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The tube of a Foley cathetar has two separated channels, or [[lumen]]s, running down its length. One lumen is open at both ends, and allows [[urine]] to drain out 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, in order to stop it from slipping out. Foley catheters are commonly made from [[silicone rubber]] or [[natural rubber]].
The tube of a Foley cathetar has two separated channels, or [[lumen]]s, running down its length. One lumen is open at both ends, and allows [[urine]] to drain out 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, in order to stop it from slipping out. Foley catheters are commonly made from [[silicone rubber]] or [[natural rubber]].

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


[[Image:Foley catheter in place.png|right|thumb|200px|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.]]
[[Image:Foley catheter in place.png|right|thumb|200px|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.]]
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===In the urinary tract===
===In the urinary tract===
In an emergency department, indwelling urinary catheters are most commonly used to assist persons who cannot urinate.<ref name="ACEPfive">{{Citation |author1 = American College of Emergency Physicians |author1-link = American College of Emergency Physicians |date = |title = Five Things Physicians and Patients Should Question |publisher = American College of Emergency Physicians |work = [[Choosing Wisely]]: an initiative of the [[ABIM Foundation]] |page = |url = http://www.choosingwisely.org/doctor-patient-lists/american-college-of-emergency-physicians/ |accessdate = January 24, 2014}}, which cites
*{{cite journal|last1=Umscheid|first1=Craig A.|last2=Mitchell|first2=Matthew D.|last3=Doshi|first3=Jalpa A.|last4=Agarwal|first4=Rajender|last5=Williams|first5=Kendal|last6=Brennan|first6=Patrick J.|title=Estimating the Proportion of Healthcare-Associated Infections That Are Reasonably Preventable and the Related Mortality and Costs|journal=Infection Control and Hospital Epidemiology|volume=32|issue=2|year=2011|pages=101–114|issn=0899823X|doi=10.1086/657912}}
*{{cite journal|last1=Lo|first1=Evelyn|last2=Nicolle|first2=Lindsay|last3=Classen|first3=David|last4=Arias|first4=Kathleen M.|last5=Podgorny|first5=Kelly|last6=Anderson|first6=Deverick J.|last7=Burstin|first7=Helen|last8=Calfee|first8=David P.|last9=Coffin|first9=Susan E.|last10=Dubberke|first10=Erik R.|last11=Fraser|first11=Victoria|last12=Gerding|first12=Dale N.|last13=Griffin|first13=Frances A.|last14=Gross|first14=Peter|last15=Kaye|first15=Keith S.|last16=Klompas|first16=Michael|last17=Marschall|first17=Jonas|last18=Mermel|first18=Leonard A.|last19=Pegues|first19=David A.|last20=Perl|first20=Trish M.|last21=Saint|first21=Sanjay|last22=Salgado|first22=Cassandra D.|last23=Weinstein|first23=Robert A.|last24=Wise|first24=Robert|last25=Yokoe|first25=Deborah S.|title=Strategies to Prevent Catheter‐Associated Urinary Tract Infections in Acute Care Hospitals|journal=Infection Control and Hospital Epidemiology|volume=29|issue=s1|year=2008|pages=S41–S50|issn=0899-823X|doi=10.1086/591066}}
*{{cite journal|last1=Munasinghe|first1=Rajika L.|last2=Yazdani|first2=Habeeb|last3=Siddique|first3=Mohamed|last4=Hafeez|first4=Wasif|title=Appropriateness of Use of Indwelling Urinary Catheters in Patients Admitted to the Medical Service • |journal=Infection Control and Hospital Epidemiology|volume=22|issue=10|year=2001|pages=647–649|issn=0899-823X|doi=10.1086/501837}}
*{{cite journal|last1=Hazelett|first1=Susan E|last2=Tsai|first2=Margaret|last3=Gareri|first3=Michele|last4=Allen|first4=Kyle|journal=BMC Geriatrics|volume=6|issue=1|year=2006|pages=15|issn=14712318|doi=10.1186/1471-2318-6-15}}
*{{cite journal|last=Gardam|first=MA|coauthors=Amihod, B; Orenstein, P; Consolacion, N; Miller, MA|title=Overutilization of indwelling urinary catheters and the development of nosocomial urinary tract infections.|journal=Clinical performance and quality health care|date=1998 Jul-Sep|volume=6|issue=3|pages=99-102|pmid=10182561}}
*{{cite journal|last1=Gould|first1=Carolyn V.|last2=Umscheid|first2=Craig A.|last3=Agarwal|first3=Rajender K.|last4=Kuntz|first4=Gretchen|last5=Pegues|first5=David A.|title=Guideline for Prevention of Catheter‐Associated Urinary Tract Infections 2009|journal=Infection Control and Hospital Epidemiology|volume=31|issue=4|year=2010|pages=319–326|issn=0899-823X|doi=10.1086/651091}}
*{{cite journal|last1=Scott|first1=Robin A.|last2=Oman|first2=Kathleen S.|last3=Makic|first3=Mary Beth Flynn|last4=Fink|first4=Regina M.|last5=Hulett|first5=Teri M.|last6=Braaten|first6=Jane S.|last7=Severyn|first7=Fred|last8=Wald|first8=Heidi L.|title=Reducing Indwelling Urinary Catheter Use in the Emergency Department: A Successful Quality-Improvement Initiative|journal=Journal of Emergency Nursing|year=2013|issn=00991767|doi=10.1016/j.jen.2012.07.022}}</ref> 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]].<ref name="ACEPfive"/>

