What are the key design features of indwelling urinary catheters. How do catheter sizes and balloon dimensions affect patient comfort and drainage efficiency. Which materials are commonly used in catheter construction and what are their benefits.

Understanding the Basics of Indwelling Urinary Catheters

Indwelling urinary catheters are essential medical devices used to drain urine from the bladder in patients who cannot void naturally. These semi-rigid yet flexible tubes are designed to balance effective drainage with patient comfort and urethral protection. The ideal catheter should closely mimic the physiological and mechanical characteristics of the natural voiding system.

What are the primary challenges in catheter design? The main objectives are:

• Creating a thin-walled, continuously lubricated, collapsible catheter to protect urethral integrity
• Developing a system to secure the catheter without relying on a balloon
• Designing a mechanism to simulate the intermittent flushing of the bladder with urine

Since the 1990s, catheter products have undergone significant improvements in composition, texture, and durability. Modern catheters feature smooth surfaces with strategically placed drainage eyes at the tip to facilitate efficient urine drainage.

Catheter Tips: Variations and Their Specific Uses

Catheter tips come in various designs, each serving a specific purpose in different clinical scenarios. Understanding these variations is crucial for healthcare professionals to select the most appropriate catheter for each patient.

Straight-Tipped Catheters

What is the most commonly used catheter tip? The straight-tipped catheter is the standard choice for most patients. Its simple design works well for uncomplicated catheterizations.

Coudé-Tipped Catheters

When might a Coudé-tipped catheter be preferred? Also known as a Tiemann catheter, this design features an upward angle at the tip. It’s particularly useful in male patients with:

• Benign prostatic hyperplasia (BPH)
• Urethral strictures

The angled tip helps navigate the upward bend in the male urethra and facilitates passage through the bladder neck when there’s obstruction due to an enlarged prostate.

Specialized Catheter Tips

Are there other catheter tip designs for specific situations? Yes, several specialized tips exist:

• Carson catheter: Features a slightly larger bulb to help negotiate restrictions
• Council catheter: Includes a reinforced hole at the tip for added durability
• Whistle-tipped catheter: Open at the end to allow drainage of large debris, such as blood clots

Catheter Sizing: The Importance of Proper Dimensions

Selecting the appropriate catheter size is crucial for patient comfort and effective drainage. Catheters are sized according to the French (Fr) gauge system, with each French unit equal to 0.33 mm in diameter.

What is the recommended catheter size for most patients? The golden rule in catheter selection is to use the smallest size that allows adequate drainage, typically 14 to 16 Fr. Larger catheters (18 Fr or above) are generally not recommended due to potential complications:

• Increased risk of erosion to the bladder neck and urethral mucosa
• Higher likelihood of stricture formation
• Interference with drainage of periurethral gland secretions, leading to irritation and infection
• Increased patient discomfort and pain

Balloon Size and Its Impact on Catheter Function

The retention balloon is a critical component of indwelling catheters, preventing expulsion and ensuring proper positioning within the bladder. Understanding balloon sizes and their implications is essential for optimal catheter performance and patient comfort.

Standard Balloon Sizes

What are the commonly used balloon sizes for indwelling catheters? Most catheters feature balloons labeled as either 5 mL or 10 mL. However, both are typically inflated with 10 mL of sterile water as per manufacturer instructions. This standardization ensures:

• Symmetrical balloon shape
• Proper catheter positioning in the bladder
• Minimized patient discomfort

Larger Balloon Sizes: When and Why?

Are there situations where larger balloons are necessary? Larger balloons (30 cc – 60 cc) serve specific purposes:

• Facilitating drainage in certain medical conditions
• Providing hemostasis, especially in postoperative scenarios

However, routine use of larger balloons for long-term catheterization is not recommended due to potential complications:

• Increased risk of bladder neck and urethral erosion
• Higher likelihood of bladder spasms
• Incomplete bladder emptying, leading to increased infection risk

The Risks of Improper Balloon Inflation

How does incorrect balloon inflation affect catheter function? Both underfilling and overfilling the balloon can lead to problems:

• Underfilling: May result in incorrect catheter positioning and potential dislodgement
• Overfilling: Can cause unilateral irritation of the bladder wall and increased patient discomfort

It’s crucial to follow manufacturer guidelines for balloon inflation to ensure optimal catheter performance and patient safety.

Material Innovations in Catheter Design

The evolution of catheter materials has significantly impacted their effectiveness, durability, and patient comfort. Modern catheters are constructed from a variety of materials, each with its own set of advantages and considerations.

Silicone Catheters

What are the benefits of silicone catheters? Silicone has become a popular material for catheter construction due to its:

• Biocompatibility, reducing the risk of allergic reactions
• Flexibility, enhancing patient comfort
• Durability, allowing for longer indwelling times

However, it’s important to note that 100% silicone catheters may lose water from the inflated balloon over time, with some studies showing up to 50% volume loss within three weeks.

Latex-Based Catheters

Are latex catheters still in use? While less common due to allergy concerns, latex-based catheters are still available. They offer:

• Good flexibility
• Lower cost compared to silicone alternatives

However, the risk of latex allergies has led many healthcare facilities to transition away from these catheters.

