From the Guidelines
For a patient with perineal pain following a Foley catheter exchange with previous bleeding, I recommend administering acetaminophen 650-1000 mg orally or IV as first-line treatment. If pain is moderate to severe, consider adding an NSAID such as ketorolfen 15-30 mg IV or ibuprofen 400-600 mg orally if there are no contraindications. For more severe pain, low-dose opioids like hydrocodone/acetaminophen 5/325 mg or oxycodone 5 mg may be appropriate. The perineal area should be assessed for active bleeding, excessive swelling, or signs of infection. Ensure the catheter is properly positioned and draining adequately. Apply cold packs to reduce inflammation and consider topical lidocaine 2% gel to the perineal area for additional pain relief.
Key Considerations
- Pain following catheter insertion or exchange is common due to urethral irritation and trauma during the procedure 1.
- Proper pain management will improve patient comfort while the irritation resolves naturally over the next 24-48 hours.
- Monitor urine output and characteristics to ensure proper catheter function.
Additional Recommendations
- Consider removing the Foley catheter within 48 hours to avoid increased risk of urinary tract infection, as recommended by the management of adult stroke rehabilitation care guideline 1.
- Use silver alloy–coated urinary catheters if a catheter is required, as recommended by the same guideline 1.
- Assess the patient's bladder function, including urinary retention, frequency, volume, and control, as well as the presence of dysuria 1.
From the Research
Patient Care
- The patient has a possible seizure diagnosis and a brain CT showing an old stroke, but the current concern is the bleeding from the Foley catheter insertion and the patient's complaint of perineal area pain.
- There is no mention of pain medication being administered to the patient.
Foley Catheter Care
- Studies have shown that antibiotic prophylaxis can be effective in preventing catheter-associated urinary tract infections (CAUTI) 2, 3.
- Antimicrobial-coated catheters have also been proposed as a method to prevent CAUTI, but evidence of their clinical efficacy is limited 4.
Pain Management
- For acute pain management after perineal trauma, such as bleeding from a Foley catheter insertion, acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) are recommended as first-line treatment 5.
- Ice or chemical cold packs are also recommended for postpartum pain first-line treatment due to their simplicity of use 5.
- Epidural morphine may be considered for severe perineal tears, but with adequate respiratory monitoring 5.
Current Situation
- The patient's bleeding from the Foley catheter insertion and perineal area pain need to be addressed promptly.
- Administering pain medication, such as acetaminophen or NSAIDs, may be necessary to manage the patient's pain.
- Monitoring the patient's condition and adjusting treatment as needed is crucial.