Is it normal to have a Foley catheter in addition to a nephrostomy (percutaneous nephrostomy tube) tube?

Urinary Catheter Management with Percutaneous Nephrostomy Tubes

Yes, it is normal and often necessary to have both a Foley catheter and a percutaneous nephrostomy tube in certain clinical scenarios, particularly when complete urinary drainage is required or when there is urinary tract obstruction.

Indications for Dual Drainage Systems

When both a nephrostomy tube and Foley catheter are used together, it's typically for the following reasons:

• Complete urinary drainage: Ensuring adequate drainage from both upper and lower urinary tract
• Urinary tract obstruction: When there is blockage that cannot be managed by a single drainage method
• Post-surgical management: Following complex urological procedures
• Monitoring purposes: To separately assess urine output from kidneys and bladder

Clinical Scenarios Requiring Both Catheters

1. Urinary tract obstruction with renal function deterioration 1

   • Nephrostomy tube provides direct kidney drainage
   • Foley catheter ensures bladder drainage and prevents bladder distension

2. Pelvic trauma with suspected urethral injury 2

   • Suprapubic tube or Foley catheter for bladder drainage
   • Nephrostomy tube may be needed if there is upper tract involvement

3. Complex urological surgeries

   • Particularly with tenuous closures or significant hematuria 2
   • Dual drainage helps reduce pressure on surgical sites

4. Pyonephrosis or infected obstructed systems 1

   • Nephrostomy tube drains infected collecting system
   • Foley catheter prevents reflux and ensures complete drainage

Management Considerations

Foley Catheter Management

• Duration: Remove Foley catheter within 24-48 hours when possible to reduce urinary tract infection risk 2
• Catheter type: Consider silver alloy-coated urinary catheters if prolonged use is anticipated 2
• Monitoring: Regular assessment for signs of infection, blockage, or displacement 2

Nephrostomy Tube Management

• Tube selection: 16-18Fr silicone catheter is typically recommended for PCN 1
• Maintenance: Regular catheter changes (every 4-12 weeks) 1
• Monitoring: Check for dislodgement, which is more common with pigtail catheters (20.32 days) compared to Foley-type nephrostomy tubes (60.92 days) 3

Complications to Monitor

1. Infection risk

   • Increased risk of UTI with prolonged catheterization 2
   • Monitor for signs of sepsis, especially in patients with infected urinary tracts 1

2. Catheter-related issues

   • Dislodgement (occurs in 26.3% of nephrostomy cases) 3
   • Blockage (3.3% for nephrostomy tubes) 1
   • Hematuria (present in approximately 50% of nephrostomy patients) 1

3. Drainage problems

   • Traditional Foley systems may not completely drain the bladder (residual volumes of 96-136 mL have been reported) 4
   • Air-locks can develop in curled drainage tubing 4

Best Practices

• Position drainage bags below patient level to prevent reflux
• Secure catheters properly to prevent accidental dislodgement
• Monitor urine output from both systems separately
• Assess for crystalline biofilm formation in long-term catheterization 5
• Consider Foley-type nephrostomy tubes for long-term use as they have lower dislodgement rates than pigtail designs 3

Remember that while dual drainage systems provide important clinical benefits in specific situations, each catheter increases infection risk, so they should be removed as soon as clinically appropriate.