A foley catheter, which is used by people with urinary retention who cannot empty their bladder on their own, is a flexible tube placed into the bladder to allow urine to drain into a collection bag. They are typically used when other methods of drainage have been unsuccessful, such as intermittent catheterization, surgical procedures, or medicines to restore urine flow. Foley catheters may also be used in patients who are very ill as a means of keeping them clean and dry. While foley catheters are not appropriate everyone, they serve an important purpose for many patients with urinary issues. Today we will explain how foley catheters work, along with best practices for caring for foley catheters at home.
How Foley Catheters Work
Foley catheters are inserted into the bladder, either through the urethral opening or through a surgically created opening in the lower abdomen. Sterile lubricant is applied to the catheter to minimize discomfort and tissue trauma during insertion. Once the catheter is in the bladder, a small balloon at the tip of the catheter is inflated with sterile water to prevent the catheter from sliding out of the bladder. The catheter is then connected to a drainage bag, which is emptied as needed throughout the day.
In most situations, the catheter is replaced monthly. Removing the catheter is simple - the balloon is deflated, allowing the catheter to be gently pulled out of the bladder and thrown away. It is then replaced with a new catheter. Some people can change out their foley catheters themselves, others may need a caregiver to assist. If it is difficult for you or a caregiver to change out the catheter, your doctor can perform monthly catheter changes in their office or send a home health nurse to replace the catheter.
Foley Catheter Sizes
Foley catheters come in a variety of sizes. “French size” is the standard measurement size for Foley catheters. French size refers to the diameter of the catheter – i.e., how big around the tube is. Which French size is right for an individual is determined by the size of the urethra. Age, sex, and differences with individual anatomy determine the size of the urethra and subsequently the French size of the catheter. In general, men will use a 14-16 French size, women will use a 12-14 French size, and children will use 5-10 French size. However, it is important to discuss French size with your doctor. If the French size is too large for you, insertion may be painful and damage the tissues. If it is too small, you may experience urine leakage around the catheter. Urine leakage can also occur from other issues such as bladder spasms or UTI. If you experience urine leakage around the catheter, it is a good idea to have your doctor evaluate the cause of the leakage before increasing the catheter size.
Foley catheters also have different sizes of balloons to anchor them in place. Most foley catheters use a 5ml balloon. The way balloon sizing is written on the catheter packaging can be confusing – it will say the product has a 5ml balloon with instructions to inflate it with 10mls of water. Just know that the 5ml balloon is meant to hold 10mls of water, and that is how much you should put in it to inflate it to the correct size. There are larger sizes of balloons available, but these are typically only used in special situations. Speak to your doctor to determine the ideal French size and balloon size for your body.
Silicone or Latex?
Foley catheters come in two main types – silicone and latex. Silicone is clear in color, and latex is opaque. Silicone catheters and latex catheters are made from different materials. If you have a latex allergy, you will need to use a silicone catheter. Latex allergies are not uncommon and there is evidence that long-term exposure to latex products increases the likelihood of developing a latex allergy. If you suspect a latex allergy or are concerned about latex exposure, make sure your doctor is aware of this when he or she orders you catheters so you can get non-latex supplies. If you have a latex allergy, always check your products to ensure they are latex-free, especially if you are receiving your supply order for the first time. Medical products are labeled with “Contains Latex” or “Latex free” on the packaging.
Drainage Bags and Insertion Supplies
Foley catheters require a drainage bag with tubing. The tubing is attached to the end of the catheter to connect it to the drainage bag. The drainage bag has a spout at the bottom and urine is emptied out of the bag whenever it becomes full. There are two types of drainage bags – bedside drainage bags, which are larger, and leg bags, which are smaller and can be worn on the leg. Bedside drainage bags are good for overnight urine collection, as they typically hold between 1500-3000ml of urine. Leg bags typically hold between 500-1000ml of urine. The bag is held in place against the leg with elastic straps. There are both calf and thigh bag options available. In all leg bags, there is a tube at the top that connects to the foley catheter. This tube can be run up the pants leg, providing a discreet option for individuals on the go. All drainage bags should always be kept off the floor. Bags should also be hung below the level of the bladder to prevent urine from backing up in the tubing, as this can obstruct urine flow and increase the risk of infection.
Sterile gloves, antiseptic cleansing wipes, sterile drapes, and sterile lubricant are used for foley catheter insertion. The antiseptic cleansing wipe is used to clean the urethral opening prior to catheter insertion. The sterile drape is placed over the lap to provide a clean workspace for insertion, and gloves are worn to minimize the risk of accidental contamination of the catheter. Lubricant is very important to use when inserting the catheter into the body, as it protects the tissues from trauma and reduces discomfort during the insertion procedure. It is recommended to use a sterile, water-based medical lubricant for catheter insertion, as this is formulated for this purpose. Vaseline or similar products are not appropriate for catheter insertion and may increase your risk of infection or other complications.
Proper Insertion Technique
Wash your hands well with soap and warm water or use an alcohol-based hand sanitizer before getting started. Lay out all of your supplies on a sanitized work surface. You can open the packaging so the items are accessible but leave them in the packaging, as this is a clean surface. Open the lubricant and apply it to the catheter without touching the catheter. Fill the syringe with sterile water and attach to the catheter. Cleanse the urethral opening with the antiseptic wipe. Wash your hands again and put on sterile gloves. Pick up the catheter. Avoid touching the catheter to the body or any surfaces, and do not use the hand that holds the catheter to do anything else - this is your “clean” hand. Use the other hand to open the labia or hold the penis. You are now ready to insert.
