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Cu Phan

Technique to remove a foley cathether

Note: This should only be done by a trained professional. Do not attempt this by yourself without an approval and further consultation from your urologist or specialist.


Background Information

  • Bacterial growth is common where the catheter enters the urethral meatus. As a result, indwelling Foley catheters run the risk of causing catheter associated urinary tract infection (CAUTI). In the United States alone, there are more than 1 million CAUTIs each year. To avoid contraction of these infections, it is very important to remove the Foley catheter as soon and safely as possible.

  • An old practice was to do “bladder training” before removal of an indwelling catheter by intermittently clamping and releasing the catheter. However, there is no clear evidence to support the effectiveness of this technique. Therefore, bladder training is not a recommended clinical practice guideline. The catheter should be removed as soon as possible when it is no longer needed.

Equipment

  • Clean gloves

  • Water proof pad

  • Empty syringes (10 cc or larger)

  • Wash cloth for cleansing of genital area afterwards

  • Urinal for male and urine output commode pan for female patient

Procedure

  1. Double check patient’s ID, the order to remove the Foley catheter, and explain the procedure to the patient.

    • For patients who just had urologic procedures done, make sure that the urologist ordered or was informed of the order to remove the Foley, because for certain procedures patients may need to go home with the Foley.

  2. Provide for the patient’s privacy (close curtain around the bed and close door) and let the patient lie down

  3. Raise bed to comfortable working height; lower side rail

  4. Wash hands and put on clean gloves

  5. Put a chuck/water-proof pad between the upper thighs of the female patient or over the thighs of the male patient.

  6. If there is an order to get a urine culture, then obtain a urine sample at this time.

  7. Remove tape/ anchor device that attached the catheter to the patient.

  8. Insert the syringe tightly into the balloon inflation port and aspirate ALL of the fluid inside the balloon (Figure 1) to prevent injury to the patient.

  9. Most common catheters have 10 cc in the balloon, but three-way irrigating catheters have 30 cc and sometimes are over-inflated up to 60 cc.

  10. Distract the patient by asking him to gently cough while counting the number of coughs, while you slowly and gently remove the catheter and wrap it in the chuck/pad.

  11. An alternative is to ask patient to take several slow deep breath but coughing and counting the number of coughs distracted the patient more in the author’s experience. The catheter should slide out easily; do not use force.

  12. Cleanse the genital area for the patient.

  13. Dispose of catheter and bag according to policy and note the amount and color of the urine in the bag.

  14. Lower the bed to lowest level; raise side rail.

  15. Perform hand hygiene.



Key Elements of Removing a Foley Catheter

  • Remove Foley catheter as soon as possible to avoid CAUTI

  • Deflate the balloon completely.

  • Do not use force.

  • Monitor for urinary frequency and amount after removal.


Unexpected Situations


Water from the balloon does not return into the syringe.

  • Ensure that the catheter is not kinked. Remove the syringe and reinsert the syringe into the balloon port tighter and aspirate the water out again. If there is still no water returning into the syringe, one possible reason is that the balloon valve is malfunctioning. Notify the physician and ask if the physician and facility policy will allow you to use a pair of scissors to cut the tubing—if so, cut just above the balloon port valve. If there is water draining out of the balloon port tubing, you can gently remove the catheter after the fluid stops draining out. If there is no water draining out, notify the physician to get a urology consultation. Another reason that the Foley catheter is not deflating may be that saline, instead of water, was inappropriately used to inflate the balloon. The saline may have crystalized and clogged the balloon port channel. A urologist can then perform appropriate procedures to remove the catheter.

Resistance was felt while attempting to pull the catheter out.

  • Stop pulling the catheter. Reinsert the syringe into the balloon port more tightly and aspirate again to make sure all of the water in the balloon has been removed. Reattempt to remove the catheter. If resistance is still present, stop removal and notify a physician of the need for a urology consultation. Reasons that there was resistance may include a stone forming around the catheter if it was placed a long time ago, or, rarely, a suture going through the catheter if the patient had surgery near the bladder or urethra.


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