indwelling urinary (foley) catheter
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Introduction
Most catheters are made of siliconized rubber.[1]
Epidemiology
- 15-25% of hospitalized patients are catheterized for brief periods of time
- 100,000 elderly nursing home patients may have long-term indwelling urinary catheters
Indications
- urinary retention that cannot be managed surgically or medically
- urinary incontinence exacerbating wounds
- stage 3 or 4 pressure ulcer
- comfort care for terminally ill patients
- reduces pain with movement
- preference of patient unresponsive to other therapies
- hourly measurement of urine volume required for treatment
- acute urinary retention
Contraindications
- bed-bound state
- urinary incontinence not exacerbating wound
- convenience
Laboratory
- routine urinalysis &/or urine culture not indicated
- urinalysis with reflex urine culture only when signs/symptoms of urinary tract infection [9]
Methods
Size:
- generally 16-18 french
- 5-10 mL balloon inflated with sterile water
- antimicrobial-covered catheters of no benefit in preventing catheter-associated urinary tract infection[6]
Complications
- leakage:
- catheter-associated urinary tract infections
- treat with narrow spectrum antibiotic[9]
- genitourinary trauma[5]
- other complications of long-term catherization
- increased mortality in hospitalized elderly catheterized for non medical reasons[3]
Management
- assess need for continued use of catheter daily
- remove catheter as soon as possible
- scheduled toileting with monitoring of input & output as needed
- remove catheter as soon as possible
- routine irrigation is NOT indicated
- irrigation is indicated only if the catheter is obstructed[11]
- 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]
- 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]
- antibiotic-coated catheters have no proven benefit[9]
- catheter-associated asymptomatic bacteriuria does not require treatment[9]
- no need to change indwelling urinary catheter for bacteriuria & pyruria
- catheter-associated candiduria almost always represents colonization[9]
- catheter-associated urinary tract infection requires catheter removal & replacement only if necessary[9]
More general terms
More specific terms
Additional terms
References
- ↑ Jump up to: 1.0 1.1 UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
- ↑ Jump up to: 2.0 2.1 UpToDate 11.1, 2002 http://www.uptodate.com
- ↑ Jump up to: 3.0 3.1 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: https://www.ncbi.nlm.nih.gov/pubmed/17302659
- ↑ Thangavelu-Veluswamy A eMedicine (MedScape: Foley Catheter http://www.emedicinehealth.com/foley_catheter/article_em.htm
- ↑ Jump up to: 5.0 5.1 Leuck A-M et al. Complications of Foley catheters - Is infection the greatest risk? J Urol 2012 May; 187:1662 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22425122
- ↑ Jump up to: 6.0 6.1 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: https://www.ncbi.nlm.nih.gov/pubmed/23134837
Leone M. Prevention of CAUTI: Simple is beautiful. Lancet 2012 Dec 1; 380:189 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23134836 - ↑ Jump up to: 7.0 7.1 Marschall J et al. Antibiotic prophylaxis for urinary tract infections after removal of urinary catheter: Meta-analysis. BMJ 2013 Jun 11; 346:f3147 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23757735
- ↑ Jump up to: 8.0 8.1 8.2 Brusch JL, Bronze MS Medscape: Catheter-Related Urinary Tract Infection http://emedicine.medscape.com/article/2040035-overview
- ↑ Jump up to: 9.0 9.1 9.2 9.3 9.4 9.5 9.6 9.7 Medical Knowledge Self Assessment Program (MKSAP) 17, 18, 19. American College of Physicians, Philadelphia 2015, 2018, 2021.
- ↑ 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: https://www.ncbi.nlm.nih.gov/pubmed/29971436 Free PMC Article https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2686144
- ↑ Jump up to: 11.0 11.1 Smith PW, Bennett G, Bradley S SHEA/APIC Guideline: Infection prevention and control in the long-term care facility. Am J Infect Control. 2008 Sep;36(7):504-35. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18786461 PMCID: PMC3375028 Free PMC article. Review. https://www.ajicjournal.org/article/S0196-6553(08)00604-4/fulltext
- ↑ MedlinePlus: Urinary catheters http://www.nlm.nih.gov/medlineplus/ency/article/003981.htm