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In urology, a Foley catheter is one of many types of urinary catheters (UC). The Foley UC was named after Frederic Foley, who produced the original design in 1929. Foleys are indwelling UC, often referred to as an IDCs (sometimes IDUCs). This differs from in/out catheters (with only a single tube and no valves, designed to go into the bladder, drain it, and come straight back out). The UC is a flexible tube if it is indwelling and stays put, or rigid (glass (very rarely) or rigid plastic(usually)) if it is in/out, that a clinician, or the client themselves, often in the case of in/out UC, passes it through the urethra and into the bladder to drain urine.
Foley and similar brand catheters usually have two separated channels, or lumina (or lumen), running down its length. One lumen, opens at both ends, drains urine into a collection bag. The other has a valve on the outside end and connects to a balloon at the inside tip. The balloon is inflated with sterile water or saline while inside the bladder to prevent it from slipping out. Manufacturers usually produce Foley catheters using silicone or coated natural latex.[citation needed] Coatings include polytetrafluoroethylene, hydrogel, or a silicone elastomer – the different properties of these surface coatings determine whether the catheter is suitable for 28-day or 3-month indwelling duration. A third type of UC has three lumens for using for bladder washouts post prostate surgery: one lumen is for urine flow out, one lumen is for saline flow in (bladder washouts solution), and the third is for the balloon to be inflated.[citation needed]
Indwelling catheters/IDCs should be used only when indicated, as use increases the risk of catheter-associated urinary tract infection (UTI) and other adverse effects.[1] While female sex is generally recognised as a risk factor for UTIs, the differences in biological sex are reduced while carrying catheters.[2]
The name comes from the designer, Frederic Foley, a surgeon who worked in Boston, Massachusetts in the 1930s.[3] His original design was adopted by C. R. Bard, Inc. of Murray Hill, New Jersey, who manufactured the first prototypes and named them in honor of the surgeon.[citation needed] There are now multiple companies worldwide who produced IDCs and in/out catheters, that are made of a range of materials, such is silicone, plastic, latex (although due to the rise in latex allergies, medical equipment made of latex is becoming less common). There are even still glass in/out catheters in use today (although very rare) as many older people who have been self catheterising for a very long time prefer them to the plastic ones, as there's no wastage. Currently in most countries the plastic in/out catheters have to be discarded after use. There is a study currently under way called "Single use versus reusable catheters in intermittent catheterisation for treatment of urinary retention: a protocol for a multicentre, prospective, randomised controlled, non-inferiority trial".[4]
Indwelling urinary catheters come in several types:
The relative size of an indwelling urinary catheter is described using French units (Fr).[6] Alternatively, the size of a 10 Fr catheter might be expressed as 10 Ch (Charriere units – named after a 19th century French scientific instrument maker, Joseph-Frédéric-Benoît Charrière). The most common sizes are 10 Fr to 28 Fr. 1 Fr is equivalent to 0.33 mm = .013" = 1/77" of diameter. Foley catheters are usually color coded by size with a solid color band at the external end of the balloon inflation tube, allowing for easy identification of the size.[7] Note: Colors for French sizes 5, 6, 8, 10 may vary significantly if intended for pediatric patients. Color for French size 26 may also be pink instead of black.
| Color | French units | mm | |
|---|---|---|---|
| Yellow-green | 6 | 2.0 | |
| Cornflower Blue | 8 | 2.7 | |
| Black | 10 | 3.3 | |
| White | 12 | 4.0 | |
| Green | 14 | 4.7 | |
| Orange | 16 | 5.3 | |
| Red | 18 | 6.0 | |
| Yellow | 20 | 6.7 | |
| Purple | 22 | 7.3 | |
| Blue | 24 | 8.0 | |
| Black | 26 | 8.7 | |
Indwelling urinary catheters are most commonly used to assist people who cannot urinate on their own.[8] Indications for using a catheter include providing relief when there is urinary retention, monitoring urine output for critically ill persons, managing urination during surgery, and providing end-of-life care.[8]
Foley catheters are used during the following situations:
A Foley catheter can also be used to ripen the cervix during induction of labor. When used for this purpose, the procedure is called extra-amniotic saline infusion.[9] In this procedure, the balloon is inserted behind the cervical wall and inflated, for example with 30-80 mL of saline.[9] The remaining length of the catheter is pulled slightly taut and taped to the inside of the leg. The inflated balloon applies pressure to the cervix as the baby's head would prior to labor, causing it to dilate. As the cervix dilates over time, the catheter is readjusted to again be slightly taut and retaped to maintain pressure. When the cervix has dilated sufficiently, the catheter drops out.[10]
They are also used in cases of severe epistaxis (nosebleed) to block blood from freely flowing down the nasal passage into the mouth.[11] Foley catheters are also used in abdominal surgery.
Indwelling urinary catheters should not be used to monitor stable people who are able to urinate or for the convenience of the patient or hospital staff. Urethral trauma is the only absolute contraindication to the placement of a urinary catheter. Examination findings such as blood at the urethral meatus, or a high riding prostate necessitate a retrograde urethrogram prior to insertion.[8]
In the United States, catheter-associated urinary tract infection is the most common type of hospital-acquired infection.[8] While UTIs are generally more common among females, the risk factor associated to anatomy is reduced while carrying catheters, some studies even showing no significant differences between the sex.[1][2] Indwelling catheters should be avoided when there are alternatives, and when patients and caregivers discuss alternatives to indwelling urinary catheters with their physicians and nurses then sometimes an alternative may be found.[8] Physicians can reduce their use of indwelling urinary catheters when they follow evidence-based guidelines for usage, such as those published by the Centers for Disease Control and Prevention.[8]
Catheterized bladders become colonized by microorganisms very quickly, with a daily incidence of 3-10%; after four days, between 10-30% of patients develop bacteriuria.[12] Whilst the presence of a catheter does increase the incidence of bloodstream infections secondary to a urinary origin, there is a huge amount of unnecessary, and likely harmful, antimicrobial prescribing on the basis of detection of asymptomatic bacteriuria. The industry is moving to silver-coated catheters in an attempt to reduce the incidence of urinary tract infections, although there is limited evidence of efficacy. An additional problem is that Foley catheters tend to become coated over time with a biofilm that can obstruct the drainage. This increases the amount of stagnant urine left in the bladder, which further contributes to urinary tract infections. When a Foley catheter becomes clogged, it must be flushed or replaced. There is currently not enough adequate evidence to conclude whether washouts are beneficial or harmful.[13]
There are several risks in using a Foley catheter (or catheters generally), including:
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