From the Guidelines
Foley catheters are indicated for specific clinical situations, including urinary retention, open wounds in the sacral or perineal area with urinary incontinence, and certain surgical procedures, as outlined in the most recent guidelines 1. The indications for Foley catheter use include:
- Urinary retention or obstruction, where close monitoring of urine output is necessary and the patient is unable to use a urinal or bedpan
- Open wounds in the sacral or perineal area with urinary incontinence
- Patients who are too ill, fatigued, or incapacitated to use alternative urine collection methods
- Post-surgical patients who require bladder drainage
- Management of urinary incontinence at the patient's request
- Neurogenic bladder management
- Emergent pelvic ultrasound
- Other acceptable indications, such as aiding in the healing process of open pressure ulcers or skin grafts for certain patients with urinary incontinence, and facilities may permit exceptions as part of palliative and/or comfort care if catheter use aligns with specific patient goals. However, Foley catheters should be used judiciously due to the significant risk of catheter-associated urinary tract infections (CAUTIs), as highlighted in recent studies 1. The risk of infection increases approximately 3-7% per day of catheterization, and bacteria can travel along the catheter surface or through the drainage system. Therefore, catheters should be removed as soon as clinically appropriate, and alternatives like intermittent catheterization, external catheters, or absorbent products should be considered when possible to minimize infection risk and patient discomfort, as recommended in the guidelines 1. It is essential to weigh the benefits and risks of Foley catheter use and to consider the individual patient's needs and circumstances when making decisions about catheter placement and removal, as emphasized in the recent consensus guidelines 1.
From the Research
Indications for Foley Catheterization
The following are indications for Foley catheterization:
- Incomplete bladder emptying due to idiopathic or neurogenic bladder dysfunction 2
- Neurogenic bladder resulting from spinal cord injury, spina bifida, or other neurological disorders 3, 4, 5
- Urinary retention due to chronic neurogenic urinary retention 3
- Need for continuous bladder drainage in patients with spinal cord injury or other conditions affecting bladder function 6
Conditions Requiring Foley Catheterization
Foley catheterization may be necessary for patients with:
- Spinal cord injury 4, 6
- Spina bifida 3, 5
- Multiple sclerosis 3
- Neurogenic detrusor overactivity 5
- Incomplete bladder emptying 2, 5
Management of Neurogenic Bladder
Foley catheterization is part of the management strategy for neurogenic bladder, which may also include: