From the Guidelines
Interventions for trauma from Foley catheter insertion should prioritize prevention, gentle technique, and immediate management to minimize complications and promote healing. When trauma occurs, immediate interventions include stopping the procedure, applying gentle pressure to control bleeding, and reassessing the need for catheterization. For minor trauma with slight bleeding, observation may be sufficient, while for moderate trauma, a smaller catheter may be attempted or a temporary period without catheterization may be necessary to allow healing 1. Severe trauma with significant bleeding or false passage creation requires urological consultation. Post-trauma care includes monitoring for continued bleeding, infection signs (fever, cloudy urine), and ensuring adequate hydration. Antibiotics are generally not needed unless infection develops, and pain management with acetaminophen or NSAIDs is usually sufficient. Urethral trauma from catheterization typically heals within days, but persistent symptoms warrant urological evaluation. In cases of suspected urethral injury, retrograde urethrography should be performed to assess the extent of the injury and guide management, as recommended by the AUA guideline 1. Prevention strategies, such as using proper catheter size and adequate lubrication, can help minimize the risk of trauma during Foley catheter insertion. Overall, a careful and gentle approach to Foley catheter insertion, combined with prompt and effective management of any trauma that occurs, is essential to preventing complications and promoting optimal outcomes. Key considerations in managing trauma from Foley catheter insertion include:
- Using proper catheter size and technique to minimize the risk of trauma
- Applying gentle pressure to control bleeding and reassessing the need for catheterization if trauma occurs
- Monitoring for signs of infection and ensuring adequate hydration in the post-trauma period
- Considering urological consultation for severe trauma or persistent symptoms
- Performing retrograde urethrography to assess the extent of urethral injury, as recommended by the AUA guideline 1.
From the Research
Interventions for Trauma from Foley Insertion
- Delaying urinary catheter insertion until after definitive truncal Computed Tomography (CT) imaging can help reduce pelvic volume and associated bleeding, as well as decrease the risk of catheter-associated urinary tract infections (CAUTIs) 2
- Using a full bladder to tamponade pelvic bleeding can be an effective technique for managing hemorrhage in adult blunt multitrauma patients with pelvic ring fractures 2
- Careful, aseptic Foley catheter insertion followed by bladder insufflation with 500-600 mL of Normal Saline (NS) and subsequent catheter clamping can help tamponade pelvic bleeding in shocked patients with major pelvic injuries 2
Catheter Management and Complications
- Understanding urinary catheter indications, placement and removal techniques, and maintenance is necessary to mitigate the associated risks, including infection and encrustation 3
- Using best practices related to catheter management can optimize bladder drainage while minimizing the associated risks, including CAUTIs, catheter encrustations, bladder spasms, and catheter-associated pain 3
- Education on CAUTI prevention can improve nurse's clinical knowledge and attitude toward Foley catheter usage and CAUTIs, and can lead to improved proper maintenance in clinical practice 4
Strategies for Reducing CAUTIs
- Early removal of urinary catheters is an effective strategy for CAUTI prevention 5
- Implementation of a nurse-driven protocol for catheter removal can result in decreased catheter utilization and CAUTI rates in a surgical trauma intensive care unit (STICU) 5
- Using a multimodal CAUTI prevention bundle, including a nurse-driven protocol for early urinary catheter removal, can lead to significant decreases in both catheter utilization and CAUTI rates 5