Management of a Chronic Foley Catheter in Place for 20+ Days
Yes, you should change the Foley catheter that has been in place for over 20 days to reduce the risk of urinary tract infection and catheter-related complications. 1
Rationale for Changing the Catheter
- Long-term indwelling catheters should be changed at intervals of not more than 5 days to prevent blockage from bacterial encrustations that can develop within 24 hours in some circumstances 2
- Prolonged catheter use increases the risk of catheter-associated urinary tract infections (CAUTIs), which can increase hospital costs, length of stay, and mortality rates 3
- The World Health Organization recommends removing Foley catheters within 24 hours after surgery when possible, highlighting the importance of minimizing catheter duration 1
Procedure for Changing the Catheter
- Use aseptic technique with sterile gloves, antiseptic cleansing of the urethral area, and proper catheter insertion to minimize infection risk 1
- Consider using a silver alloy-coated urinary catheter for continued long-term catheterization as they reduce infection risk according to the CDC 1
- After insertion, secure the catheter properly to prevent accidental traction which can cause urethral trauma 2
Post-Catheter Change Considerations
- Document the date of catheter change and establish a schedule for the next change (typically every 2-4 weeks for long-term catheters) 1
- Assess for signs of urinary tract infection such as fever, suprapubic pain, or changes in urine appearance 4
- Consider implementing a bladder training program if the goal is eventual catheter removal 1
Potential Complications to Monitor
- Catheter-associated genitourinary trauma occurs in approximately 1.5% of Foley catheter days and can require interventions such as prolonged catheterization or cystoscopy 4
- Catheter-associated urinary tract infections remain one of the primary sources of hospital-acquired infections 5
- Catheter blockage from encrustations can occur, particularly when bacteriuria is present 2
Important Considerations
- Assess whether the catheter is still clinically necessary - remove it if possible as this is the most effective way to prevent catheter-related complications 3
- If the patient has signs of catheter-related infection (exit site infection or bacteremia), follow appropriate antibiotic protocols and consider catheter removal 6
- For patients requiring long-term catheterization, implement proper catheter care practices including regular changes to minimize complications 1