Monday, June 4, 2012
A urinary bladder catheter, more commonly called a Foley catheter after its inventor, is frequently necessary and required when undergoing bladder or other urology procedures, or when after surgery the bladder is not expected to function right way. Often patients go home with the Foley to a leg bag and it can be managed easily, though it can be annoying. Often when debilitation occurs such as after stroke or long term immobility, the Foley is left in the bladder long term, months or even years and needs to be changed at least monthly to avoid bladder infections.
Despite good hygiene and Foley changes, bladder infections can still occur. However more often than infection, bacteria can colonize the catheter and urine, but remain asymptomatic and not lead to overt infection. These are not infections per se.
Foley catheters should be inspected on a periodic basis, can be taken into the shower and cleaned with soap (not with alcohol), and the urethra and skin around the urethra must be cared for as it can develop irritation and discharge. The catheter can stir up blood in the urine which is expected but is usually minor and resolves with water consumption. Individuals who take blood thinners (aspirin, Plavix, warfarin, pradaxa) are going to be at higher risk of bleeding in the urine with a chronic catheter in the bladder, which leads to irritation (which resolves after it is removed).
Foley trauma is equally an issue. The catheter drains and is usually connected to a legbag or long bedside bag. If the catheter pulls inadvertently, or gets tugged on, it will be painful, may stop draining or stir up blood and then stop draining as well. This is especially an issue in those requiring catheters for longer periods of time. When the catheter is left in too long the tip can become encrusted with stone deposit making it difficult to remove or traumatic upon removal. Sometimes if the urethra is narrow or the anatomy is difficult the Foley may not pass in easily and trauma can occur to the urethra which then will lead to bleeding, infection or both. These types of problems require overseeing by urologists, yet unfortunately, if issues occur over the weekend this leads to emergency room visits.
Taking antibiotics for infections is often required, and sometimes the catheter leads to infections itself, but constant or repeated antibiotic usage when catheters are present will lead to bacterial resistance to antibiotics. Antibiotics are like torpedoes, they need to be aimed precisely and used only when absolutely necessarily. Overuse can also lead to diarrhea, yeast infection, and other side effects.
Posted by Matthew E. Karlovsky, M.D. at 10:38 AM