Foley Catheters

Avg In/Out of person /day

2.5L

how much of avg I/O is urine

1 L in urine

urethra length to bladder in men

6-7 inch

urethra length to bladder in women

~1.5-2 inch

foley catheter indications

• To obtain sterile urine sample

• Monitor urine output

• Bypass obstructive processes in urethra (strictures), prostate (BPH), or bladder neck caused by dz or trauma until repair can be made

• Facilitate urine drainage in incapacitated pt

• Post-op urethral stricture repair, prostatectomy

• Traction device to control bleeding

• Specialized 3 way catheters for hematuria = Large, 24 French

• Protocol for intermittent catheterizing pts w/ neurogenic bladder

• To deliver topical antineoplastic meds to the bladder

• To assess post void residuals (Now more commonly use U/S)

which catheter is used to obtain sterile urine sample

straight cath

which catheter is used to monitor urine output

indwelling foley catheter

catheter CIs

Appearance of blood at the urethral meatus in pt who has sustained pelvic injury

catheter insertion complications

• Urethral dilatation d/t placement on long-term indwelling Foley in woman

  • Leaking occurs b/c bladder spasm, progressively larger catheters are placed to txt

• Urinary structural trauma

• UTIs

  • Risk increases 5% for every day catheter left inside

• Males w/ urethral stricture dz, bladder neck contracture, enlarged prostate may present technical insertion problems

• If urethral stricture, BPH, can cause false passages by damaging "drilling" and undermining the lining of the urethral tissues

• Catheters "double back" on themselves

• Trauma from pt pulling out catheter

indwelling catheter complications

• Infection

  • Position bag below bladder

  • Avoid kinks in tubing

  • Empty before bag full

  • Avoid contaminating bag when emptying

  • Avoid contact w/ contaminated objects (toilet bowl)

  • Monitor for sign of infection

• Trauma

  • Protect the catheter

  • Secure correctly

short term in/out catheter/stright cath complications

• Urethral irritation and infection

• Pts "burn" the 1st few times they urinate post-catheterization (admin OTC Pyridium)

French scale of catheters

0.33mm = 1 Fr

Pediatric boy catheter size

5-12 Fr

adult men cath size

16-18 Fr

14 Fr less rigid and tend to curl

adult women cath size

14-18 Fr

large clot evacuation clot size

20-30 Fr

Robinson cath

straight/in and out

made of rubber

foley cath

Straight urethral catheter w/ single port used to inflate the balloon

Coude cath

• Same as Foley except terminal 2 in are curved upward

• Indications for men

  • Can't withdraw foreskin, strictures

• Indications for women

  • Older and structures sink in

  • Perform vaginal exam to feel urethra

    • 3rd hole from the bottom

• Balloon port points same way as tip, want balloon port facing upwards

3 way cath

Murphy Drip/CBI (Continuous Bladder Irrigation)

pull out any clots that may be in bladder

external Texas male cath

condom cath

divert urine from entering wounds

tend to fall off

external female catheter

PureWick

sits in btw labia and collects any urine output

CI yeast infection

adhesive anchor device

leaves a little slack, secure at cath bifurcation

catheter straps

• Commonly used for catheter stabilization

• Elastic band placed around thigh (def above knee) and velco strap secures catheter prot for stabilization

• Easy to use w/ less skin irritation or rashes

Urojet

Syringe like tube of viscous lidocaine jelly used for numbing urethra

bed pans/urinals

Best thing is to get pt up to actual bathroom or bedside commode

procedure for men

• Position, observe universal blood and body fluid precautions

• Stretch/point upwards, if retracting foreskin to visualize meatus ensure you put it back when done!

• Cleanse meatus, isolate genitalia with sterile drapes or towels

• Use lubricant/anesthetic jelly (urojet)- leave it in place 5 min (if able)- determine patient discomfort level if in acute urinary retention..

•  Hold the penis taut while directing it toward the umbilicus to straighten the urethra. With dominant hand, pass the catheter into the bladder the FULL LENGTH, up to the junction of the foley catheter and inflation port. Inflate the balloon--- if during inflation patient endorses pain that was not there before, STOP. Retry, seek help, don’t force it, talk to the patient.

• Once catheter in place, secure to the leg.

procedure for women

• Position, observe universal blood and body fluid precautions

• Isolate genitalia with sterile drapes or towels

• Use lubricant/anesthetic jelly (urojet)- leave it in place 5 min (if able)- determine patient discomfort level if in acute urinary retention..

• Follow anticipated course of the urethra, pass the catheter into the bladder

• Usually 3 inches, then advance another inch beyond where urine is obtained to allow room for inflation of the balloon. Pull gently outward to allow balloon to rest against the bladder neck

• Once catheter in place, secure to the leg

procedural troubleshooting

• Women: use your index finger

• Men: use coude, reduce foreskin, dorsal slit for phimosis, glidewire, filiform/followers, bedside suprapubic tube