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indwelling urinary (foley) catheter

Most catheters are made of siliconized rubber. [1] Indications: Criteria [2,9] 1) urinary retention that cannot be managed surgically or medically 2) urinary incontinence exacerbating wounds - stage 3 or 4 pressure ulcer 3) comfort care for terminally ill patients - reduces pain with movement 4) preference of patient unresponsive to other therapies 5) hourly measurement of urine volume required for treatment 6) acute urinary retention Contraindications: - bed-bound state - urinary incontinence not exacerbating wound - convenience Method: Size: 1) generally 16-18 french 2) 5-10 mL balloon inflated with sterile water 3) antimicrobial-covered catheters of no benefit in preventing catheter-associated urinary tract infection [6] Epidemiology: 1) 15-25% of hospitalized patients are catheterized for brief periods of time 2) 100,000 elderly nursing home patients may have long-term indwelling urinary catheters Laboratory: - routine urinalysis &/or urine culture not indicated - urinalysis with reflex urine culture only when signs/symptoms of urinary tract infection [9] Complications: 1) leakage: a) not uncommon - develops in most catheterized patients within 2-4 weeks of catheter insertion b) etiology - encrusted debris composed of mineral & bacterial complexes - urine builds up within the bladder due to obstructed drainage & leaks around the sides of the catheter 2) catheter-associated urinary tract infections - treat with narrow spectrum antibiotic [9] 3) genitourinary trauma [5] - creation of a false passage - prostatic catheter placement - intraperitoneal catheter placement - urethral meatal erosion or other penile trauma - gross hematuria - pain or discomfort - urinary urgency 4) other complications of long-term catherization - urinary calculi - urethritis - epididymitis - vesicoureteral reflux - chronic pyelonephritis - chronic tubulo-interstitial nephritis 5) increased mortality in hospitalized elderly catheterized for non medical reasons [3] Management: 1) assess need for continued use of catheter daily - remove catheter as soon as possible - scheduled toileting with monitoring of input & output as needed 2) routine irrigation is NOT indicated 3) antibiotic therapy lowers risk of UTI in catheterized patients [8] - greatest benefit in those catheterized for 3-14 days - chronically catheterized patients are often receiving antibiotics for other reasons [8] 4) antibiotic prophylaxis after catheter removal (ciprofloxaxin single dose) reduces incidence of symptomatic urinary tract infection (RR ~ 0.5); number needed to treat to prevent 1 symptomatic UTI = 17 [7] 5) antibiotic-coated catheters have no proven benefit [9] 6) catheter-associated asymptomatic bacteriuria does not require treatment [9] - no need to change indwelling urinary catheter for bacteriuria & pyruria 7) catheter-associated candiduria almost always represents colonization [9] 8) catheter-associated urinary tract infection requires catheter removal & replacement only if necessary [9]

Related

catheter-associated urinary tract infection (CAUTI) external condom catheter

Specific

Coudet catheter (Bardex catheter) Gouley catheter

General

urinary catheter

References

  1. UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
  2. UpToDate 11.1, 2002 http://www.uptodate.com
  3. Holroyd-Leduc JM, Sen S, Bertenthal D, Sands LP, Palmer RM, Kresevic DM, Covinsky KE, Seth Landefeld C. The relationship of indwelling urinary catheters to death, length of hospital stay, functional decline, and nursing home admission in hospitalized older medical patients. J Am Geriatr Soc. 2007 Feb;55(2):227-33. PMID: 17302659
  4. Thangavelu-Veluswamy A eMedicine (MedScape: Foley Catheter http://www.emedicinehealth.com/foley_catheter/article_em.htm
  5. Leuck A-M et al. Complications of Foley catheters - Is infection the greatest risk? J Urol 2012 May; 187:1662 PMID: 22425122
  6. Pickard R et al. Antimicrobial catheters for reduction of symptomatic urinary tract infection in adults requiring short-term catheterisation in hospital: A multicentre randomised controlled trial. Lancet 2012 Dec 1; 380:1927 PMID: 23134837 - Leone M. Prevention of CAUTI: Simple is beautiful. Lancet 2012 Dec 1; 380:189 PMID: 23134836
  7. Marschall J et al. Antibiotic prophylaxis for urinary tract infections after removal of urinary catheter: Meta-analysis. BMJ 2013 Jun 11; 346:f3147 PMID: 23757735
  8. Brusch JL, Bronze MS Medscape: Catheter-Related Urinary Tract Infection http://emedicine.medscape.com/article/2040035-overview
  9. Medical Knowledge Self Assessment Program (MKSAP) 17, 18, 19. American College of Physicians, Philadelphia 2015, 2018, 2021.
  10. Saint S et al. A multicenter study of patient-reported infectious and noninfectious complications associated with indwelling urethral catheters. JAMA Intern Med 2018 Aug; 178:1078 PMID: 29971436 Free PMC Article https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2686144
  11. MedlinePlus: Urinary catheters http://www.nlm.nih.gov/medlineplus/ency/article/003981.htm