Foley catheter

Last updated
Diagram of a Foley catheter Foley catheter inflated and deflated EN.svg
Diagram of a Foley catheter
Ultrasound image of a Foley catheter Ultrasound Scan ND 013.jpg
Ultrasound image of a Foley catheter

In urology, a Foley catheter is a brand name for one of many brands of urinary catheters (UC). Foleys and their namesakes are indwelling UC, often referred to as an IDCs (sometimes IDUCs) or the alternative type being an in/out catheters (with only a single tube and no valves, designed to go into the bladder, drain it, and come straight back out). The foley UC was named after Frederic Foley, who produced the original design in 1929. The UC is a flexible tube if it is indwelling and stays put, or rigid (glass (very rarely) or rigid plastic(usually)) if it is in/out, that a clinician, or the client themselves, often in the case of in/out UC, passes it through the urethra and into the bladder to drain urine.

Contents

Foley and similar brand catheters usually have two separated channels, or lumina (or lumen), running down its length. One lumen, opens at both ends, drains urine into a collection bag. The other has a valve on the outside end and connects to a balloon at the inside tip. The balloon is inflated with sterile water or saline while inside the bladder to prevent it from slipping out. Manufacturers usually produce Foley catheters using silicone or coated natural latex.[ citation needed ] Coatings include polytetrafluoroethylene, hydrogel, or a silicone elastomer – the different properties of these surface coatings determine whether the catheter is suitable for 28-day or 3-month indwelling duration. A third type of UC has three lumens for using for bladder washouts post prostate surgery: one lumen is for urine flow out, one lumen is for saline flow in (bladder washouts solution), and the third is for the balloon to be inflated.[ citation needed ]

A section cut of the distal end of a Foley catheter. The image shows a burst balloon, balloon lumen, and main drain lumen. Section cut - Foley cath.jpg
A section cut of the distal end of a Foley catheter. The image shows a burst balloon, balloon lumen, and main drain lumen.

Indwelling catheters/IDCs should be used only when indicated, as use increases the risk of catheter-associated urinary tract infection (UTI) and other adverse effects. [1] While female sex is generally recognised as a risk factor for UTIs, the differences in biological sex are reduced while carrying catheters. [2]

History

The name comes from the designer, Frederic Foley, a surgeon who worked in Boston, Massachusetts in the 1930s. [3] 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.[ citation needed ] There are now multiple companies worldwide who produced IDCs and in/out catheters, that are made of a range of materials, such is silicone, plastic, latex (although due to the rise in latex allergies, medical equipment made of latex is becoming less common). There are even still glass in/out catheters in use today (although very rare) as many older people who have been self catheterising for a very long time prefer them to the plastic ones, as there's no wastage. Currently in most countries the plastic in/out catheters have to be discarded after use. There is a study currently under way called "Single use versus reusable catheters in intermittent catheterisation for treatment of urinary retention: a protocol for a multicentre, prospective, randomised controlled, non-inferiority trial". [4]

Types

Indwelling urinary catheters come in several types:

Sizes

The relative size of an indwelling urinary catheter is described using French units (Fr). [6] Alternatively, the size of a 10 Fr catheter might be expressed as 10 Ch (Charriere units – named after a 19th century French scientific instrument maker, Joseph-Frédéric-Benoît Charrière). The most common sizes are 10 Fr to 28 Fr. 1 Fr is equivalent to 0.33 mm = .013" = 1/77" of diameter. Foley catheters are usually color coded by size with a solid color band at the external end of the balloon inflation tube, allowing for easy identification of the size. [7] Note: Colors for French sizes 5, 6, 8, 10 may vary significantly if intended for pediatric patients. Color for French size 26 may also be pink instead of black.

