Foley Catheters For Stroke Patients: When And Why?

A Foley catheter is a medical device that helps drain urine from a patient's bladder. It is inserted into the urethra and travels to the bladder, where a balloon at the tip is filled with sterile water to keep the catheter in place. The catheter then drains urine into a collection bag outside the body.

Foley catheters are used when a patient has a condition that makes it difficult or impossible to urinate, or after surgery. They are safe and come in different sizes.

This introduction will now discuss the specific case of whether a Foley catheter should be placed in a stroke patient.

When to place a foley catheter in a stroke patient

A Foley catheter is a medical device used to drain urine from a patient's bladder. It is inserted through the urethra and into the bladder, where a small balloon at the tip is filled with sterile water to keep the catheter in place.

Foley catheters are used when a patient is unable to urinate on their own or when there is a need to monitor urine output, such as in a hospital setting. In the context of stroke patients, there are several considerations for when to place a Foley catheter:

• Urinary Retention: Stroke patients may experience urinary retention, which is the inability to empty the bladder completely. If a stroke patient is unable to urinate or is experiencing difficulty urinating, a Foley catheter may be placed to relieve urinary retention and prevent complications such as urinary tract infections or bladder damage.
• Output Monitoring: Foley catheters allow for accurate monitoring of urine output, which can be important in stroke patients to assess fluid balance and kidney function.
• Incontinence: Stroke patients, especially older adults, may experience urinary incontinence, which can be managed with a Foley catheter. The catheter provides a way to collect urine and maintain hygiene, reducing the risk of skin breakdown and infections associated with incontinence.
• Surgery or Procedures: If a stroke patient undergoes surgery or certain medical procedures, such as an epidural, a Foley catheter may be placed temporarily to manage urinary function during and after the procedure.
• Bladder Management: In some cases, stroke patients may have pre-existing bladder conditions or complications that require the use of a Foley catheter for bladder management. This includes conditions like benign prostatic hyperplasia or neurogenic bladder.

It is important to note that the decision to place a Foley catheter in a stroke patient should be made by a healthcare professional based on the patient's individual needs and condition. The use of Foley catheters should be carefully considered as they can cause discomfort and carry risks, such as urinary tract infections. Proper care and maintenance of the catheter are also essential to prevent complications.

How to place a foley catheter in a male stroke patient

Preparation

Before placing a Foley catheter, it is important to ensure that the procedure is necessary and that the patient is comfortable and prepared. The patient should be in a supine position, lying flat, and the genital area should be cleaned with an antiseptic to prevent infection. A numbing gel and lubricant can also be applied to minimise discomfort during the procedure.

Insertion

Once the patient is ready, the Foley catheter can be inserted. The catheter is a thin, flexible tube that is placed through the urethra and into the bladder. It is important to hold the penis under gentle traction to straighten the urethra and gently but firmly insert the catheter. The catheter should be advanced slowly and with gentle pressure to avoid causing discomfort or injury.

Securing the Catheter

Once the catheter reaches the bladder, it will begin to drain urine into the collection bag. To secure the catheter in place, the balloon at the tip of the tube is filled with sterile water. Adjustable straps are then used to secure the catheter tube and collection bag to the patient's leg, ensuring that there is some slack in the tubing to prevent pulling or discomfort.

Post-insertion Care

It is important to monitor the patient and the catheter after insertion. The patient should be instructed on how to care for the catheter and collection bag, including washing their hands before and after handling the catheter and emptying the collection bag regularly. The catheter tube should also be cleaned at least twice a day, and the collection bag should be changed daily or when it becomes full.

How to place a foley catheter in a female stroke patient

Gather Supplies and Prepare the Patient

Before you start, gather all the supplies you will need, including an indwelling Foley catheter tray with a 10 cc balloon (size 16fr is a common size for adults), a syringe, a soapy washcloth, and a wet washcloth. Wash your hands with soap and water, and prepare the supplies.

Ask the patient to lie flat on their back with their legs flat. If there is already a catheter in place, remove it by deflating the balloon with a syringe. Attach the syringe to the end of the "Y" pigtail (side port) and withdraw the plunger to deflate the balloon. Once the balloon is fully deflated, gently pull out the catheter.

Clean the Area

Wash the patient's urinary opening with the soapy washcloth and then rinse with the wet washcloth. Dry the area thoroughly. Wash your hands again.

Insert the Catheter

Open the indwelling catheter tray carefully and set up the supplies. Place a paper pad under the patient's hips. Put on gloves if this is not self-catheterization. Pour betadine onto cotton balls and use them to clean the urinary area. Use one cotton ball per wipe, always wiping from the top of the area towards the bottom, and never reuse a cotton ball.

