Foley catheters are thin flexible tubes that are inserted through the urethra into the bladder. When in the bladder, a small balloon at the tip of the tube is filled with sterile water to keep the tube in place. Urine collects in a bag at the other end of the tube. Urinary obstructions, inability to urinate and the need to monitor urine output are all indications for catheter use. Problems with Foley catheters can develop during insertion or over continued use.
Urinary Tract Infections
Bacterial infections are the biggest complication of using Foley catheters. Urinary tract infections are more likely if the tube becomes obstructed, if the collection bag is not emptied frequently enough or if the bag is placed above bladder level, allowing urine back flow. Risk of infection also increases with duration of catheter usage,
Long-term indwelling Foley catheters can cause bladder stones and blood in the urine. They are also associated with damage to the urethral opening, a condition know as meatal erosion. Other complications of indwelling Foley catheters include penile scrotal fistulas and epididymitis, an inflammation of a part of the testicle. If a Foley is used for over 10 years, there is also an increased risk of bladder cancer.
In "Evidence-Based Pressure Ulcer Prevention," author Karen Clay notes that Foley catheters can cause pressure ulcers if they are not positioned properly. A Foley holder should be used instead of taping apparatus to the patient's thigh. Tape can press the catheter and saline port into the skin, and this can cause ulceration. The catheter should also not be placed under the patient, where it can dig into the skin.
Proper Foley insertion requires that the balloon at the tip of the tube remain uninflated until it is completely inside the bladder. Inflating the balloon while it is still in the urethra can cause permanent tissue damage. The balloon can also break after insertion, necessitating removal of the catheter and balloon fragments. The balloon might fail to inflate after insertion, calling for replacement with another catheter.
Patients often have a negative perception of Foley catheters. They can be uncomfortable and a hindrance when walking. Many patients find them embarrassing.
To quote the authors of "Avoiding Common Nursing Errors," Foley catheters "can be placed in the wrong patients for the wrong reasons with at least patient discomfort and possibly infections, sepsis, and even patient death" as results. Health care workers should provide careful oversight and documentation to make sure patients aren't catheterized unnecessarily.