ColorFrench unitsmm
        Yellow-green62.0
Cornflower Blue82.7
Black103.3
White124.0
Green144.7
Orange165.3
Red186.0
Yellow206.7
Purple227.3
Blue248.0
Black268.7

Medical uses

Urinary tract

Indwelling urinary catheters are most commonly used to assist people who cannot urinate on their own. [8] 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. [8]

Foley catheters are used during the following situations:

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. [9] In this procedure, the balloon is inserted behind the cervical wall and inflated, for example with 30-80 mL of saline. [9] The remaining length of the catheter is pulled slightly taut and taped to the inside of the leg. The inflated balloon applies pressure to the cervix as the baby's head would prior to labor, causing it to dilate. As the cervix dilates over time, the catheter is readjusted to again be slightly taut and retaped to maintain pressure. When the cervix has dilated sufficiently, the catheter drops out. [10]

Other

They are also used in cases of severe epistaxis (nosebleed) to block blood from freely flowing down the nasal passage into the mouth. [11] Foley catheters are also used in abdominal surgery.

Contraindications

Indwelling urinary catheters should not be used to monitor stable people who are able to urinate or for the convenience of the patient or hospital staff. Urethral trauma is the only absolute contraindication to the placement of a urinary catheter. Examination findings such as blood at the urethral meatus, or a high riding prostate necessitate a retrograde urethrogram prior to insertion. [8]

In the United States, catheter-associated urinary tract infection is the most common type of hospital-acquired infection. [8] While UTIs are generally more common among females, the risk factor associated to anatomy is reduced while carrying catheters, some studies even showing no significant differences between the sex. [1] [2] 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. [8] 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. [8]

Adverse effects

Catheterized bladders become colonized by microorganisms very quickly, with a daily incidence of 3-10%; after four days, between 10-30% of patients develop bacteriuria. [12] Whilst the presence of a catheter does increase the incidence of bloodstream infections secondary to a urinary origin, there is a huge amount of unnecessary, and likely harmful, antimicrobial prescribing on the basis of detection of asymptomatic bacteriuria. The industry is moving to silver-coated catheters in an attempt to reduce the incidence of urinary tract infections, although there is limited evidence of efficacy. 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 urinary tract infections. When a Foley catheter becomes clogged, it must be flushed or replaced. There is currently not enough adequate evidence to conclude whether washouts are beneficial or harmful. [13]

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

Related Research Articles

<span class="mw-page-title-main">Urethra</span> Tube that connects the urinary bladder to the external urethral orifice

The urethra is a tube that connects the mammalian urinary bladder to the urinary meatus. Male and female placental mammals release urine through the urethra during urination, but males also release semen through the urethra during ejaculation.

<span class="mw-page-title-main">Urinary tract infection</span> Infection that affects part of the urinary tract

A urinary tract infection (UTI) is an infection that affects a part of the urinary tract. When it affects the lower urinary tract it is known as a bladder infection (cystitis) and when it affects the upper urinary tract it is known as a kidney infection (pyelonephritis). Symptoms from a lower urinary tract infection include pain with urination, frequent urination, and feeling the need to urinate despite having an empty bladder. Symptoms of a kidney infection include fever and flank pain usually in addition to the symptoms of a lower UTI. Rarely the urine may appear bloody. In the very old and the very young, symptoms may be vague or non-specific.

<span class="mw-page-title-main">Cystoscopy</span> Medical procedure; endoscopy of the urinary bladder via the urethra

Cystoscopy is endoscopy of the urinary bladder via the urethra. It is carried out with a cystoscope.

<span class="mw-page-title-main">Urinary incontinence</span> Uncontrolled leakage of urine

Urinary incontinence (UI), also known as involuntary urination, is any uncontrolled leakage of urine. It is a common and distressing problem, which may have a large impact on quality of life. It has been identified as an important issue in geriatric health care. The term enuresis is often used to refer to urinary incontinence primarily in children, such as nocturnal enuresis. UI is an example of a stigmatized medical condition, which creates barriers to successful management and makes the problem worse. People may be too embarrassed to seek medical help, and attempt to self-manage the symptom in secrecy from others.

