Acetic Acid Flushing of Foley Catheters
Acetic acid is NOT a standard or recommended flush solution for Foley catheters, and routine flushing of Foley catheters is not recommended as standard practice. When flushing is clinically indicated (such as for catheter obstruction), sterile 0.9% normal saline should be used 1.
Standard Foley Catheter Management
The CDC explicitly recommends against routine flushing of urinary catheters 1. The primary management principle is to maintain a closed drainage system and minimize manipulation to reduce infection risk 1.
When Flushing Is Clinically Indicated
If flushing becomes necessary due to catheter obstruction or malfunction:
- Use sterile 0.9% sodium chloride (normal saline) as the flush solution 1
- Volume: Typically 30-60 mL of sterile saline is used when irrigation is required, though specific volumes are not standardized in guidelines
- Maintain strict aseptic technique during any manipulation of the catheter system 1
- Use a 60 mL syringe to avoid excessive pressure that could damage the catheter (extrapolated from central line guidance) 2
Acetic Acid Use in Urinary Catheters
While acetic acid solutions (typically 0.25% to 0.5%) have been used historically for bladder irrigation in cases of:
- Alkaline-encrusted catheters
- Certain urinary tract infections (particularly Proteus species)
- Prevention of mineral encrustation
There is no guideline-level evidence supporting routine acetic acid flushing, and this practice is not mentioned in current CDC or major society guidelines for Foley catheter management 1.
Critical Safety Considerations
- Never use acetic acid for routine catheter maintenance - it can cause bladder irritation and mucosal damage
- The closed drainage system should be maintained whenever possible to prevent infection 1
- Remove the catheter as soon as clinically unnecessary rather than attempting to maintain patency through repeated flushing 1
Key Pitfalls to Avoid
- Breaking the closed drainage system for unnecessary flushing increases catheter-associated urinary tract infection (CAUTI) risk 1
- Using non-sterile solutions or improper technique during any catheter manipulation 1
- Confusing central venous catheter flushing protocols (which use heparin or saline) with urinary catheter management - these are entirely different systems with different requirements 3, 1