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Foley (Urethral) Catheterization

Assess indications.  Note that catheter insertion carries a risk of infection.  A specific surgical consent is not generally obtained.  Explain urethral catheterization (may be intermittent or indwelling).

Indications:

·         Diagnostic

         To collect uncontaminated urine specimen

         Study anatomy of the urinary tract

         Urine output monitoring

·         Therapeutic

                                 Acute urinary retention

                                 Chronic obstruction causing hydronephrosis

                                 Intermittent bladder decompression for neurogenic bladder

                                 Chronically bed-ridden patients for hygiene

Contraindications:

            1.   Urethral injury                                            

                     Trauma patients with blood at meatus or abnormal prostate location on rectal exam.

 Equipment:

1.       Catheter tray.

2.       Foley Catheter:

                        18 F  Adults

                        18 F  Coudé if obstruction at prostrate

                           5 – 12 F Children

                          5 F feeding tube with tape – infants < 6 months

3.       Drainage bag.

4.       Transurethral topical Lidocaine jelly (Uro-jet).   [OPTIONAL]

Procedure:

1. Consider prophylactic antibiotics: valvular heart disease or acute prostatitis.

2. Consider intraurethral anesthetic (Uro-jet).

            3. Position: supine, frogleg or knees flexed.

            4. Locate meatus. (Fig. A)

5. Apply antiseptic.

6. Gently insert lubricated tube until urine is obtained. (Fig. B)

7. Inflate retention balloon slowly with 5cc saline.

8. Connect to drainage system.

9. Secure tube with tape.                                             

                    

Figure A                                                                                                                                                                                Figure B

                       

Removal:

·        Deflate retention balloon by aspirating contents with 10cc syringe from side port.

Complications: Prevention and Management

Complication:

Prevention:

Management:

Inability to locate urethra:

 Proper position.

Compress foreskin edema. Use lubricated pediatric vaginal speculum with edematous foreskin.

Vaginal catheterization

Position.

Discard catheter.

Re-attempt with fresh catheter.

Paraphimosis:

Properly replace foreskin.

Urology consult.

Urethral stricture:

 

Trial of smaller tube.

 

Enlarged prostrate:

 

Coudé Catheter.

UTI:

Aseptic technique.

Minimize time Foley remains in.

Prophylactic abx as indicated

Change catheter

antibiotics

Inability to deflate:

 

Remove syringe adaptor.

Insert guidewire into inflating channel – balloon water should flow out.

·        Withdraw catheter gently, taking care not to splash from tip.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Documentation:

·        Note indications.

·        Describe technique, size / type of catheter and amount of fluid injected into retention balloon.

·        Note complications, if any, and management.

 

General Items for Evaluation:

·         Understands indications/contraindications

·         Educates/prepares patient

·         Identifies proper landmarks

·         Uses sterile techniques

·         Performs procedure correctly

·         Understands potential complications and their management

·         Adequate documentation performed