<span class="mw-page-title-main">Urinary catheterization</span> Insertion of a catheter through the urethra to drain urine

In urinary catheterization, a latex, polyurethane, or silicone tube known as a urinary catheter is inserted into the bladder through the urethra to allow urine to drain from the bladder for collection. It may also be used to inject liquids used for treatment or diagnosis of bladder conditions. A clinician, often a nurse, usually performs the procedure, but self-catheterization is also possible. A catheter may be in place for long periods of time or removed after each use.

<span class="mw-page-title-main">Hematuria</span> Medical condition

Hematuria or haematuria is defined as the presence of blood or red blood cells in the urine. "Gross hematuria" occurs when urine appears red, brown, or tea-colored due to the presence of blood. Hematuria may also be subtle and only detectable with a microscope or laboratory test. Blood that enters and mixes with the urine can come from any location within the urinary system, including the kidney, ureter, urinary bladder, urethra, and in men, the prostate. Common causes of hematuria include urinary tract infection (UTI), kidney stones, viral illness, trauma, bladder cancer, and exercise. These causes are grouped into glomerular and non-glomerular causes, depending on the involvement of the glomerulus of the kidney. But not all red urine is hematuria. Other substances such as certain medications and foods can cause urine to appear red. Menstruation in women may also cause the appearance of hematuria and may result in a positive urine dipstick test for hematuria. A urine dipstick test may also give an incorrect positive result for hematuria if there are other substances in the urine such as myoglobin, a protein excreted into urine during rhabdomyolysis. A positive urine dipstick test should be confirmed with microscopy, where hematuria is defined by three or more red blood cells per high power field. When hematuria is detected, a thorough history and physical examination with appropriate further evaluation can help determine the underlying cause.

<span class="mw-page-title-main">Urinary retention</span> Inability to completely empty the bladder

Urinary retention is an inability to completely empty the bladder. Onset can be sudden or gradual. When of sudden onset, symptoms include an inability to urinate and lower abdominal pain. When of gradual onset, symptoms may include loss of bladder control, mild lower abdominal pain, and a weak urine stream. Those with long-term problems are at risk of urinary tract infections.

<span class="mw-page-title-main">Transurethral resection of the prostate</span> Surgical procedure to perform a prostatectomy

Transurethral resection of the prostate is a urological operation. It is used to treat benign prostatic hyperplasia (BPH). As the name indicates, it is performed by visualising the prostate through the urethra and removing tissue by electrocautery or sharp dissection. It has been the standard treatment for BPH for many years, but recently alternative, minimally invasive techniques have become available. This procedure is done with spinal or general anaesthetic. A triple lumen catheter is inserted through the urethra to irrigate and drain the bladder after the surgical procedure is complete. The outcome is considered excellent for 80–90% of BPH patients. The procedure carries minimal risk for erectile dysfunction, moderate risk for bleeding, and a large risk for retrograde ejaculation.

<span class="mw-page-title-main">Mitrofanoff procedure</span>

The Mitrofanoff procedure, also known as the Mitrofanoff appendicovesicostomy, is a surgical procedure in which the appendix is used to create a conduit, or channel, between the skin surface and the urinary bladder. The small opening on the skin surface, or the stoma, is typically located either in the navel or nearby the navel on the right lower side of the abdomen. Originally developed by Professor Paul Mitrofanoff in 1980, the procedure represents an alternative to urethral catheterization and is sometimes used by people with urethral damage or by those with severe autonomic dysreflexia. An intermittent catheter, or a catheter that is inserted and then removed after use, is typically passed through the channel every 3–4 hours and the urine is drained into a toilet or a bottle. As the bladder fills, rising pressure compresses the channel against the bladder wall, creating a one-way valve that prevents leakage of urine between catheterizations.

<span class="mw-page-title-main">Suprapubic cystostomy</span> Surgical procedure to drain urine

A suprapubic cystostomy or suprapubic catheter (SPC) is a surgically created connection between the urinary bladder and the skin used to drain urine from the bladder in individuals with obstruction of normal urinary flow. The connection does not go through the abdominal cavity.

