What is the procedure for monitoring post void residuals after Foley (Foley catheter) removal?

Protocol for Monitoring Post Void Residuals After Foley Catheter Removal

After Foley catheter removal, implement intermittent catheterization every 4-6 hours to determine post-void residual (PVR) volumes, with continued monitoring until bladder volumes are consistently less than 100-200 mL. 1

Initial Assessment After Foley Removal

• Remove Foley catheter within 24-48 hours after placement to minimize risk of urinary tract infection 1
• Assess bladder function thoroughly after catheter removal, including measurement of urinary frequency, volume, and control 2
• Ensure patient voids within 4-6 hours after catheter removal 2

Post-Void Residual (PVR) Measurement Protocol

• Measure PVR after the first void following catheter removal using either:
  • Ultrasound bladder scanner (non-invasive, quick, and comfortable for patients) 3
  • Intermittent catheterization (more invasive but considered gold standard) 3
• For confirmation of abnormal findings, repeat PVR measurement to improve precision due to marked intra-individual variability 4

PVR Volume Thresholds and Management

• PVR <100 mL: Normal bladder emptying, continue routine monitoring 4
• PVR 100-200 mL: Initiate intermittent catheterization and monitor for urinary tract infections 4
• PVR >200 mL: Implement intermittent catheterization every 4-6 hours and evaluate for underlying causes 4

Voiding Trial Techniques

• Back fill technique: Fill bladder with 300 cc saline before removing Foley catheter, then measure PVR after voiding 5
  • This technique appears to be a better predictor of adequate postoperative bladder emptying than auto fill 5
• Auto fill technique: Remove catheter and allow bladder to fill spontaneously before measuring PVR 5
• Consider successful voiding as:
  • Voided volume >200 mL with PVR <100 mL 6, or
  • Voiding efficiency of at least 68% (voided volume ÷ total bladder volume) 7

Special Considerations

• Avoid using indwelling catheters when intermittent catheterization is feasible, as indwelling catheters increase UTI risk 4
• For patients with neurogenic bladder, continue catheterization until bladder volumes are consistently less than 30 mL for 3 consecutive days 1
• Consider implementing a prompted voiding schedule based on the patient's voiding pattern for patients with difficulty voiding 1
• Ultrasound bladder scanners provide good correlation with catheterization for PVR measurement with high specificity (91%) and negative predictive value (93.1%) 3

Common Pitfalls to Avoid

• Failing to repeat PVR measurements when first measurement is abnormal 4
• Not considering associated conditions like constipation that may contribute to elevated PVR 4
• Setting arbitrary PVR thresholds without considering individual patient factors 4
• Unnecessary re-catheterization when PVR is only mildly elevated (standardized protocols can reduce unnecessary re-catheterization by up to 90%) 8