HWN Suggests

Why You Should Stop Overusing Foley Catheters

Think of it – how many patients come in and get put on a monitor, have an IV started and get supplemental oxygen? Tens of thousands of patients daily. Yet, in many cases each of these procedures is unnecessary and unindicated...

The literature indicates that many Foley catheters started in the hospital are avoidable and that the emergency department has the dubious honor of being the place where most of these unnecessary catheters are ordered. There are a number of papers affirming this practice and encouraging the implementation of validated policies that can reduce the placement of unindicated catheters. Hospitals are especially interested in in this issue as catheters are often…

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  Complex Urethral Catheter Management

Insertion 18F Coudé catheter...

  Tips for Successful Urinary Catheter Placement

Placing a foley catheter in a patient with BPH or acute urinary retention can be very difficult at times. Here are some tips to increase your chance of a successful placement.

 How many uses of a urinary catheter can you think of?

Urinary catheters are versatile things, that can be useful in a variety of situations. How many uses of a urinary catheter can you think of (medical only please, not recreational)? We have thought of 6, but reckon there are more so we need your help to expand the list. Please comment if you can think of a use.

 Ins and outs of urinary catheters

There is evidence that IDCs are often used when not indicated and improperly managed when inserted. IDCs can cause significant morbidity, prolong hospital stay and increase healthcare costs. Infection and traumatic insertion are common complications; advances in catheter design have helped to limit these complications.

Articles of Interest

Avoid Foley Catheters to Improve ED Patients’ Comfort, Reduce Costs

Prevent overuse of Foleys in the ED by knowing which patients do—and don’t—need them and working with the care team to follow best practices.

Back to Basics Urinary Catheterization

Catheterization is the most common way to empty urine from your bladder after a spinal cord injury. Unfortunately, it is also a common source of infection. Although you may be performing intermittent catheterization or have an indwelling catheter and using the best technique, it is important to review how and what you are doing periodically.

Catheter Conundrum: Reducing Unnecessary Placement

Catheters are commonly placed when patients are admitted through the emergency department, but in many cases those catheters are unwarranted.

Chapter 142. Urethral Catheterization

Although this is one of the more routinely performed procedures in the Emergency Department, great care must be taken to avoid lower urinary tract injury, reduce the introduction of infection, and minimize patient discomfort. The basic principles underlying urethral catheterization are gender-neutral...

Current Trends in the Management of Difficult Urinary Catheterizations

Complicated urinary catheterization is a commonly encountered medical problem, the frequency of which is difficult to estimate.

Difficult Foley Catheterization

A difficult catheterization can be anticipated and properly addressed with a better understanding of patient-reported symptoms and a detailed genitourinary review of systems and physical examination.

Foley Catheter Patients: Common ED Presentations / Management / Pearls & Pitfalls

Do NOT remove a Foley catheter from a recent post-operative patient without contacting your friendly urologist first.

Insertion of an Indwelling Urethral Catheter in the Adult Male

If you are not able to pass the catheter because of resistance, stop the procedure, consider using a Coudé-tip catheter. If still unable to pass with a Coudé-tip catheter, notify the prescribing provider.

International Emergency Medicine Education Project

For difficult urinary catheterization, change the size: 20-24 F catheter for benign prostate hyperplasia, small caliber for the urethral stricture (12-16 F). If catheterization is unsuccessful, it is best to avoid multiple blind attempts since they increase the risk of infection, exacerbate the patient’s discomfort, and produce urethral congestion and edema, rendering further attempts even more challenging.

Male Catheterisation – OSCE Guide

This male catheterisation guide provides a step-by-step approach to performing catheterisation in an OSCE setting, with an included video demonstration.

Male Urological Issues part 2 – Urethral Catheterisation

Here’s part two of our urological problems in men blog – focussing on catheterisation and problems associated with it.

My Foley Balloon Won’t Deflate!

Sometimes when it's time to remove a Foley catheter, the balloon won't deflate. This problem occurs more commonly in patients with long-term Foley catheters. Even though we have all seen nursing home patients present with penile bleeding after pulling out their Foley catheter with the balloon still inflated, that is obviously not an option for emergency physicians. The problem is that the recalcitrant balloon is sitting out of reach, deep in the urinary bladder

The Challenge of Difficult Catheterization in Men: A Novel Technique and Review of the Literature

Male bladder transurethral catheterization can be difficult and is still a familiar problem for urologists. It can be a challenge involving a urethral stricture, false passages as a result of previous unfruitful attempts at catheterization, prostate cancer, bladder neck contractures following transurethral resection of the prostate, and obliterated anastomosis following a radical prostatectomy.

Ultimate Guide to the Different Types of Urinary Catheters

Typically, catheters are made from silicone, latex, or a combination of the two.

Unseen Perils of Urinary Catheters

An IUC has been associated with a greater risk of death—four times higher during hospitalization and two times higher within 90 days after discharge. Inappropriate IUC use has been equated to a one-point restraint, because like restraints, catheters can cause functional impairment leading to emboli, discomfort, and pressure ulcers.

Urinary Catheter Placement

Urinary catheter insertions is a common procedure in the ED. They may be external (condom) or indwelling (urethral, suprapubic). Condom catheters are indicated in men with functional disabilities such as restricted mobility or dementia with incontinence, who can void spontaneously. Suprapubic catheters are an option if urethral catheters fail.

Urinary Catheterisation

Choose the smallest catheter that will allow adequate urinary drainage. Size 12–14F is usually adequate for males and females. Use size 16–20F if the patient has urine with debris, mucous, blood clots or haematuria, which may occlude smaller lumens. A 22F triple lumen is the standard size for bladder irrigation and ‘washout’. Smaller sizes (6–10F) are available for children.

Urinary catheters

Obstruction at prostatic urethra may be due to external sphincter spasm: try 2nd dose of lubricant and milk down urethra, try gentle sustained pressure with catheter try 16F silastic...

Resources

International Emergency Medicine Education Project

For difficult urinary catheterization, change the size: 20-24 F catheter for benign prostate hyperplasia, small caliber for the urethral stricture (12-16 F). If catheterization is unsuccessful, it is best to avoid multiple blind attempts since they increase the risk of infection, exacerbate the patient’s discomfort, and produce urethral congestion and edema, rendering further attempts even more challenging.