What are the recommendations for inserting, changing, and flushing an 18 French (F) irrigation Foley catheter?

Foley Catheter Management: 18F Irrigation Catheter Recommendations

For an 18F irrigation Foley catheter, use aseptic technique for insertion and maintain sterility during care, change the catheter every 2-4 weeks based on clinical indications, and flush as needed only when obstructed rather than on a routine schedule.

Insertion Technique

• Use maximal sterile barrier precautions including cap, mask, sterile gown, sterile gloves, and sterile full body drape during insertion 1
• Prepare the insertion site with an appropriate antiseptic (0.5% chlorhexidine preparation with alcohol is preferred) 1
• Allow the antiseptic to dry completely according to manufacturer's recommendations before catheter insertion 1, 2
• Use sterile lubricant to minimize urethral trauma during insertion 3
• Secure the catheter after insertion to prevent movement and urethral trauma 3

Catheter Selection and Maintenance

• Select an 18F irrigation catheter only when irrigation is specifically needed, as smaller catheters (14-18F) with 5cc balloons are generally recommended to minimize urethral trauma 3
• Use sterile water or normal saline for balloon inflation (studies show no significant difference in deflation failure rates between the two) 4
• Connect to a closed drainage system to minimize infection risk 1
• Position the drainage bag below bladder level but not touching the floor 2
• Do not disconnect the catheter from the drainage system unless absolutely necessary 1

Dressing Management

• Use either sterile gauze or sterile, transparent, semi-permeable dressing to cover the catheter insertion site 2
• If the patient is diaphoretic or if the site is bleeding/oozing, use gauze dressing until resolved 2
• Replace gauze dressings every 2 days 1
• Replace transparent dressings at least every 7 days 1
• Replace any dressing immediately if it becomes damp, loosened, or visibly soiled 2

Catheter Replacement Schedule

• Do not replace catheters at routine, fixed intervals 1
• Change the catheter based on clinical indications such as:
  • Obstruction or decreased flow 1
  • Leakage 3
  • Encrustation 3
  • Infection with symptomatic UTI 1, 3
  • Visible biofilm formation 3
• For long-term indwelling catheters, replacement every 2-4 weeks is typically recommended based on individual patient factors and catheter performance 3

Irrigation Recommendations

• Do not perform routine irrigation of catheters 3
• Only irrigate when clinically indicated for obstruction 3
• If irrigation is necessary:
  • Use aseptic technique 1
  • Use a closed irrigation system when possible 1
  • Use sterile irrigation solution 2
  • Document the reason for irrigation, amount and type of solution used, and patient response 2

Infection Prevention

• Perform hand hygiene before and after handling the catheter or drainage system 1, 2
• Maintain a closed drainage system at all times 1
• Do not use topical antibiotic ointments at the insertion site due to risk of promoting fungal infections and antimicrobial resistance 1, 2
• Regularly assess for signs of infection (fever, suprapubic pain, cloudy urine, hematuria) 2
• Remove the catheter as soon as it is no longer needed 1

Common Pitfalls to Avoid

• Do not submerge the catheter or insertion site in water; showering is permitted if precautions are taken to protect the catheter 1, 2
• Avoid routine catheter irrigation which can introduce pathogens 3
• Do not clamp the catheter unnecessarily as this can lead to bladder distension and increased infection risk 1
• Avoid using catheters larger than necessary as they increase urethral trauma and patient discomfort 3, 5
• Do not use force when inserting or removing catheters 2, 6

Special Considerations for 18F Irrigation Catheters

• The larger lumen of an 18F catheter is beneficial for drainage of thick secretions or blood clots 3
• When used for continuous bladder irrigation, ensure proper setup of the irrigation system to prevent reflux 2
• Monitor fluid balance carefully when continuous irrigation is used 2
• Consider changing to a smaller catheter once irrigation is no longer needed 3