A foley catheter is inserted in patients to help in voiding the urine. Such patients have difficulty in voiding on their own due to several reasons such as bladder outlet obstruction, acute urinary retention, perineal wound with incontinence, prolonged immobilization, and urologic procedures. Some of the patients are inserted the catheters prior to operations, and these can be removed immediately after the process but only with directives from the physician. Removal of the catheters is essential when they are no longer necessary. Removing them on time prevents the occurrence of Catheter-Associated Urinary Tract Infections (CAUTIs). An evidence-based project to demonstrate the removal of these foley catheters was carried out to illustrate the importance of apt removal of the catheters. The method of how this should be done was also shown. Following the right protocol during the procedure is necessary to obtain the best results.
Keywords: Foley catheter, Urethra, Bladder, Catheter-Associated Urinary Tract Infections, Protocols, Removal.
Indwelling Urinary Catheter Removal
A Foley catheter is a thin, sterile tube inserted into the bladder to drain urine and is left in there for quite some time. The catheter is used in cases of acute urinary retention, obstruction of the bladder outlet, output monitoring in critical patients, urologic procedures, sacral/perineal wound with incontinence, prolonged immobilization, and in cases of comfort care/end of life care. A catheter of the best fit should be inserted into the patient. If the catheter is too big, then there will be urethral trauma, and when the catheter is too small, then there will be leakage of urine. The IDC insertion rationale should be considered at all times. The catheter is selected according to the patient’s age, any allergy or sensitivity, gender, history of symptomatic UTI, patient preference and comfort, previous catheter history, the reason for catheterization, and the duration of the catheter to remain in the body. The catheter is changed based on the clinical indications such as contamination, infection, obstruction, disconnection of the system, or if the catheter is damaged or leaking. Aseptic technique is applied when changing the catheter.
The need for using the catheter is reviewed on a daily basis. When there is no longer a need to retain the catheter, it is removed to avoid cases of catheter-associated urinary tract infections (CAUTI). The catheter is removed when decompression of the bladder is no longer necessary, when catheter obstruction occurs or when the patient can resume voiding normally. Before removal from the urethra, the bladder is assessed for the presence of irrigation infusion. If there is continuous bladder infusion (CBI), then the urology technician is notified to remove the catheter. The presence of blood clots or bleeding is also assessed before the removal of the catheter. The need for urine specimens is also determined, and the collaboration with a specialist in cases where the patient had urology surgery or where multiple provider services are involved. Removal of the catheter requires deflation of the balloon and pulling it out
Review of procedure
Specific criteria have to be followed when removing the catheter from a patient.
- The patient should be awake, alert, and oriented. He or she should express no trouble voiding as when the catheter was inserted. When the patient regains normal functioning of the urinary tract the catheter has to be removed
- The patient should be able to resume the voiding position.
- The order for I/O is discontinued when the patient can adhere to strict I/O monitoring.
- A physician order is required to remove foley in patients who have recently undergone urologic surgery.
- The epidural catheter is removed.
To perform the procedure, gloves, fluid impermeable pad, drape, 10ml Luer lock syringe, perineal care supplies, and graduated containers are required. The equipment are inspected, and in case of any defect or expiry, the equipment is removed from the rest. All the tools are supposed to be sterile before starting the process.
Foley Removal Procedure
- After all the necessary equipment are gathered at the patient’s bedside, hand hygiene is then performed.
- At least two identifiers confirm the patient identity, and then privacy is provided before the practitioner begins the work.
- The procedure is explained to the patient to increase cooperation, reduce fears, and increase their understanding of what will take place.
- The patient’s waist is then raised to bed level to prevent the caregiver from having a back strain.
- Hand hygiene is performed again, and then the necessary personal protective equipment such as gloves are put on.
- The fluid impermeable pad is then placed under the patient to protect the bed linen.
- The patient is then positioned for easy access to the urinary catheter and draped for privacy.
- The urinary catheter securement device is then removed gently according to the manufacturer’s directions.
- The patient’s perineum and meatus are then assessed for irritation, redness, and discharge.
- The syringe is then attached to the Luer lock mechanism of the catheter. The pressure from the urinary catheter balloon is allowed to force back the plunger, and the syringe is filled with sterile water in the balloon to deflate it.
- The patient is instructed to breathe in deeply and then exhale. This helps to relax the pelvic muscle floor, and while doing this, the catheter is gently removed by withdrawing it slowly and evenly. If any resistance is met in the process, the procedure is stopped, and a practitioner notified.
