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A Foley catheter is a flexible tube that is passed through the urethra and into the bladder. The tube has two separated channels, or lumens, running down its length. One lumen is open at both ends, and allows urine to drain out into a collection bag. The other lumen has a valve on the outside end and connects to a balloon at the tip; the balloon is inflated with sterile saline when it lies inside the bladder, in order to stop it from slipping out. Foley catheters are commonly made from silicone rubber or natural rubber.
The name comes from the designer, Frederic Foley, a surgeon working in Boston, Massachusetts in the 1930s.[1] His original design was adopted by C. R. Bard, Inc. of Murray Hill, New Jersey, who manufactured the first prototypes and named them in honor of the surgeon.
The relative size of a Foley catheter is described using French units(F).The most common sizes are 10 F to 28 F. 1 F is equivalent to 0.33 mm = .013" = 1/77" of diameter. Thus the size in French units is roughly equal to the circumference of the catheter in millimetres. • Side view diagram of a three-way Foley catheter, in place for bladder irrigation and drainage. The balloon near the tip holds the catheter in place.
Foley catheters come in several sub-types: "Coudé" (French for elbowed) catheters have a 45° bend at the tip to allow easier passage through an enlarged prostate. "Council tip" catheters have a small hole at the tip which allows them to be passed over a wire. "Three way" or "triple lumen" catheters have a third channel, which is used to infuse sterile saline or another irrigating solution. These are used primarily after surgery on the bladder or prostate, to wash away blood and blood clots.
A Foley catheter can also be used to "ripen" the cervix, to allow the induction of labour. The balloon is inserted behind the cervical wall and inflated. The remaining length of the catheter is pulled slightly taut, and taped to the inside of the woman's leg. The inflated balloon applies pressure to the cervix, as the baby's head would prior to labour, causing it to dilate. As the cervix dilates over time, the catheter is readjusted to again be slightly taut, and re-taped to maintain pressure on the cervix. When the cervix has dilated sufficiently, the catheter simply drops out.[3]
A major problem with Foley catheters is that they have a tendency to contribute to urinary tract infections (UTI). This occurs because bacteria can travel up the catheters to the bladder where the urine can become infected. To combat this, the industry is moving to antiseptic coated catheters. This has been helpful, but it has not completely solved this major problem. An additional problem is that Foley catheters tend to become coated over time with a biofilm that can obstruct the drainage. This increases the amount of stagnant urine left in the bladder, which further contributes to the problem of urinary tract infections. When a Foley catheter becomes clogged, it must be flushed or replaced.
When Foley catheters are used Foley catheters are used during the following situations: • On patients who are anesthesized or sedated for surgery or other medical care • On comatose patients • On some incontinent patients • On patients whose prostate is enlarged to the point that urine flow from the bladder is cut off. The catheter is kept in until the problem is resolved. • On patients with acute urinary retention. • On patients who are unable due to paralysis or physical injury to use either standard toilet facilities or urinals. • Following urethral surgeries • Following ureterectomy • To ripen the cervix during induction of labor • On patients with kidney disease whose urine output must be constantly and accurately measured
Risks There are several risks when using a Foley catheter (or catheters generally), including: • The balloon can break while the catheter is being inserted. In this case, the doctor will remove all the balloon fragments. • The balloon might not inflate after it is in place. Usually the doctor will check the balloon inflation before inserting the catheter into the urethra. If the balloon still does not inflate after its placement into the bladder, the doctor will then insert another Foley catheter. • Urine stops flowing into the bag. The doctor will check for correct positioning of the catheter and bag or for obstruction of urine flow within the catheter tube. • Urine flow is blocked. The doctor will have to change the bag or the Foley catheter or both. • The urethra begins to bleed. The doctor will have to monitor the bleeding. • Introduction of an infection into the bladder. The risk of infection in the bladder or urinary tract increases with the number of days the catheter is in place.
Caution • If the balloon is opened before the Foley catheter is completely inserted into the bladder, bleeding, damage and even rupture of the urethra can occur. In some individuals, long-term permanent scarring and strictures of the urethra could occur.
During the Procedure • Urinary catheterization kits are sterile. They contain a Foley catheter, water-soluble lubricant jelly, a 10cc syringe with sterile water for the Foley balloon, a sterile drainage bag with sample port and tubing, sterile drapes, sterile gloves, iodine, sterile gauze, sterile specimen cup, and forceps.
Female catheterization: The female urethra is short compared to the male urethra. It is located above the vagina in the pelvis. Insertion of the catheter is facilitated by having you lie down on your back with your buttocks at the edge of the examination table. Adequate exposure of the urethra is obtained by elevating and supporting your legs by stirrups or placing them in a frog-legged position. Finally, the labia are separated to expose the urethra. • Male catheterization: The male urethra is long compared to the female urethra. A catheter is placed while lying down or in the frog-legged position. If there is a foreskin, it is retracted to its maximal limit.
The doctor or medical assistant will insert the Foley catheter in this manner: • The urethra and the surrounding areas are cleaned with a cotton-ball dipped in antiseptic solution. Beginning at the urethra, the cleansing is performed in a circular motion, moving outward to the surrounding areas. • A Foley catheter, lubricated with water-soluble jelly, is inserted into the bladder through the urethra. • Once the catheter is passed, the balloon is in the bladder. It is then slowly inflated with about 10cc of water using a syringe. Inflating the balloon should not be painful. • At this time, urine, if present in the bladder, should flow back through the catheter and into the sterile drainage bag.
Drainage bag • While at the hospital, the urinary drainage bag will be hung to the bedside rail by a hook on the bag. • If you need to be discharged from the hospital and sent home wearing the Foley catheter, the drainage bag will be replaced with a portable drainage bag (leg bag). Adhesive tape will be used to hold the bag to the calf area. • Removal of the catheter and bag
The catheter balloon is deflated by inserting a syringe into the catheter valve and pulling back on the syringe. • The pressure in the balloon will cause the water to flow into the syringe. • Once the balloon is empty, the Foley catheter can be pulled out.
