Urinary catheter (IDC or Foley)

OVERVIEW

  • urinary catheter
  • aka Foley catheter
  • aka IDC or indwelling catheter

INDICATIONS

Bladder insertion

  • urinary retention
  • urine output measurement
  • clot retention and bladder irrigation
  • bed bound or comatose patients
  • post-operative e.g. prostate surgery
  • therapeutic, e.g. clot removal
  • urinary incontinence
  • urine specimen collection

Other sites

  • insertion in wound for balloon tamponade of bleeding vessel
  • nasal insertion for posterior epistaxis

CONTRA-INDICATIONS

  • recent prostate surgery (consult urologist)
  • suspected urethral injury (controversial)
  • patient refusal

DESCRIPTION

  • flexible tube with central lumen that allows urine to flow from the bladder
  • second lumen allows inflation of balloon to secure catheter in position

Types

  • Foley = silastic or rubber, size 12 Fr to 24 Fr, usually use 14-16 Fr
  • Others (PVC)
    — Tiemans – prostate surgery
    — Nellertons – ureteric catheterisation
    — Whistletip – removal of clots
  • 3-way catheter (22 Fr) has a third lumen allowing bladder irrigation

METHOD OF INSERTION/ USE

COMPLICATIONS

Insertion

  • malposition
  • trauma – false passage, urethral stricture (delayed), hemorrhage, balloon inflation in urethra
  • pain
  • failure (e.g. meatal, urethral or prostatic stricture – may require SPC or dilation)

When in situ

  • infection – 100% colonised at 1 week, 5% risk of septic complication per day, 8% bacteremia, 1-3% UTI
  • paraphimosis
  • bladder irritation and erosion
  • hemorrhage post-decompression (if >1 litre bladder)
  • concretion formation

Removal

  • traumatic removal (e.g. balloon not deflated, concretions)
  • unable to remove (e.g. balloon won’t deflate, concretions)

OTHER INFORMATION

  • administer antibiotics prior to IDC insertion if infection suspected
  • review ongoing need for IDC daily and monitor for infection[

References and Links


CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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