In urology, voiding cystourethrography (VCUG) is a frequently performed technique for visualizing a person's urethra and urinary bladder while the person urinates (voids). It is used in the diagnosis of vesicoureteral reflux, among other disorders. The technique consists of catheterizing the person in order to fill the bladder with a radiocontrast agent, typically diatrizoic acid. Under fluoroscopy the radiologist watches the contrast enter the bladder and looks at the anatomy of the patient. If the contrast moves into the ureters and back into the kidneys, the radiologist makes the diagnosis of vesicoureteral reflux, and gives the degree of severity a score. The exam ends when the person voids while the radiologist is watching under fluoroscopy. Consumption of fluid promotes excretion of contrast media after the procedure. It is important to watch the contrast during voiding, because this is when the bladder has the most pressure, and it is most likely this is when reflux will occur. Despite this detailed description of the procedure, at least as of 2016 the technique had not been standardized across practices.

<span class="mw-page-title-main">Ureteral stent</span> Medical device

A ureteral stent, or ureteric stent, is a thin tube inserted into the ureter to prevent or treat obstruction of the urine flow from the kidney. The length of the stents used in adult patients varies between 24 and 30 cm. Additionally, stents come in differing diameters or gauges, to fit different size ureters. The stent is usually inserted with the aid of a cystoscope. One or both ends of the stent may be coiled to prevent it from moving out of place; this is called a JJ stent, double J stent or pig-tail stent.

Neurogenic bladder dysfunction, often called by the shortened term neurogenic bladder, refers to urinary bladder problems due to disease or injury of the central nervous system or peripheral nerves involved in the control of urination. There are multiple types of neurogenic bladder depending on the underlying cause and the symptoms. Symptoms include overactive bladder, urinary urgency, frequency, incontinence or difficulty passing urine. A range of diseases or conditions can cause neurogenic bladder including spinal cord injury, multiple sclerosis, stroke, brain injury, spina bifida, peripheral nerve damage, Parkinson's disease, multiple system atrophy or other neurodegenerative diseases. Neurogenic bladder can be diagnosed through a history and physical as well as imaging and more specialized testing. In addition to symptomatic treatment, treatment depends on the nature of the underlying disease and can be managed with behavioral changes, medications, surgeries, or other procedures. The symptoms of neurogenic bladder, especially incontinence, can severely degrade a person's quality of life.

<span class="mw-page-title-main">Retrograde urethrogram</span> Medical imaging of the urethra

A retrograde urethrography is a routine radiologic procedure used to image the integrity of the urethra. Hence a retrograde urethrogram is essential for diagnosis of urethral injury, or urethral stricture.

<span class="mw-page-title-main">Prostatic stent</span>

A prostatic stent is a stent used to keep open the male urethra and allow the passing of urine in cases of prostatic obstruction and lower urinary tract symptoms (LUTS). Prostatic obstruction is a common condition with a variety of causes. Benign prostatic hyperplasia (BPH) is the most common cause, but obstruction may also occur acutely after treatment for BPH such as transurethral needle ablation of the prostate (TUNA), transurethral resection of the prostate (TURP), transurethral microwave thermotherapy (TUMT), prostate cancer or after radiation therapy.

Urologic diseases or conditions include urinary tract infections, kidney stones, bladder control problems, and prostate problems, among others. Some urologic conditions do not affect a person for that long and some are lifetime conditions. Kidney diseases are normally investigated and treated by nephrologists, while the specialty of urology deals with problems in the other organs. Gynecologists may deal with problems of incontinence in women.

<span class="mw-page-title-main">Urodynamic testing</span> Assessment of bladder and urethra performance

Urodynamic testing or urodynamics is a study that assesses how the bladder and urethra are performing their job of storing and releasing urine. Urodynamic tests can help explain symptoms such as:

Dyssynergia is any disturbance of muscular coordination, resulting in uncoordinated and abrupt movements. This is also an aspect of ataxia. It is typical for dyssynergic patients to split a movement into several smaller movements. Types of dyssynergia include Ramsay Hunt syndrome type 1, bladder sphincter dyssynergia, and anal sphincter dyssynergia.

