Foley catheter

Diagram of a foley catheter

Ultrasound image of a foley catheter

A Foley catheter is a flexible tube passed through the urethra and into the bladder to drain urine. It is the most common type of indwelling urinary catheter.

The tube of a Foley catheter has two separated channels, or lumens, running down its length. One lumen is open at both ends, and drains urine into a collection bag. The other lumen has a valve on the outside end and connects to a balloon at the tip. The balloon is inflated with sterile water when it lies inside the bladder to stop it from slipping out. Foley catheters are commonly made from silicone rubber or natural rubber.

Foley catheters should be used only when indicated, as use increases the risk of catheter-associated urinary tract infection and other adverse effects.

Side view diagram of a three-way Foley catheter, in place for bladder irrigation and drainage. The balloon near the tip holds the catheter in place.

Medical uses

In the urinary tract

In an emergency department, indwelling urinary catheters are most commonly used to assist persons who cannot urinate.^[1] Indications for using a catheter include providing relief when there is urinary retention, monitoring urine output for critically ill persons, managing urination during surgery, and providing end-of-life care.^[1]

Foley catheters are used during the following situations:

• On patients who are anesthesized or sedated for surgery or other medical care
• On comatose patients
• On some incontinent patients
• On patients whose prostate is enlarged to the point that urine flow from the bladder is cut off. The catheter is kept in until the problem is resolved.
• On patients with acute urinary retention.
• On patients who are unable due to paralysis or physical injury to use either standard toilet facilities or urinals.
• Following urethral surgeries
• Following ureterectomy
• On patients with kidney disease whose urine output must be constantly and accurately measured
• Before and after cesarean sections
• Before and after hysterectomies
• On patients who had genital injury
• On anorexic patients who are unable use standard toilets due to physical weakness and whose urine output must be constantly measured
• On patients with fibromyalgia who cannot control their bladder

Cervical

A Foley catheter can also be used to ripen the cervix during induction of labor. When used for this purpose, the procedure is called extra-amniotic saline infusion (EASI).^[2] In this procedure, the balloon is inserted behind the cervical wall and inflated, such for example with 30 mL per hour.^[2] The remaining length of the catheter is pulled slightly taut, and taped to the inside of the woman's leg. The inflated balloon applies pressure to the cervix, as the baby's head would prior to labour, causing it to dilate. As the cervix dilates over time, the catheter is readjusted to again be slightly taut, and re-taped to maintain pressure on the cervix. When the cervix has dilated sufficiently, the catheter simply drops out.^[3]

Other

They are also used in cases of severe epistaxis (nosebleed), to block blood from freely flowing down the nasal passage into the mouth.^[4]

Contraindications

Indwelling urinary catheters should not be used in emergency departments to monitor stable people who are able to urinate or for the convenience of the patient or hospital staff.^[1]

In the United States, catheter-associated urinary tract infection is the most common type of hospital-acquired infection.^[1] Indwelling catheters should be avoided when there are alternatives, and when patients and caregivers discuss alternatives to indwelling urinary catheters with their physicians and nurses then sometimes an alternative may be found.^[1] Emergency physicians can reduce their use of indwelling urinary catheters when they follow evidence-based guidelines for usage, such as those published by the Centers for Disease Control and Prevention.^[1]

Adverse effects

A major problem with Foley catheters is that they tend to contribute to urinary tract infections (UTI). This occurs because bacteria can travel up the catheter to the bladder, where the urine can become infected. To combat this, the industry is moving to antiseptic coated catheters. This has been helpful, but has not completely solved this major problem. An additional problem is that Foley catheters tend to become coated over time with a biofilm that can obstruct the drainage. This increases the amount of stagnant urine left in the bladder, which further contributes to the problem of urinary tract infections. When a Foley catheter becomes clogged, it must be flushed or replaced.

There are several risks in using a Foley catheter (or catheters generally), including:

• The balloon can break as the healthcare provider inserts the catheter. In this case, the healthcare provider must remove all balloon fragments.
• The balloon might not inflate after it is in place. In some institutions, the healthcare provider checks the balloon inflation before inserting the catheter into the urethra. If the balloon still does not inflate after placement into the bladder, it is discarded and replaced.
• Urine stops flowing into the bag. The healthcare provider checks for correct positioning of the catheter and bag, or for obstruction of urine flow within the catheter tube.
• Urine flow is blocked. The Foley catheter is discarded and replaced.
• The urethra begins to bleed. The healthcare provider monitors the bleeding.
• Catheterization introduces an infection into the bladder. The risk of bladder or urinary tract infection increases with the number of days the catheter is in place.
• If the balloon is opened before the Foley catheter is completely inserted into the bladder, bleeding, damage and even rupture of the urethra can occur. In some individuals, long-term permanent scarring and strictures of the urethra could occur.^[5]
• Defective catheters may be supplied, which break in situ. The most common fractures occur near the distal end or at the balloon.
• Catheters can be pulled out by patients while the balloon is still inflated, leading to major complications or even death. This may occur when patients are mentally impaired (e.g. they have Alzheimer's) or are in a mentally altered state (e.g. they are coming out of surgery).

Society

History

The name comes from the designer, Frederic Foley, a surgeon who worked in Boston, Massachusetts in the 1930s.^[6] His original design was adopted by C. R. Bard, Inc. of Murray Hill, New Jersey, who manufactured the first prototypes and named them in honor of the surgeon.

Manufactured types

The relative size of a Foley catheter is described using French units (F).^[7] The most common sizes are 10 F to 28 F. 1 F is equivalent to 0.33 mm = .013" = 1/77" of diameter.

