Foley Catheters Placement and How They Work

A Foley catheter is a flexible tube that is inserted through the urethra to help drain urine from the bladder. It is a type of indwelling catheter, meaning one that is kept in place so that urine is continuously drained from the bladder.

A Foley catheter is typically inserted by a healthcare provider before surgery or to treat certain people with urinary incontinence or the inability to pee. Once the catheter is placed, extreme care is needed to avoid a urinary tract infection (UTI).

This article explains what Foley catheters are and what they are used for. It also describes how they are inserted and cared for, including the possible risks and complications.

What Is a Foley Catheter?

The Foley catheter is a thin tube inserted into the urethra (the tube through which urine exits the body) in order to drain urine from the bladder (the organ that collects and stores urine from the kidneys).

It is a type of indwelling catheter that is kept in place longer than an intermittent catheter (which is used and removed once the bladder is emptied). After insertion, a Foley catheter is intended to remain in place for several hours or longer.

A Foley catheter consists of two separate channels (called lumens) running down the entire length of the tube:

• The first lumen opens at both ends and drains urine into a collection bag.
• The second lumen has a valve on the outside and a balloon on the inside which is inflated to hold the catheter securely in place.

There are also triple-lumen catheters that have a third channel used to push sterile fluids into the bladder to flush out blood and blood clots after urinary tract surgery.

Foley catheters can also vary by their size, measured in millimeters (mm). In clinical practice, the color of the catheter describes its size:

Different coatings are also applied to the catheter which can extend its use. Some coatings enable use for up to 28 days, while others may enable use for up to three months.

Purposes of a Foley Catheter

A Foley catheter has specific uses. This includes certain types of surgery, conditions that cause severe urinary retention (the inability to pee), or cases of severe incontinence that cannot be controlled by other means. It is also sometimes used for diagnostic purposes or during the delivery of a baby.

Foley catheters are not used for the general treatment of incontinence.

A Foley catheter may be used for:

• People who are anesthetized for surgery (as anesthesia can affect bladder control)
• Urethral or bladder surgery (to decrease the risk of postoperative urinary retention)
• People with acute or chronic urinary retention (caused by an enlarged prostate, pelvic organ prolapse, kidney stones, genital injury, or other causes)
• Paralyzed people or those with spinal cord injuries who cannot control their bladders
• Severe neurogenic bladder (incontinence caused by nervous system problems)
• Comatose people
• People with end-stage kidney disease whose urine output must be constantly measured
• Induced pregnancy (during which the balloon is inflated behind the cervix to widen it)
• Cesarean section (to prevent bladder injury and postoperative urinary retention)
• Hysterectomy (to make the surgical area more visible and avoid postoperative urinary retention)
• People near the end of their lives

How a Foley Is Inserted

Foley catheters are commonly placed before surgery to keep the bladder empty during and after the procedure (typically after the person is anesthetized). In non-surgical situations, they are placed by a healthcare provider after a numbing gel is applied.

Irrespective of the situation, the process of catheterization more or less follows the same steps:

1. The genital area is cleaned with an antiseptic to prevent infection.
2. A numbing gel and lubricant are applied to the catheter to minimize discomfort.
3. The catheter is threaded into the urethra.
4. As the catheter enters the bladder, pee will spill out into the collection bag.
5. The balloon at the end of the catheter is inflated with saline or sterile fluid to secure it in place.
6. Adjustable straps are tightened to secure the tube and collection bag to your leg or abdomen.
7. The catheter is positioned so there is some slack. This helps ease discomfort.

There are situations in which a person with a lifelong condition (like paralysis) may be taught to catheterize themselves, but this can be difficult and requires the utmost care to avoid infection.

The insertion of a Foley catheter may be uncomfortable but should not cause significant pain. Most people adjust to having a catheter once they relax a bit.

With that said, the catheter may make you feel as if you need to pee even though it keeps the bladder empty. This is because the catheter can irritate the bladder, causing contractions and spasms that usually occur when the bladder is full.

How to Care for a Foley Catheter

Once the catheter is in place, you can walk and move about, but care should be taken to avoid pulling the tube out of place. Something as simple as tripping or stumbling can do this.

When using a Foley catheter, excellent hygiene is essential to preventing UTIs and other health concerns.

Among some of the key tips:

• Wash around the catheter and perineum (the space between the anus and genitals) every day with soap and water. Rinse and dry well.
• You may shower while wearing the catheter, but avoid soaking in a tub.
• Wash your hands before changing the collection bag.
• When changing the bag, use an alcohol swab to clean the end of the tubing thoroughly.
• Flush the collection bag with tap water after emptying. Sterilize with a recommended cleanser for at least 30 minutes before draining, rinsing, and reattaching.
• Drink at least 2 quarts of water a day to constantly flush the catheter and remove any bacteria.
• Always keep the catheter securely in place. People with vaginas should strap it to their thighs. People with penises can strap it to their thighs or abdomen.
• Avoid strapping the tube too tightly to your leg as this can block circulation and lead to a serious blood clot.

Never remove a Foley catheter unless a healthcare provider has taught you how and when to do so. Removing the catheter without properly deflating the balloon is not only extremely painful, but it can also cause permanent damage to the urethra.

Urinary Catheter Risks

As a rule, a Foley catheter should only be used as long as necessary and removed once it is no longer needed. It should not be considered the standard of care if other options for managing incontinence or urinary retention exist.

The largest concern is related to UTIs, the risk of which increases the longer a catheter is used. In severe cases, a catheter-associated UTI can lead to urosepsis in which the infection moves into the bloodstream and causes a potentially deadly immune reaction.

According to the Centers for Disease Control and Prevention, the risk of bacteriuria (bacteria in urine increases) by 3% to 7% every day that an indwelling catheter is used. After one month, nearly 100% of people with Foley catheters will have bacteriuria.

There may also be mechanical problems that can harm you while using a Foley catheter. These include the breakage of the catheter balloon, the obstruction of a catheter, and the accidental yanking of the tube.

People who use a Foley catheter for a long time may also develop urinary retention (the inability to fully empty the bladder) once it is removed.

Summary

A Foley catheter is a thin, flexible tube inserted into the urethra to drain urine from the bladder. It is commonly used during and after certain surgery. It can also be used for people with severe urinary retention or cases of urinary incontinence that cannot be controlled by other means.

A Foley catheter can be used for days or weeks. However, it should only be used when indicated and never for longer than needed. The longer a Foley catheter is used, the greater the risk of a urinary tract infection.