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Appropriate Foley Catheter Use

In the past, it was mainly acute and chronically ill patients in all types of medical setups that had Foley urinary catheters inserted. Today, long-term use of Foley catheters has increased becoming more common in patients’ homes with aid from a health professional and also in a number of medical facilities with high elderly populations.

The aging of baby boomers has led perhaps to too many Foley catheters being placed at home. Although there should be solid reasons justifying Foley catheterizations, there seems to be countless instances where a less compromising alternative should have been the option.

The numbers of those using Foley catheters because of urinary incontinence and urinary retention are not clear, but the unwarranted use to deal with incontinence is on the rise.

As many as 1 in 5 cases of urinary catheter use in health facilities have no clear medical indication and in most instances the primary physician doesn’t know about them. Currently there is an effort to educate clinicians on the need to use urinary catheters when absolutely necessary and for the shortest time possible. This includes adopting other non-invasive ways of assessing bladder functionality.

Reasons to use a Foley catheter:

To be considered after other alternatives of urinary retention or incontinence management have been evaluated and found inappropriate. Catheter insertion should only be done when there is proof that the bladder has retained urine. Incontinence should be managed with a condom in all compliant men without urinary retention.

  • Urine retention.
  • Urine outlet blockage.
  • In sacral wound management in patients with urine incontinence.
  • In terminal conditions such as coma and end stage disease.
  • In strictly immobilized patients.

Intra-operative catheterization needs:

  • Urological or other procedures in enclosed environments.
  • Long duration surgeries.
  • Intra-operative use of high volumes of intravenous fluids or diuretics.
  • As a means of maintaining intra-operative input/output fluid chart.

Other medical needs:

  • To gauge fluid intake and output.
  • To deal with sudden and total urine retention.
  • To quickly decompress the bladder.

Due to urinary blockage which can follow:

  • Hypertrophied prostate.
  • Urethral narrowing (stricture).
  • Prolapsed pelvic organ.
  • Failure of intermittent catheterization due to chronic urine outlet obstruction.
  • Surgery on the urinary tract.

Other instances include:

  • Advanced cases of pressure sores following chronic urine leakage.
  • Absence of continuous urinary incontinence care.

Use of Foley catheters in acute care:

Surgery, monitoring of input/output fluid charts and retention are some of the reasons hospital take the lead in catheterization cases. These remain in place for only 2-4 days in an effort to reduce the incidence of bacteriuria (bacteria in the urine). Elderly patients who have to retain a catheter and are discharged to a nursing facility have a higher rate of re-hospitalization due to catheter associated urinary tract infections. Mortality within 30 days of discharge is also higher among these patients in comparison with those who had their catheters removed before discharge. Chances of infection are determined by the following:

  • Catheterization duration.
  • Immune status of the patient.
  • How well the catheter is managed.

Some cases of bacteriuria can remain symptomless but others become serious enough to complicate health and quality of life.

Facts about long-term Foley catheter use

  • Incidence in nursing homes is about 7%.
  • Facilities with poor urinary incontinence management use it as way to maintain patient dryness and dignity.
  • Urinary tract infections account for up to 40% of cases in nursing homes.
  • 80% of UTIs in nursing homes are catheter associated.

Long-term catheter use in urinary incontinence is mostly due to presence of pressure sores.