What are the guidelines for using a Foley catheter in adults?

Guidelines for Using Foley Catheters in Adults

Foley catheters should only be used when absolutely necessary, for the shortest duration possible, and should be promptly removed when no longer essential to reduce the risk of catheter-associated urinary tract infections (CAUTIs). 1

Indications for Foley Catheter Use

• Appropriate indications:

  • Acute urinary retention or bladder outlet obstruction
  • Need for accurate measurements of urinary output in critically ill patients
  • Perioperative use for selected surgical procedures
  • To assist in healing of open sacral or perineal wounds in incontinent patients
  • For patients requiring prolonged immobilization (e.g., unstable thoracic or lumbar spine)
  • For end-of-life comfort care when needed

• Inappropriate indications:

  • As a substitute for nursing care in incontinent patients
  • For obtaining urine specimens when patient can void
  • For prolonged postoperative use without appropriate indications

Insertion Technique

1. Preparation:

   • Use maximal sterile barrier precautions including cap, mask, sterile gown, sterile gloves, and sterile full body drape 2
   • Prepare clean skin with an antiseptic (70% alcohol, tincture of iodine, an iodophor, or chlorhexidine gluconate) 2

2. Catheter selection:

   • Select catheters based on intended purpose, duration of use, known complications, and operator experience 2
   • Use the smallest appropriate catheter size to minimize urethral trauma
   • Use a catheter with the minimum number of ports or lumens essential for management 2

3. Insertion process:

   • Use aseptic technique with sterile equipment
   • Apply sterile lubricant before insertion
   • Maintain sterile field throughout the procedure
   • Secure catheter properly after insertion to prevent movement and urethral traction

Catheter Maintenance

1. Daily care:

   • Evaluate the catheter insertion site daily 2
   • Maintain a closed drainage system 2
   • Keep the collection bag below the level of the bladder at all times
   • Empty the collection bag regularly using a separate, clean container for each patient

2. Preventing infection:

   • Clean injection ports with 70% alcohol or an iodophor before accessing the system 2
   • Do not routinely apply prophylactic topical antimicrobial or antiseptic ointment to the insertion site 2
   • Do not administer systemic antimicrobial prophylaxis routinely 2

3. Drainage system management:

   • Maintain unobstructed urine flow
   • Keep the drainage tube free from kinking
   • Cap all stopcocks when not in use 2

Catheter Replacement and Removal

1. Replacement indications:

   • Replace when the catheter becomes obstructed or malfunctions
   • Replace if catheter-associated infection occurs and continued catheterization is necessary 1
   • Replace if it has been in place for 12 weeks at the start of an infection and is still indicated 1

2. Removal criteria:

   • Promptly remove any intravascular catheter that is no longer essential 2
   • Remove if the patient develops signs of infection or a malfunctioning catheter 2
   • Consider suprapubic catheter placement if long-term drainage is needed 1

3. Post-removal monitoring:

   • A post-void residual (PVR) volume of more than 300 cc after Foley catheter removal requires immediate reinsertion 1
   • Schedule follow-up within 1-2 weeks after successful catheter removal 1

Alternatives to Indwelling Catheters

• Intermittent catheterization is preferred over indwelling catheters when possible 1
• External condom catheters may reduce the incidence of catheter-associated bacteriuria in male patients 1
• Suprapubic catheters may be considered for long-term drainage as they have a lower risk of urethral trauma 1

Complications and Management

1. Catheter-associated UTI:

   • Recommended duration of antimicrobial treatment is 7 days for those with rapid symptom resolution, and 10-14 days for delayed response 1
   • Silver alloy-coated catheters may be considered for patients requiring prolonged catheterization 1

2. Bladder spasms and leakage:

   • Anticholinergic medications (e.g., oxybutynin) are recommended as first-line treatment 1
   • Beta-3 agonists (mirabegron) may be considered as alternatives 1
   • Alpha-blocker therapy may be considered prior to catheter removal in patients with urinary retention 1

3. Urethral trauma:

   • For urethral meatus splitting, prompt catheter removal is necessary 1
   • Avoid repeated catheterization attempts as they may increase injury extent 1
   • For significant bleeding or suspected deeper urethral injury, perform retrograde urethrography 1

Special Considerations

• In pediatric patients: The hand, dorsum of foot, or scalp can be used as catheter insertion sites 2
• For long-term use: Consider tunneled or implanted devices rather than standard catheters 2
• For patients with neurological conditions: Implement a bladder training program to improve function and reduce leakage 1

Warning Signs Requiring Immediate Attention

• Inability to void after catheter removal
• Severe suprapubic pain
• Signs of infection (fever, chills, altered mental status)
• Hematuria
• Decreased urine output
• Abdominal distention (possible sign of bladder rupture) 1