What is the recommended frequency for flushing a Foley catheter in the presence of hematuria?

Foley Catheter Flushing for Hematuria

For Foley catheters with hematuria, routine flushing is not recommended unless there is evidence of clot obstruction causing catheter occlusion. When clot obstruction occurs, saline irrigation should be performed as needed to maintain patency.

Understanding Catheter Flushing in Hematuria

Hematuria in a Foley catheter is a common clinical scenario that requires proper management to maintain catheter patency while avoiding complications. The evidence provides guidance primarily on central venous catheters, which we can apply with appropriate modifications to urinary catheters.

When to Flush a Foley with Hematuria

• Do not perform routine prophylactic flushing of Foley catheters with hematuria
• Only flush when clinically indicated by signs of obstruction:
  • Decreased or absent urine output
  • Patient discomfort or bladder distension
  • Visible clots obstructing the catheter lumen

Proper Flushing Technique

When flushing is necessary due to obstruction:

1. Use sterile 0.9% sodium chloride (normal saline) 1, 2
2. Use a 30-60 mL syringe (never smaller than 10 mL to avoid excessive pressure) 2
3. Apply gentle pressure during irrigation to prevent bladder trauma
4. Continue irrigation until the effluent is clear or obstruction is relieved
5. Maintain strict aseptic technique throughout the procedure 2

Management of Severe Clot Retention

In cases of severe clot retention that cannot be managed with standard irrigation:

1. Consider using a larger bore catheter (22-24 Fr) to facilitate clot removal 3
2. For persistent clot retention despite irrigation attempts, urologic consultation may be necessary
3. In severe cases, continuous bladder irrigation (CBI) may be required

Important Considerations

• Avoid routine prophylactic flushing as it may increase the risk of:

  • Introducing infection
  • Causing trauma to the bladder mucosa
  • Exacerbating bleeding

• Monitor for complications including:

  • Signs of infection (fever, cloudy urine, suprapubic tenderness)
  • Worsening hematuria after manipulation
  • Bladder spasms or discomfort

Special Situations

• Gross hematuria with clots: May require more aggressive irrigation and potentially continuous bladder irrigation
• Post-procedural hematuria: Usually self-limiting; avoid unnecessary manipulation 4
• Microscopic hematuria: Rarely requires catheter irrigation; focus on identifying underlying cause 5

By following these evidence-based recommendations, you can effectively manage Foley catheters in patients with hematuria while minimizing complications and maintaining patient comfort.