The Foley catheter is a flexible straight tube made of latex or other material that is used to drain urine from the urinary bladder. The catheter is placed through the urethra into the bladder and fixed with a balloon that is inflated with sterile water or sometimes air. It is a type of permanent catheter.
These catheters or tubes were designed in 1930 by Dr. Frederick Foley when he was still a medical student. CR Bard Inc. of Murray Hill, New Jersey, made the first prototypes in 1934 and named them Foley after the surgeon.
Graphic representation of a Foley Catheter (Source: Olek Remesz (wiki-pl: Orem, commons: Orem) via Wikimedia Commons)
There are several types of Foley catheters: the classic two-way Foley catheter and the three-way Foley catheter. These probes are made of various materials such as silicone and Teflon, although initially they were made of latex. They come in different lengths and gauges.
Urinary catheterization can establish permanent, intermittent, or temporary urine drainage for therapeutic and / or diagnostic purposes. It is used in patients who are going to enter the operating room, in patients with severe incontinence, in prostate or urinary bladder interventions and in patients with bedsores in the genital area, among others.
The placement and maintenance of these tubes must be done with great care, on the one hand, to avoid injuries to the urinary tract or the bladder, but above all to avoid urinary infections that are one of the most important complications with chronic use of these probes.
What is it for
The Foley catheter is used to drain urine from the bladder, and in many conditions it is necessary to place the catheter. Among these, the following can be named:
- Patients who must enter the operating room to undergo any surgical intervention that requires general anesthesia.
- It is used in cases of obstructions of the urethra that generate urinary retention.
- In urinary tract surgeries to allow healing.
- In patients with urinary incontinence who present lesions in the urogenital or sacral area such as bedsores, dermatitis or ulcers that are difficult to handle, the probe is used to keep the area dry and be able to treat it.
- For the control of diuresis (measure urinary volume) in hospitalized patients, especially in patients hospitalized in intensive care units.
- They are also placed to collect sterile samples and introduce drugs for diagnostic or therapeutic purposes.
Placement
Properly trained and trained personnel must be available to place the probe. It can be a nurse, a technician or the treating doctor. Personnel must be experienced, know the technique and standards for probe placement and maintenance.
Sterile gauze and gloves, soap solution, sterile drapes, sterile probes of various gauges as needed, sterile closed-circuit collection bag, bag hanger, 10cc syringes, and ampoules of sterile distilled water should be available to inflate the balloon. You should also have a water-soluble urological lubricant to facilitate the insertion of the catheter.
The person who is going to place the probe should wash their hands with soap and water, put on non-sterile gloves and proceed to wash the entire genital area with soap solution and then rinse it with saline solution, dry it and discard the gloves.
Then, after washing hands with alcoholic solution, sterile gloves will be placed and the fields will be located. The probe and collecting system gasket is opened. The catheter and the urinary meatus are lubricated abundantly, the catheter is gently inserted without forcing so as not to injure the urethra and not create false pathways.
Once the urine begins to come out, the balloon is filled with 8 to 10 cc of distilled water. The catheter is gently pulled to check fixation, the catheter is fixed on the inner thigh to avoid urethral traction and injury, and the bag is placed in its holder.
Handling of the probe, the connecting tubes and the bag must be done with strict aseptic standards. Once the procedure is finished, the remains of lubricant are removed from the genital area and all disposable material is discarded. Staff should wash their hands and follow hospital protocol.
Care
Daily hygiene care of the hands and the genital area should be extreme. Periodically, after cleaning, make small rotating movements of the probe to avoid adhesions. No forward or backward traction should be applied.
Local antiseptics should not be used or bladder washes unless indicated as in the case of hematuria (blood in the urine). The probes should be kept as short as possible.
The best care to avoid infection is to keep the system closed and it should only be opened to empty the collection bag or in absolutely necessary cases. The bag should be emptied every 8, 12 or 24 hours. The longer the period the better, to avoid unnecessary disconnections.
Types
Foley catheters are of two types: two-way and three-way. The two-way are the most used for hospitalized patients and for urinary retentions. The three-way are used in urinary tract, bladder and prostate surgeries, as they allow the extraction of small clots and wash off any blood that may accumulate, avoiding blockage of the tract.
Many other probes have been designed and manufactured from Foley catheters by modifying the shape of the tip, making them suitable for certain uses. For example, probes with an angled and pointed tip called Tiemann probes have been manufactured for use in patients with prostate problems in whom emptying is difficult.
Types of probing
Foley catheters can be used for various types of catheterization which, depending on their permanence, are classified as: permanent, short-term, long-term, and intermittent catheterization.
The Foley catheter is used for short and long term permanent catheters. Those of short duration are those that require times less than 30 days in hospitalized patients or with acute pathologies. Long-lasting ones are used for more than 30 days in cases of chronic urinary retention.
Intermittent soundings are those that are carried out several times a day for which one-way probes are generally used that do not require fixation.
Type of material
The probes were initially made of latex, however this material causes many allergies. For people allergic to latex, probes with a silicone cover are used; This type of catheter is used for bladder emptying in catheters of short duration, generally less than 15 days.
There are probes made entirely of silicone. The advantages of these probes are that they have thinner walls and have the same outer gauge of a latex probe, but a larger inner gauge, so they can be used thinner and have more tolerance. They are used for long-term probes and for patients who have a latex allergy.
Then there are the polyvinyl chloride probes called Nélaton probes. These are more rigid one-way probes that are used for intermittent drilling or self-catheterization.
Probe gauge
To refer to the caliber of a probe, the French Charriere scale (CH or Ch) is used, which is equivalent to 1/3 of a millimeter.
The gauges are selected according to the sex, age and characteristics of the patient. For adults, the sizes used range from number 8 to 30 and from 20 to 40 cm in length. The gauges most used in men are from 16 to 22 Ch. In women 14 and 16 Ch.
References
- Davidson, JB (1969). US Patent No. 3,434,869. Washington, DC: US Patent and Trademark Office.
- Hamilton, RJ, Jewett, MA, & Finelli, A. (2006). An efficient solution to the retained Foley catheter. Urology, 68 (5), 1109-1111.
- Jiménez Mayorga, Isabel; Soto Sánchez, María; Vergara Carrasco, Luisa; Cordero Morales, Jaime; Rubio Hidalgo, Leonor; Coll Carreño, Rosario et al. Bladder catheterization protocol. Lascasas Library, 2010; 6 (1). Available at www.index-f.com/lascasas/documentos/lc0509.php
- López, JFM (2011). TCAE in the intensive care unit. Editorial Vértice.
- Luz, GVA, Amine, MJL, del Carmen, L. Á. C., del Rosario, VPM, Anahí, SFM, Ytzeen, MCA, & Esperanza, FML (2011). Permanence of the Foley catheter associated with urinary infection and drug resistance. Infectious Diseases and Microbiology, 31 (4), 121-126.
- Rosenberg, P. (1987). US Patent No. 4,701,162. Washington, DC: US Patent and Trademark Office.