Using one hand, spread the labia open to find the urinary opening. This is now your "dirty" hand, so do not use it to touch any of the supplies. With your other hand, slowly and gently insert the catheter into the urinary opening.

Secure the Catheter

Continue to insert the catheter slowly until you see urine flow into the catheter. Insert another 2 inches, then blow up the balloon. While holding the catheter in place, attach a pre-filled syringe to the "Y" pigtail port and fill it with water. Do not blow up the balloon until you see urine flowing into the catheter.

Final Steps

Wash off any excess betadine from the urinary area. Hang or attach the drainage bag to the chair or bed frame below the level of the bladder to allow for proper drainage. Consider using a leg strap to secure the catheter to the inner thigh and keep it in place. If using a leg bag, always wear it below the knee.

Ongoing Care

Clean around the catheter and urethra daily with unscented antibacterial soap and water, gently patting the area dry when finished. Wash the area after each bowel movement. Catheters can usually be left in for about a month, as long as there is no leaking and the area around the urethral opening is clean. Wash the urinary opening at least twice a day while the catheter is in place.

Risks and complications of foley catheterization

Foley catheters are generally safe to use, but there are some risks and complications associated with their use. Here are some of the potential risks and complications:

• Urinary Tract Infections (UTIs): This is one of the most common complications of using a Foley catheter. The catheter can introduce bacteria into the urethra, bladder, or, less commonly, the kidneys, leading to an infection. UTIs are particularly common when the catheter is left in place continuously. Symptoms of a UTI include pain in the lower abdomen or groin area, feeling cold, and shivering.
• Bladder Spasms: These are quite common when a catheter is in the bladder. The pain is caused by the bladder trying to squeeze the balloon of the catheter. Bladder spasms can lead to leakage around the catheter, especially during a bowel movement.
• Blood or Debris in the Catheter Tube: This is common with indwelling catheters and can become problematic if the catheter drainage system becomes blocked.
• Urethral Injury: This can occur during the insertion of the catheter or due to repeated catheter use, leading to narrowing of the urethra from scar tissue.
• Bladder Stones: These usually develop after long-term catheter use and can form on the catheter or the retention balloon.
• Bladder Cancer: This is a rare complication that can occur after long-term catheter use.
• Allergy or Sensitivity to Latex: Some people may experience an allergic reaction or sensitivity to latex catheters.
• Kidney Damage: This is usually associated with long-term, indwelling catheter use.
• Pain and Discomfort: Insertion and removal of a Foley catheter can be uncomfortable or painful. Using a numbing gel can help reduce the pain.
• Infection Prevention: It is important to maintain good hygiene and clean the catheter and drainage bags regularly to prevent infections.
• Proper Placement: It is crucial to ensure that the catheter is placed correctly and secured properly to avoid discomfort and potential complications.
• Maintenance and Care: Regular maintenance and care of the catheter and drainage bags are essential to prevent infections and other complications. This includes cleaning the catheter tube, emptying the drainage bags, and maintaining proper hydration.

Caring for a foley catheter

A Foley catheter is a thin, flexible tube placed through the urethra and into the bladder. It is held in place by a balloon filled with sterile water. Urine drains from the bladder through the catheter into a collection bag.

Cleaning and Maintenance

• Wash your hands with soap and water or use an alcohol-based hand sanitiser before and after handling the catheter and collection bag.
• Clean the catheter tube at least twice a day with soapy water and a wet paper towel or washcloth. Gently pat the tube dry.
• Empty the collection bag every two to three hours. If you have a larger collection bag, empty it every eight hours.
• Clean the drainage port with soap and water, wiping away from the port to prevent the spread of germs.
• Wash your drainage bags every day. You can also rinse the bag with a solution of 1 and a quarter cups of white vinegar in 2 quarts of water to reduce odour and prevent infection.
• Drink plenty of liquids to stay hydrated.
• Keep the catheter and bag below the level of your bladder.
• Avoid lying down for longer than two hours while wearing the leg bag.
• Take a shower every day to keep the catheter clean and prevent infections.
• Do not take a bath until the catheter is removed.
• Always use a lubricant when necessary to prevent soreness.
• Change your drainage bag twice a day and replace it with a new bag once a week or if it gets clogged.

When to Call a Healthcare Provider

• If you have a fever over 38 degrees Celsius.
• If your urine becomes cloudy or has a strong odour.
• If there is leaking around the catheter.
• If you experience pain or fullness in your abdomen.
• If you notice blood clots or blood in your urine.
• If there is little to no urine flow into the collection bag.
• If the catheter comes out.

Frequently asked questions