Foley catheters are used during the following situations:
Foley catheters are used during the following situations:
*On patients who are [[anesthesia|anesthesized]] or [[sedation|sedated]] for surgery or other medical care
*On patients who are [[anesthesia|anesthesized]] or [[sedation|sedated]] for surgery or other medical care
Line 31: Line 42:


==Contraindications==
==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.<ref name="ACEPfive"/>
[[Prostatic stents]] are an alternative option most commonly used for people with [[Benign prostatic hyperplasia]]. In some circumstances intermittent self catheterization can be used in place of a Foley catheter.<ref>{{cite journal|last=Nazarko|first=L|title=Intermittent self-catheterisation: past, present and future.|journal=British journal of community nursing|date=2012 Sep|volume=17|issue=9|pages=408, 410-12|pmid=23123484}}</ref>

In the United States, catheter-associated urinary tract infection is the most common type of [[hospital-acquired infection]].<ref name="ACEPfive"/> Iindwelling 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.<ref name="ACEPfive"/> 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]].<ref name="ACEPfive"/>


===Other===
===Other===

Revision as of 16:51, 3 April 2014

Diagram of a foley catheter
Ultrasound image of a foley catheter

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

The tube of a Foley cathetar has two separated channels, or lumens, running down its length. One lumen is open at both ends, and allows urine to drain out 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, in order to stop it from slipping out. Foley catheters are commonly made from silicone rubber or natural rubber.

Foley catheters should only be used when indicated, as using it 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.
File:Foley catheter protruding from human penis.jpg
Foley catheter (F/Ch. 24) balloon blocked and outlet plug put on

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

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][dead link]

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] Iindwelling 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]

Other

They are also used in cases of severe epistaxis, in order to block blood from freely flowing down the nasal passage into the mouth.[citation needed]

Adverse effects

A major problem with Foley catheters is that they have a tendency to contribute to urinary tract infections (UTI). This occurs because bacteria can travel up the catheters 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 it 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 when using a Foley catheter (or catheters generally), including:

  • The balloon can break while the catheter is being inserted. In this case, the healthcare provider will remove all the balloon fragments.
  • The balloon might not inflate after it is in place. In some institutions, the healthcare provider will check the balloon inflation before inserting the catheter into the urethra. If the balloon still does not inflate after its placement into the bladder, it will be discarded and replaced with a new catheter.
  • Urine stops flowing into the bag. The healthcare provider will check 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 will be discarded and replaced with a new catheter.
  • The urethra begins to bleed. The healthcare provider will monitor the bleeding.
  • Introduction of an infection into the bladder. The risk of infection in the bladder or urinary tract 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.[4]
  • 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 working in Boston, Massachusetts in the 1930s.[5] 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).[6] 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 sub-types: "coudé" (French for elbowed) catheters have a 45° bend at the tip to allow easier passage through an enlarged prostate. "Councill tip" catheters[7] have a small hole at the tip which allows them to be passed over a wire. "Three way" or "triple lumen" catheters have a third channel, which is 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. ^ a b c d e f 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.
    • 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.
    • 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.
    • Hazelett, Susan E; Tsai, Margaret; Gareri, Michele; Allen, Kyle (2006). BMC Geriatrics. 6 (1): 15. doi:10.1186/1471-2318-6-15. ISSN 1471-2318. {{cite journal}}: Missing or empty |title= (help)CS1 maint: unflagged free DOI (link)
    • Gardam, MA (1998 Jul-Sep). "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. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
    • 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.
    • 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. ^ a b Attention: This template ({{cite pmid}}) is deprecated. To cite the publication identified by PMID 15295370, please use {{cite journal}} with |pmid=15295370 instead.
  3. ^ WHO article on induction of labour
  4. ^ December 18, 2012. "Foley Catheter Causes, Symptoms, Treatment - Foley Catheter Risks on eMedicineHealth". Emedicinehealth.com. Retrieved 2012-12-19.{{cite web}}: CS1 maint: numeric names: authors list (link)
  5. ^ 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.
  6. ^ Dorland's Illustrated Medical Dictionary
  7. ^ 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
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