.