<span class="mw-page-title-main">Artificial urinary sphincter</span> Medical device

An artificial urinary sphincter (AUS) is an implanted device to treat moderate to severe stress urinary incontinence, most commonly in men. The AUS is designed to supplement the function of the natural urinary sphincter that restricts urine flow out of the bladder.

The genitourinary tract, or simply the urinary tract, consists of the kidneys, ureters, bladder, and the urethra. The kidney is the most frequently injured. Injuries to the kidney commonly occur after automobile or sports-related accidents. A blunt force is involved in 80-85% of injuries. Major decelerations can result in vascular injuries near the kidney's hilum. Gunshots and knife wounds and fractured ribs can result in penetrating injuries to the kidney.

References

  1. 1 2 Karlsson, Philip A.; Pärssinen, Julia; Danielsson, Erik A.; Fatsis-Kavalopoulos, Nikos; Frithiof, Robert; Hultström, Michael; Lipcsey, Miklos; Järhult, Josef D.; Wang, Helen (7 February 2023). "Antibiotic use during coronavirus disease 2019 intensive care unit shape multidrug resistance bacteriuria: A Swedish longitudinal prospective study". Frontiers in Medicine. 10. doi: 10.3389/fmed.2023.1087446 . PMC   9941185 . PMID   36824610.
  2. 1 2 Lee JH, Kim SW, Yoon BI, Ha US, Sohn DW, Cho YH (January 2013). "Factors that affect nosocomial catheter-associated urinary tract infection in intensive care units: 2-year experience at a single center". Korean Journal of Urology. 54 (1): 59–65. doi:10.4111/kju.2013.54.1.59. PMC   3556556 . PMID   23362450.
  3. ↑ Foley, FE (1937). "A hemostatic bag catheter: one piece latex rubber structure for control of bleeding and constant drainage following prostatic resection". Journal of Urology. 38: 134–139. doi:10.1016/S0022-5347(17)71935-0.
  4. ↑ van Doorn, Tess; Berendsen, Sophie A; Scheepe, Jeroen R; Blok, Bertil F M (10 April 2022). "Single use versus reusable catheters in intermittent catheterisation for treatment of urinary retention: a protocol for a multicentre, prospective, randomised controlled, non-inferiority trial (COMPaRE)". BMJ Open. 12 (4): e056649. doi:10.1136/bmjopen-2021-056649. PMC   9003620 . PMID   35410930.
  5. ↑ Siroky, Oates & Babayan 2004, p. 65.
  6. ↑ "Dorland's Illustrated Medical Dictionary". Archived from the original on 2008-02-29. Retrieved 2006-06-18.
  7. ↑ "Indwelling Urinary Catheters: Types". UroToday. Retrieved 22 Jan 2020. Catheter sizes are colored-coded at the balloon inflation site for easy identification.
  8. 1 2 3 4 5 6 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
  9. 1 2 Guinn DA, Davies JK, Jones RO, Sullivan L, Wolf D (July 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.
  10. ↑ WHO article on induction of labour Archived May 19, 2009, at the Wayback Machine
  11. ↑ 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): 14–15. doi:10.1111/j.1742-1241.2001.tb10969.x. PMID   11219312. S2CID   44835941.
  12. ↑ "Complications -- Indwelling Catheters". UroToday. Retrieved January 1, 2023.
  13. ↑ Shepherd AJ, Mackay WG, Hagen S (March 2017). "Washout policies in long-term indwelling urinary catheterisation in adults". The Cochrane Database of Systematic Reviews. 2017 (3): CD004012. doi:10.1002/14651858.CD004012.pub5. PMC   6464626 . PMID   28262925.
  14. ↑ "Foley Catheter Causes, Symptoms, Treatment – Foley Catheter Risks on eMedicineHealth". Emedicinehealth.com. December 18, 2012. Retrieved 2012-12-19.

Sources

This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.