Foleys catheter

A short PPT Presentation for Medical Students (Undergraduate & Post Graduate) appearing for Obstetrics & Gynecology Pratical Exams.

1. Foley’s Catheter. OBGYN Practical Exam View Point. Dr. D evdatta Dabholkar . MBBS, DGO, DNB (OBGYN) DR. Manasi Dabholkar . MBBS; DGO; DMRE. Tathastu Women’s Hospital. Sector 14; Kalamboli; MH – 410218.

2. Opening Statement. “ This is a No 16 self retaining double lumen Foley’s Catheter made of latex rubber in a gamma irradiated double pack with balloon capacity of 50 mls ”

3. Vital Stats of Catheter. Material: Latex, polythene & silicone. Most standard Foleys are of 40 cms . Thinnest is 12 F & thickest is 30 F. Foleys used for Cesarean is 14 or 16 F. F represents circumference. F / 3 gives external diameter in mm. Capacity of Balloon is 50 ml.

4. Parts of Foley’s Catheter.

5. MOA of Foley’s Catheter.

6. Types of Foley’s Catheter.

7. Color Code.

8. Female Urethral Catheterization. Flexible tube is inserted into bladder via urethra so that urine can be drained freely from bladder for collection. Indications: treatment of acute urinary retention. preoperative bladder emptying. monitoring of urine output.

9. Steps of Catheterization. Four steps; explanation & consent, preparation, procedure & after-care. Procedure is different in men & women – due to difference in pelvic anatomy. Catheter size is selected according to size of urethral meatus.

10. Counseling & Consent. Confirm patients identification Explain rationale for procedure Ask about relevant past medical history Previous urethral trauma, urethral strictures, or lower urinary tract surgery Blood clotting disorders or medication that affects blood clotting ( warfarin ) Recent haematuria , urethral discharge, or urinary tract infection

11. Explain Procedure Risks. Inability to pass catheter into bladder Trauma to urethra or bladder neck Infection (rare) Para- phimosis (Males) Bladder spasm (due to presence of catheter balloon)

12. Catheterization Tray. Pre Sterilized Catheter & Uri sac. Sterile 2 % Lignocaine Gel. 100 ml NS & Packed 10 ml Sterile Syringe. Chlorhexidine Wipes / Betadine - Savlon . Sterile Forceps (to push catheter in). 2 pairs sterile gloves & 1 Surgical Drape. Sterile Kidney Tray. Sterile swabs & Cotton Pads.

13. Pre Procedure Preparation. Patient should wash her genitals before hand. Choose correct catheter size - based upon gender, time of insertion & allergies to latex. Catheter size should be smallest as possible Expose patient from the waist down Throughout procedure maintain dignity of patient. Prepare your sterile trolley next to patient’s beds. Ensure proper Illumination (Adjust Light) Procedure is done in Dorsal Lithotomy Position.

14. Procedure of Catheterization. Pre procedure wash & sterile gloves. Sterile drape is placed below buttocks. Use sterile cotton pads for disinfection. Clean perineum with savalon & betadine . Then separate labia with left hand. Clean - front to back & outside to inside. Inject 5ml of 2% Lignocaine Gel in Urethra. Maintain strict asepsis throughout.

15. Procedure of Catheterization. Ask assistant to open catheter & fill syringe. Place Kidney tray between patients legs. Catheter should be opened such that only catheter tip is exposed. Without touching catheter directly, insert the catheter along urethra into bladder If any resistance is felt, ask patient to cough to ease insertion Once urine begins to flow, advance the catheter a further 5cm Inject contents of syringe into catheter to inflate the balloon in the catheter

16. Procedure of Catheterization. Monitor Patient for any discomfort. Give gentle traction on catheter to ensure that it is self retaining. Make sure that catheter is properly fitting the uri sac (use extra sticking if need be) Attach Uri sac to bed or stand ensuring that there is no pull or stretch on catheter. Discard all waste in proper containers. Remove gloves & wash hands.

17. Inflating Foley’s Balloon. Capacity of Balloon is 30 – 50 cc. In Conscious patient Balloon is inflated only 10-15 cc as more inflation can cause pressure on rectum giving a constant urge to defecate. Most commonly Normal Saline or Distilled water may be used to inflate balloon.

18. Inflation of Foley’s Balloon. NS: may precipitate in hot climate. Air: irritates bladder & cause cystitis. Embolism? Dextrose: Media for Bacteria growth. Tap Water: contamination. May block catheter. Distilled Water: makes balloon heavy so it does not float. If Rupture no infection.

19. Post Procedure Instructions. Do not pull the catheter. Inform Nursing Staff if pain or desire to urinate. Inform if Catheter comes out by itself. She can walk with Uri sac in hand (If Fit) In prolonged catheterization wash perineum & catheter with soap water at least once a day. Clean catheter away from urethra Catheter removal is not patients job.

