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 – Urinary catheterisation
- CCC – Foley catheter balloon tamponade
- Eponymythology – Frederic Eugene Basil Foley (1891-1966)
- Clinical Case – A Problem with Plumbing
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC