How often should a Foley (urinary) catheter be changed?

Foley Catheter Replacement Timing

Foley catheters should be routinely changed every 2-3 weeks for patients with uncomplicated extraperitoneal bladder injuries, and consideration for longer intervals may be appropriate in specific clinical circumstances. 1

Standard Replacement Intervals

For Uncomplicated Urinary Drainage

• Leaving a Foley catheter in place for 2-3 weeks is the standard practice for uncomplicated extraperitoneal bladder injuries 1
• In patients with significant concurrent injuries, it is acceptable to leave the Foley catheter in place longer than the standard 2-3 weeks 1

For Complicated Cases

• For patients with non-healing bladder injuries who are unresponsive to Foley catheter drainage, consideration for open repair may be appropriate after 4 weeks 1
• Follow-up cystography should be used to confirm that extraperitoneal bladder injuries have healed after treatment with catheter drainage 1

Clinical Decision-Making Algorithm

1. Assess the indication for catheterization:

   • Uncomplicated extraperitoneal bladder injury: Change every 2-3 weeks
   • Complicated extraperitoneal bladder injury: Consider surgical repair rather than prolonged catheterization
   • Significant concurrent injuries: May extend beyond 2-3 weeks based on clinical judgment

2. Monitor for signs requiring immediate catheter change:

   • Catheter blockage or encrustation
   • Signs of infection (fever, cloudy urine, suprapubic pain)
   • Leakage around the catheter
   • Catheter malfunction

3. Follow-up evaluation:

   • Perform cystography to confirm healing before catheter removal
   • For non-healing injuries after 4 weeks of drainage, consider surgical intervention

Important Considerations

Infection Prevention

• Maintaining a closed drainage system is critical for preventing catheter-associated urinary tract infections (CAUTIs) 2
• Proper catheter care and aseptic technique during insertion and maintenance are essential to reduce infection risk 2

Complications to Monitor

• Foley catheters can cause various harms including infection, pain, and genitourinary trauma 3
• Genitourinary trauma from catheters can be as common as symptomatic urinary tract infections and may require interventions such as prolonged catheterization or cystoscopy 3

Pitfalls to Avoid

• Leaving catheters in place longer than necessary increases risk of CAUTIs and other complications
• Failure to recognize non-healing bladder injuries after 4 weeks of catheter drainage may delay appropriate surgical intervention
• Interrupting the closed drainage system unnecessarily increases infection risk

By following these evidence-based guidelines for Foley catheter replacement timing, clinicians can minimize catheter-associated complications while ensuring proper healing of bladder injuries.