20. Post Procedure Notes. Always write notes post procedure. Mention size of catheter. Mention that procedure was done under strict aseptic precautions. Mention that procedure was uneventful & well tolerated. No antibiotics after catheterization. Catheter is changed every 5-7 days Urine R&M is sent before each change .

21. Bladder Wash. If Foley’s is kept for more than 3 days bladder wash is given using mixture of equal amounts of KMnO4 & Betadine (in Normal Saline. If this is anticipated then three lumen Foley’s Cather’s are used. Bladder wash can also be given by attaching simple catheter to 50 cc sterile syringe

22. Bladder Training. This is small precautionary procedure done before removal of catheter whenever catheter is left in situ for more than 72 hours. Foleys Catheter (Not Uri sac Tube) is clamped for 2 hours & released for 10 minutes for 24 hours before removal. Urologist do not advocate this Gynecologist do it as a ritual.

23. Removal of Foley’s. Counsel & Perineal Toileting. Deflate balloon slowly with Sterile Syringe. Ideally allow Catheter to come out slowly by weight of urine in uri sac. Gentle traction can be given. Cut tip is send for C&S if prolonged catheter. If Foleys does not come out push it inside & inflate balloon with NS / distilled water to dislodge any debris. If still Foleys does not come out call for help.

24. Complications of Catheterization. False Passage (Blood at meatus) 4 % risk of UTI. Catheter Fever. Urethral Stricture. (Prolonged) Reflex Anuria . (Rare)

25. Management of Retained Foley’s Cut Foleys from valve onwards so that block can be bypassed. Flush side channel with Soda bicarb as it dissolves organic material. Ureteric Stent / Catheter can be passed to straighten urethra. ~ 2 cc Ether can be injected in side channel ruptures the balloon. Supra pubic Puncture can be done under USG Guidance using Spinal Needle on Full Bladder

26. Removal Retained Catheter.

27. Period of Catheterization. VH + Anterior Repair: 3 – 5 days. Kelly’s Stitch (SUI): 14 days. Bladder Repair: 7 days. Wertheim’s Hysterectomy: 10 days. VVF Repair: 21 days

28. Uses of Catheter. Therapeutic: Urinary Retention. Bladder Wash. Monitor Urinary Output. Diagnostic: To differentiate anuria from retention. In UTI to collect Bladder (Catheter ) Sample. Retrograde Urethrograms (Males)

29. Non Urological Uses of Catheter. Tourniquet (Drawing Blood Samples). II Trimester MTP (Extra Amniotic). Diagnosis of Cervical Incompetence(16 F) Sono Salpingoraphy (8 or 10 F). Atonic PPH ( Shivkar’s Pack) Anterior Cord Prolapse (Retrograde Bladder Filling) Bleeding from Laparoscopy Port. Myomectomy (Rubin’s Method) After Hysteroscopic Adhesiolysis . (Prevention of Ashermann’s ) To control bleeding after TCRE.

30. Post Surgery Low Output ? It is commonest cause of low output if Bladder is abdominally palpable (full). Obstructed Foleys Catheter is rare cause of Low Urine Output After Surgery. Never the less Foleys Catheter should be checked for proper placement or leakage (balloon not filled properly) in all cases of Low Urine Output post surgery.

31. Post Catheter Removal Retention. Art of Counseling is put to test. Reassure woman as anxiety is common. Take her to washroom & encourage to micturate. “Sound of Running Water” may act as trigger. Hot water bags can be given. Local perineal examination can be done to rule out local inflammation. Re- catheterization should be last option. Drinking excessive fluid does not relieve retention

32. Shifting Patient with Catheter. Many a times patient needs to be shifted to higher center which can be a long ride; patient may be semi conscious or comatose; due to work load doctor may or may not accompany. In such cases it is safer approach to fix the catheter & uri sac tube to inner lateral aspect of thigh so there is no relative moment of catheter in & out off bladder.

33. Clinical Tips. Foleys is one time use item. Macleot’s Catheter: is another self retaining catheter. It was used initially for supra pubic drainage. Not used now a days as Foleys is avaliable . Silicon catheters to be used if catheterization is prolonged (> 4 weeks)

34. Clinical Tip. Hematuria Vs Blood From Urethra …. to catheterize or not…. Hematuria is blood stained urine (frank red color) it implicates that pathology is (mostly) in bladder & not urethra. Frank Bleeding from Urethral meatus or injury in Perineal area denotes probable urethral injury & urethral catheterization is better avoided in these cases. Supra pubic catherization is a safer option. Concentrated urine is dark yellow to orange colored urine & denotes hypovolemia can catheterize if indicated

35. Thanks! Tathastu Women’s Hospital. Plot 19 A; Sector 14; Kalamboli. Navi Mumbai. MH 410218. Email: [email protected] Phone: 022 – 2742 - 0400 / 0800. Mobile: + 91 – 96194 83093 .