Foley catheters come in several types:

• Coudé (French for elbowed) catheters have a 45° bend at the tip that facilitates easier passage through an enlarged prostate.
• Councill tip catheters^[8] have a small hole at the tip so they can be passed over a wire.
• Three way, or triple lumen catheters have a third channel used to infuse sterile saline or another irrigating solution. These are used primarily after surgery on the bladder or prostate, to wash away blood and blood clots.

Notes

1. American College of Emergency Physicians, "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation (American College of Emergency Physicians), retrieved January 24, 2014, which cites
   • Umscheid, Craig A.; Mitchell, Matthew D.; Doshi, Jalpa A.; Agarwal, Rajender; Williams, Kendal; Brennan, Patrick J. (2011). "Estimating the Proportion of Healthcare-Associated Infections That Are Reasonably Preventable and the Related Mortality and Costs". Infection Control and Hospital Epidemiology 32 (2): 101–114. doi:10.1086/657912. ISSN 0899-823X. PMID 21460463.
   • Lo, Evelyn; Nicolle, Lindsay; Classen, David; Arias, Kathleen M.; Podgorny, Kelly; Anderson, Deverick J.; Burstin, Helen; Calfee, David P.; Coffin, Susan E.; Dubberke, Erik R.; Fraser, Victoria; Gerding, Dale N.; Griffin, Frances A.; Gross, Peter; Kaye, Keith S.; Klompas, Michael; Marschall, Jonas; Mermel, Leonard A.; Pegues, David A.; Perl, Trish M.; Saint, Sanjay; Salgado, Cassandra D.; Weinstein, Robert A.; Wise, Robert; Yokoe, Deborah S. (2008). "Strategies to Prevent Catheter‐Associated Urinary Tract Infections in Acute Care Hospitals". Infection Control and Hospital Epidemiology 29 (s1): S41–S50. doi:10.1086/591066. ISSN 0899-823X. PMID 18840088.
   • Munasinghe, Rajika L.; Yazdani, Habeeb; Siddique, Mohamed; Hafeez, Wasif (2001). "Appropriateness of Use of Indwelling Urinary Catheters in Patients Admitted to the Medical Service • ". Infection Control and Hospital Epidemiology 22 (10): 647–649. doi:10.1086/501837. ISSN 0899-823X. PMID 11776352.
   • Hazelett, Susan E; Tsai, Margaret; Gareri, Michele; Allen, Kyle (2006). "The association between indwelling urinary catheter use in the elderly and urinary tract infection in acute care". BMC Geriatrics 6 (1): 15. doi:10.1186/1471-2318-6-15. ISSN 1471-2318. PMC 1618836. PMID 17038177.
   • Gardam, MA; Amihod, B; Orenstein, P; Consolacion, N; Miller, MA (Jul–Sep 1998). "Overutilization of indwelling urinary catheters and the development of nosocomial urinary tract infections.". Clinical performance and quality health care 6 (3): 99–102. PMID 10182561.
   • Gould, Carolyn V.; Umscheid, Craig A.; Agarwal, Rajender K.; Kuntz, Gretchen; Pegues, David A. (2010). "Guideline for Prevention of Catheter‐Associated Urinary Tract Infections 2009". Infection Control and Hospital Epidemiology 31 (4): 319–326. doi:10.1086/651091. ISSN 0899-823X. PMID 20156062.
   • Scott, Robin A.; Oman, Kathleen S.; Makic, Mary Beth Flynn; Fink, Regina M.; Hulett, Teri M.; Braaten, Jane S.; Severyn, Fred; Wald, Heidi L. (2013). "Reducing Indwelling Urinary Catheter Use in the Emergency Department: A Successful Quality-Improvement Initiative". Journal of Emergency Nursing. doi:10.1016/j.jen.2012.07.022. ISSN 0099-1767.
2. Guinn, D. A.; Davies, J. K.; Jones, R. O.; Sullivan, L.; Wolf, D. (2004). "Labor induction in women with an unfavorable Bishop score: Randomized controlled trial of intrauterine Foley catheter with concurrent oxytocin infusion versus Foley catheter with extra-amniotic saline infusion with concurrent oxytocin infusion". American Journal of Obstetrics and Gynecology 191 (1): 225–229. doi:10.1016/j.ajog.2003.12.039. PMID 15295370.
3. WHO article on induction of labour Archived May 19, 2009, at the Wayback Machine.
4. Holland, NJ; Sandhu, GS; Ghufoor, K; Frosh, A (Jan–Feb 2001). "The Foley catheter in the management of epistaxis.". International journal of clinical practice 55 (1): 14–5. PMID 11219312.
5. December 18, 2012. "Foley Catheter Causes, Symptoms, Treatment - Foley Catheter Risks on eMedicineHealth". Emedicinehealth.com. Retrieved 2012-12-19.
6. Foley, FE (1937). "A hemostatic bag catheter: one piece latex rubber structure for control of bleeding and constant drainage following prostatic resection". J Urol 38: 134–9.
7. Dorland's Illustrated Medical Dictionary
8. http://books.google.com/books?id=y3s0mI_BmZ4C&pg=PA65&lpg=PA65&dq=councill+tip+catheter&source=bl&ots=nEx3adVflK&sig=a_nQgbk4K6HIpayS2mXxKjKwnO8&hl=en&sa=X&ei=w-MzU9yRL6feyAGpj4CYCQ&ved=0CGcQ6AEwCQ#v=onepage&q=councill%20tip%20catheter&f=false