- Perineal care is then provider by the patient him/herself if they can, but if they can’t, the nurse will perform the responsibility.
- The fluid impermeable pad is then removed and discarded. The patient I then positioned for comfort. Before discarding the urine, its volume is measured and recorded. The patient is encouraged to intake oral fluid to flush the bladder of microorganisms that may be present due to indwelling catheter use. Hand hygiene then ensues.
Foley catheters are widely used in several cases among hospitalized patients. Catheter-related problems often occur in cases where the catheter in dwells for long. These complications include Urinary Tract Infection, patient discomfort, bladder pain, catheter leakage or blockage, bleeding, and in rare circumstances, catheter retention. The use of a non-deflating balloon to remove the catheter can sometimes be a challenge and cause a urological problem. A catheter should be removed as soon as possible when it is no longer needed. In Post-operative patients who require a catheter, it should be removed, preferably within 24 hours. Before the removal of the catheter, catheter care is done using warm water and soap. This reduces the transfer of microorganisms into the urethra. When removing the balloon, a syringe is placed in the balloon port and fluid drained from the balloon. The syringe is allowed to naturally pull back as this prevents the catheter balloon from collapsing in either crease or ridge formation. The balloon has to deflate completely since a partially deflated balloon will cause trauma to the urethra wall and pain.The catheter is then pulled out slowly and smoothly. In case of any resistance, the procedure is stopped, and a physician notified. Perineal care is provided to promote patient comfort, after which the patient is repositioned comfortably. Post-catheter care, fluid intake, and expected and unexpected outcomes in the patient are monitored. The bed of the patient is lowered to help prevent fall after the procedure. The procedure, including the time of removal, condition of the urethra, time, amount, and characteristics of the first void urine, are documented. If the patient is unable to void after six to eight hours of removing the catheter, or has the sensation of not emptying the bladder, or is experiencing small voiding amounts with increased frequency, a ladder scan may be performed. This helps to assess is excessive urine is being retained. Catheter removal prevents the occurrence of CAUTI, autonomic dysreflexia, catheter blockage, and excrustation.
Evidence and Policy Comparison
The written policies in the clinical setting and the evidence located from the literature synthesis are more alike. The criteria for the continuation and the discontinuation of the catheter are assessed well before determining the way forward. If there is no need to continue having the catheter, it is removed. However, if there is still known or suspected urinary obstruction, bladder dysfunction, urinary incontinence, gross hematuria with potential clots, epidural catheter still in place, need for accurate measurement of urinal output, post-surgical procedure or physician order to retain the catheter it remains in the patient. The optimal time for the removal of the catheter is in the morning at around 7 AM. The post catheter removal actions taken are also similar, whereby there are perineal care, documentation, and bladder management to ensure normal voiding is regained. The standard procedures and protocols are followed according to the nursing guidelines in both scenarios hence the similarity. The only contrast was in the removal of the catheters in post-operative patients. According to the literature synthesis, the catheter should be removed after 24 hours, but in the clinical setting, it is left to stay longer like 48 hours.
The nurses in the clinical setting follow the policy to the latter. This is because failure to do this may result in the failure of the procedure and injury to the patient. The nurses fail to remove the foley catheter from the post-operative patients at 24 hours and leave it there for at least 48 hours to save on the hospital resources. They, however, monitor the patients strictly just in case they need to remove the catheter arises urgently. There was ease in locating quality, timely, and relevant evidence because the nurses in the facility were cooperative. Being one of them made the process easy and even received help with the project. From the level of evidence in the literature, producing a practice change should be an easy task. Following the protocols from the research is bound to ensure quality patient-centered care. The patients get to heal faster and not suffer from any catheter-related urinary tract infections. This is promoting the main goal in nursing, and therefore, I think making a practice change will be a significant step. Implementation of the EBP means that the nurses have to spend more time serving one patient. Since the hospital often has a lot of patients with limited nurse staff, it may be challenging to implement the practice. The EBP may, therefore, face resistance with the given high workload.
Removal of the indwelling (foley) urinary catheter has to follow a specific protocol to be successful. The indwelling catheters should not be allowed to stay in the urinary tract for long to prevent the occurrence of CAUTIs. Removal is essential when the catheter is nolonger needed. The principles that guide whether the catheter should be removed or whether it should be retained for some time should be adhered to. The catheter should be removed aseptically, slowly and smoothly to avoid contamination and causing further injury. The catheter should be removed by a qualified practitioner to avoid causing harm to the patient.
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