How to use a Foley catheter for uterine tamponade in postpartum hemorrhage (PPH) management?

From the Guidelines

To effectively manage postpartum hemorrhage (PPH) using a Foley catheter for uterine tamponade, it is crucial to follow a step-by-step approach that prioritizes patient safety and efficacy, as supported by recent guidelines 1.

Introduction to the Procedure

The use of a Foley catheter for uterine tamponade in PPH management is a valuable technique, especially in settings where resources are limited. This method involves inserting a Foley catheter into the uterine cavity and inflating the balloon to apply pressure to the uterine walls, thereby promoting hemostasis.

Steps for the Procedure

To perform this procedure:

• Gather necessary equipment, including a 24-30 French Foley catheter with a 30-60 mL balloon, sterile saline, IV tubing, and a 60 mL syringe.
• Empty the patient's bladder and clean the vaginal area with antiseptic solution to minimize the risk of infection.
• Insert the catheter through the cervix into the uterine cavity, using ring forceps or manual guidance as needed.
• Once the catheter is properly positioned, inflate the balloon with 60-80 mL of sterile saline. The volume may be adjusted up to 150 mL if necessary, based on the patient's response and the severity of the hemorrhage.
• Apply gentle traction to the catheter by securing it to the patient's thigh or attaching a weight, which helps in maintaining the catheter's position and ensuring continuous pressure on the uterine walls.

Monitoring and Removal

• Monitor the patient closely for signs of continued bleeding or improvement. The effectiveness of the tamponade can be assessed by observing a decrease in bleeding.
• Leave the catheter in place for 12-24 hours, during which time other management strategies, such as uterotonic medications, should be continued to support uterine contraction and hemostasis.
• Before removing the catheter, partially deflate the balloon and observe the patient for any signs of renewed bleeding. If no bleeding occurs, the balloon can be completely deflated, and the catheter removed.

Considerations and Recommendations

This technique is particularly useful in low-resource settings due to its simplicity, availability, and cost-effectiveness. However, when possible, commercial balloon tamponade systems are preferred due to their design specificity for this application and potential for better outcomes. The decision to use a Foley catheter for uterine tamponade should be made as part of a comprehensive approach to managing PPH, considering the patient's overall clinical condition, the severity of the hemorrhage, and the availability of other treatment options, as outlined in recent clinical guidelines 1.

From the Research

Using a Foley Catheter for Uterine Tamponade in PPH Management

• The use of a Foley catheter for uterine tamponade is not explicitly mentioned in the provided studies 2, 3, 4, 5, 6.
• However, the studies discuss the use of intrauterine balloon tamponade as a treatment option for postpartum hemorrhage (PPH) due to uterine atony 2, 3.
• Intrauterine balloon tamponade is a procedure where a balloon is inserted into the uterus and inflated to apply pressure to the uterine walls, helping to stop bleeding 3.
• The studies also mention the importance of identifying the underlying cause of PPH, estimating blood loss, and initiating a resuscitation protocol with fluid replacement, blood transfusion, and close monitoring of the woman 2, 3.
• Other treatment options for PPH include uterine massage, bimanual uterine compression, administration of uterotonics, and surgical interventions such as hemostatic brace sutures and hysterectomy 2, 3, 4.

Alternative Treatment Options

• The use of uterotonics, such as oxytocin, ergot alkaloids, and prostaglandins, is recommended for the prevention and treatment of PPH 5.
• Tranexamic acid (TXA) and fibrinogen concentrate are also being studied as potential treatments for PPH, with TXA showing promise in reducing intraoperative blood loss and mortality 6.
• The importance of early identification and intervention in PPH management is emphasized in the studies, with a focus on coordinated care and timely treatment to minimize blood loss and ensure optimal clinical outcomes 2, 3, 4.