Tense muscles can make catheter insertion a more challenging process. Therefore, try to take several deep breaths and relax your muscles before you insert the catheter. Focus especially on relaxing the muscles of the pelvic floor. When ready, gently insert the catheter into the urethral opening, upward at approximately 30-degree angle. Using slow, steady pressure until the tip of the catheter reaches the bladder. You will know you have reached the bladder once urine begins to flow through the catheter. Once the urine has started to flow, insert the catheter approximately one more inch to ensure the balloon is all the way inside the bladder. Slowly inflate the balloon. If there is any pain during balloon inflation, the catheter may not be far enough inside the bladder. Stop inflation, reposition the catheter, and try again.
If you have ongoing difficulties inserting the catheter, or experience pain during insertion, talk to your doctor. In some cases, people experience changes to the urethra or prostate that can make insertion of a traditional foley catheter difficult. In these cases, you may benefit from a foley catheter with a special tapered tip, known as a coude’ tip. Coude’ tip catheters are especially useful for men with enlarged prostates. If you believe you have an enlarged prostate, talk to your doctor about to see if coude’ tip catheters are appropriate for you.
Showering and Cleaning your Catheter
You can shower while you have your catheter in place. However, taking baths or submerging yourself in water is not recommended, as this may increase the risk of infections. You can clean your catheter while you’re in the shower. Using mild soap and water, clean your genital area. If you have a penis, pull back your foreskin if uncircumcised. If you have a vagina, separate the labia and clean the area from front to back. Start cleaning the catheter from where it enters your body and work your way down. This way, you are not pushing germs into your body but out away from your body. Rinse well. When done showering, use a clean towel to pat the genital and catheter area dry.
Cleaning and Changing Out Your Drainage Bags
Many people keep several drainage bags on hand so they can be switched out and cleaned. To change to a different drainage bag, pinch off the catheter with your fingers to stop urine flow and disconnect the used bag. Wipe the end of the catheter with an alcohol pad. Wipe the connector on the new bag with another alcohol pad and connect the clean bag to the catheter.
You will want to properly clean your used bag. This will help reduce urine odor. Consider purchasing a condiment style squeeze bottle for bag cleaning. This bottle should be filled with a cleaning solution. You can make your own cleaning solution by mixing 2 parts water to 1 part white vinegar, or 10% bleach to 90% water. Use the bottle to squirt the cleaning solution into the bag tubing and bag. Let the cleaning solution sit in the bag for a few minutes before draining. After draining, hang the bag over the shower rod to dry.
Recognizing and Preventing Complications
Urethral trauma, bladder stones, and urinary tract infection are some of the most common complications associated with foley catheters. Urethral trauma can occur when the catheter is pulled, causing injury to the surrounding tissues. Sometimes these injuries can be severe. People with reduced sensation to the genital area (e.g., individuals with a spinal cord injury) are more likely to experience urethral trauma from foley catheters, as they cannot always tell when the catheter is being pulled. Using a securing device can prevent urethral trauma. A securing device is attached to the skin with an adhesive and contains a plastic clip that holds the catheter. That way, if the tubing catches on something, the securing device protects the catheter from being pulled. Place the securing device on the thigh or lower abdomen for best results.
Urinary tract infections (UTI) are more common in foley catheter users. Virtually all long-term foley catheter users will have bacteria in their urinary tracts. This is because the catheter allows bacteria from the outside world to enter the bladder. So, while we cannot prevent the bacteria from getting inside, we can reduce the risk of serious infection. One of the best ways to do that is by staying hydrated. By consuming enough fluids, you will wash the bacteria out of your bladder, reducing chances of bacteria “setting up shop” in your tissues. Try to drink 1-2 glasses of water every hour while you are awake unless your doctor has placed you on fluid restriction. Identifying the signs of urinary tract infection is important, as you will want to seek medical treatment right away to prevent the infection from getting worse and harming the kidneys or other organs. Symptoms of UTI include fever paired with other physical symptoms such as malaise, changes in mental status, urinary frequency, increased bladder spasms, foul-smelling or cloudy urine, or abdominal and flank pain. If you have these symptoms, seek medical care right away. You may need antibiotics to stop the infection.
Stones are another complication to be aware of. If your catheter frequently becomes blocked by hard mineralized deposits, known as encrustations, you may be at increased risk of stone development. Sometimes people with bladder or kidney stones can have more frequent UTI. Drinking enough fluids can reduce the risk of stones, as a steady flow of urine will flush sediment out of the bladder. If you have ongoing problems with catheter blockages or encrustations, talk to your doctor. There may be additional treatments that can help reduce your risk of stone formation.
The Importance of a Medical Supplier
Foley catheters are a specialized medical device where accuracy matters. You need the correct size and type with all the accessory products in a timely manner for the best results.
A quality medical supply company that specializes in catheters is an important ally in keeping up with your routine. ABC Medical will work with your doctor’s office to obtain the necessary documentation so your order is accurate. Their team of insurance specialists will help ensure maximum insurance coverage of the products you need. Your products will be shipped quickly and discreetly to your door, minimizing the inconvenience of having to try to find someone who carries these specialized medical devices in your area. In addition to this, ABC Medical has nurses and specialists available to help you understand your products and troubleshoot with you over the phone if you are having problems. They can also send free samples of different catheter types so you can find the ideal catheter supplies that work for you. To learn more about these services, please visit our website or call ABC Medical today.
Disclaimer: This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. For medical advice, please speak with your healthcare provider.
References
Madigan E, Neff DF. Care of patients with long-term indwelling urinary catheters. https://pubmed.ncbi.nlm.nih.gov/14656194/ Online J Issues Nurs. 2003;8(3):7.
Newman DK. The indwelling urinary catheter: principles for best practice. J Wound Ostomy Continence https://pubmed.ncbi.nlm.nih.gov/18030105/ Nurs. 2007;34(6):655-663. doi:10.1097/01.WON.0000299816.82983.4a
