Evaluation of Inability to Void: Foley Catheter Use Poor Pump vs. Blocked Outlet UT Southwestern Medical Center (Detrusor Muscle) (Sphincters or Compression) • Adapted from: CHAMP: Foley Catheters/Voiding, Catherine DuBeau, MD, Geriatrics, University of Chicago Action Step Possible Medical Reasons Only 4 Indications for Foley Use: Review Meds α-cholinergics, narcotics, Ca-Ch Blockers, 1. Retention / inability to void (see reverse) α-agonists 2. Urinary Incontinence AND Review Med Hx Diabetes with neuropathy, sacral / subsacral -Open stage 4 sacral or perineal wound cord, B12 deficiency, GU surgery or radiation, -Palliative care BPH, MS, constipation / impaction 3. Urine output monitoring AND -ICU - frequent / urgent monitoring needed Physical Exam Prostate exam, women-pelvic for prolapsed -Patient unable to collect urine bladder, rectocele, cystocele; GU for 4. After general or spinal anesthesia obstructive lesion, all-sacral roots S2-4—anal wink & bulbocavernosus reflexes, rectum for Why minimize catheter use? impaction a. Infection risk: Postvoiding Residual Perform in evaluation of patient’s inability to -5% risk of infection per day of use void, and repeated after catheter removal -Causes 40% of nosocomial infections with voiding trial. (Can use hand-held bladder -More people die from hospital-acquired infections than from auto scanner to measure rather than catheter.) accidents and homicides combined b. Morbidity -Internal Catheters -Associated with delirium/falls Catheter Troubleshooting: -Urethral & meatal injury Trouble placing: -Fever 1. Use lidocaine gel to decrease spasm at sphincter -Polymicrobial bacteruria 2. Insert with slight torque while patient exhales -External (condom/Texas) Catheters 3. Try larger lumen -Penile cellulitus / necrosis 3. Coude (stiffer) -Urinary retention -Bacteruria & infection Leakage around catheter: c. Foleys are uncomfortable / painful 1. Flush catheter d. Limits mobility (tether) 2. Check for infection e. Cost (immediate and cost associated with above complications) 3. Decrease balloon inflation 4. Decrease lumen size