Also called a bladder outlet obstruction, this is when something is blocking or obstructing the ability of the bladder to empty.

Common causes include Benign Prostatic Hyperplasia (BPH), tumors, blood clots, or severe constipation. Other causes include infections, scarring, strictures, or trauma. 

This is when the bladder doesn’t work normally due to a central cause – aka there’s something with the brain. This could be from a stroke, degenerative diseases like MS, spinal cord injuries, or nerve damage. 

Certain medications can lead to the bladder being unable to fully empty itself, requiring a foley catheter insertion.

Medications that weaken the bladder muscles include anticholinergics like Tricyclic antidepressants and diphenhydramine (Benadryl).

Medications that increase the tone of the prostate and bladder neck include decongestants, stimulants, or other sympathomimetics.

There are many other medications that can cause urinary retention, including muscle relaxers, certain antipsychotics, hormones, or even NSAIDs and opioids. 

If a patient has significant bleeding in their urine, a foley catheter insertion can be ordered to monitor their output.

When there is significant amount of bleeding, this often clots, causing an obstruction and a distended bladder, along with severe discomfort.

A three-way catheter is usually placed and CBI (continuous bladder irrigation) is started to prevent the patient’s urinary tract from obstructing again. 

Patients who need strict I&Os done may have a foley catheter insertion ordered. This is often critically ill patients in the ICU, like with severe CHF or renal failure.

For hourly output, make sure your foley bag has a urometer. This way the urine first drains into the urometer, then each hour can be emptied into the main collection bag.

Patients who are intubated and many of those who are critically ill are unable to empty their bladder on their own. To prevent skin breakdown as well as monitor their urinary output, foleys can beneficial.

Foleys are placed before/during surgery to monitor fluid status and prevent bladder overdistention.

Patient’s who are immobilized from spinal cord injuries, strokes, or pelvic fractures often have foley catheters placed.

Hip fractures will almost always be going for surgery anyway, so a foley can help offer quite a bit of comfort.

If the patient is incontinent and has open sacral or coccygeal wounds, sitting in their urine can make the breakdown worse and make it more difficult to heal. A foley can help promote wound healing in these cases.

Patients who are reaching their end of life often are very weak and uncomfortable, and a foley catheter insertion gives them one less thing to worry about and can make them feel more comfortable overall.

Also called a condom catheter, this fits over a man’s penis that drains incontinent urine into a suction canister. 

This is the same concept but placed in incontinence women attached to suction. 

Make sure you have all of the required equipment for the procedure. This usually includes:

• Foley catheter insertion tray
• Foley Catheter connected to tubing & foley bag
• Lubricant
• Betadine swabs or solution/cotton swabs/forceps
• Sterile gloves
• Cath-secure device or tape
• Sterile gloves

Assess the urine. Is it draining? What color is it? Is there any blood, pus, or sediment? 

Is there any skin breakdown, erythema, or discharge near the insertion site?

Assess the tubing and collection bag, checking for any leakage. Make sure it is secure and in place, and that the collection bag always remains below the level of the bladder. 

Infections are a common complication of UTIs. While common, UTIs can be severe and even kill patients, so preventing this is very important.

Using sterile technique is super important during the procedure to decrease the risk of infection. Also, make sure the collection bag remains below the level of the bladder at all times to prevent backflow.

Foley catheters can rarely lead to epididymitis in males and sometimes extend to orchitis (infection and pain of the testicle).

While rare, catheters can cause a bladder perforation. If so, the patient will develop extreme pain, bloody urine, and signs of peritonitis (abdomen rigidity and rebound tenderness, etc). 

Bladder stones can form due to the presence of a foreign body within the bladder. This can lead to obstruction and pain.

Urea-splitting bacteria (like proteus mirabilis and Pseudomonas aeruginosa) are more likely to cause these stones. 

A fistula is when a false passage forms between two different organs due to chronic inflammation, such as with a chronic Foley catheter. These are rare but can lead to significant complications, and infections, and will need surgery to fix it.

The foley should be assessed with each head-to-toe shift assessment. You should be monitoring for things as below. 

Clean the insertion area with soap and water daily

To secure the tube in place and prevent any urethral trauma, secure the foley to the patient’s leg. Many facilities will have Cath secures, but basic medical tape can also be used instead. 

Keep the bag below the level of the bladder to prevent backflow. This should be drained often as well.

See if the patient is ordered I&Os, and chart how many mLs are emptied each time. 

If a UA is ordered, you can now obtain and send this after the foley catheter insertion. 

Everything online will tell you NOT to use the collection bag to obtain urine samples, as they may be contaminated. But nothing seems to distinguish a foley that was just placed or one that has been already drained and in place for some time.

However, if you just put in the foley, the bag should still be sterile, so some nurses do consider this first urine as a sterile sample. Whether or not this is appropriate is unsure, but always follow your facility protocols.

The recommended method to collect urine from a foley is to clamp the foley and withdraw urine from the collection port with a needle and large syringe, then transfer the urine to a sterile specimen cup.

To learn how to actually interpret the UA results, you can check that out here!