Coated Catheters

How do coated catheters improve patient outcomes? Various coatings have been developed to enhance catheter performance:

• Hydrogel coatings: Reduce friction during insertion and minimize tissue trauma
• Silver-alloy coatings: Provide antimicrobial properties, potentially reducing the risk of catheter-associated urinary tract infections (CAUTIs)
• Antibiotic-impregnated catheters: Offer localized antibiotic delivery to prevent bacterial colonization

Best Practices for Catheter Selection and Management

Proper catheter selection and management are crucial for patient safety and comfort. Healthcare professionals should consider several factors when choosing and maintaining indwelling urinary catheters.

Individualized Catheter Selection

How should healthcare providers approach catheter selection? The choice of catheter should be tailored to each patient’s specific needs, considering:

• Reason for catheterization
• Expected duration of catheter use
• Patient anatomy and any existing urological conditions
• History of allergies or sensitivities to catheter materials

Regular Assessments and Maintenance

What ongoing care is necessary for indwelling catheters? Proper catheter care includes:

• Regular assessment of the need for continued catheterization
• Monitoring for signs of infection or complications
• Ensuring proper catheter positioning and unobstructed urine flow
• Maintaining a closed drainage system to reduce infection risk

Education and Training

How can healthcare facilities improve catheter-related outcomes? Implementing comprehensive education and training programs for healthcare staff is essential. These programs should cover:

• Proper catheter insertion techniques
• Guidelines for catheter care and maintenance
• Recognition and management of catheter-related complications
• Strategies for reducing unnecessary catheter use

Addressing Common Catheter-Related Issues

Despite advances in catheter design and materials, certain issues can still arise during long-term catheter use. Understanding these problems and their potential solutions is crucial for effective catheter management.

Catheter Encrustation and Blockage

What causes catheter encrustation, and how can it be prevented? Encrustation occurs when minerals in the urine crystallize and adhere to the catheter surface, potentially leading to blockage. Strategies to minimize this issue include:

• Ensuring adequate fluid intake to dilute urine
• Regular catheter changes as recommended by healthcare providers
• Using catheters with anti-encrustation coatings
• Implementing bladder irrigation protocols when necessary

Catheter-Associated Urinary Tract Infections (CAUTIs)

How can the risk of CAUTIs be reduced? CAUTIs are a common complication of long-term catheter use. Prevention strategies include:

• Strict adherence to aseptic insertion techniques
• Maintaining a closed drainage system
• Removing catheters as soon as they are no longer necessary
• Using antimicrobial-coated catheters in high-risk patients
• Ensuring proper perineal hygiene

Catheter Bypassing and Leakage

What causes urine to leak around the catheter, and how can it be addressed? Catheter bypassing can occur due to various factors:

• Bladder spasms
• Catheter blockage
• Improper catheter size or positioning

Addressing this issue may involve:

• Reassessing catheter size and type
• Treating underlying bladder spasms with medication
• Ensuring the catheter is not kinked or obstructed
• Considering alternative drainage methods in persistent cases

Future Directions in Catheter Technology

The field of urinary catheter design continues to evolve, with ongoing research aimed at improving patient outcomes and reducing complications. Several promising areas of development are emerging.

Smart Catheters

How might technology enhance catheter function in the future? Smart catheters incorporating sensors and wireless technology are being developed to:

• Monitor urine output and composition in real-time
• Detect early signs of infection or blockage
• Adjust drainage parameters automatically

Biofilm-Resistant Materials

What advancements are being made to combat catheter-associated infections? Researchers are exploring new materials and surface modifications to prevent bacterial adhesion and biofilm formation, including:

• Nanostructured surfaces that repel bacteria
• Novel antimicrobial coatings that remain effective over extended periods
• Biodegradable materials that release antibiotics or other protective agents

Tissue-Engineered Solutions

Could biological approaches replace traditional catheters? Tissue engineering research is exploring the possibility of creating:

• Artificial urethras to bypass damaged sections
• Bioengineered bladder tissue for reconstruction
• Cell-based therapies to restore bladder function

While these technologies are still in the experimental stage, they hold promise for revolutionizing long-term urinary management in patients with chronic conditions.

Conclusion: Optimizing Catheter Use for Improved Patient Care

Indwelling urinary catheters remain an essential tool in healthcare, but their use requires careful consideration and management. By understanding the various design features, materials, and best practices associated with catheter use, healthcare providers can significantly improve patient outcomes and reduce complications.

Key takeaways for optimal catheter management include:

• Selecting the appropriate catheter type and size for each patient’s specific needs
• Adhering to strict infection control protocols during insertion and maintenance
• Regularly assessing the ongoing need for catheterization
• Staying informed about advances in catheter technology and materials
• Providing comprehensive education to both healthcare staff and patients

As research continues to drive innovations in catheter design and materials, the future holds promise for even safer and more effective urinary management solutions. By combining these technological advancements with evidence-based clinical practices, healthcare providers can continue to enhance the quality of life for patients requiring long-term catheterization.

Designs – Indwelling Urinary Catheters

Catheters are semi-rigid but flexible tubes. They drain the bladder but block the urethra.

The challenge is to produce a catheter that matches as closely as possible to the normal physiological and mechanical characteristics of the voiding system.

This requires construction of a thin-walled, continuously lubricated, collapsible (conformable) catheter to protect the integrity of the urethra; a system to hold the catheter in place without a balloon; and a design to imitate the intermittent washing of the bladder with urine.

Catheter products have changed significantly in their composition, texture, and durability since the 1990s.

The catheter should have a smooth surface with two drainage eyes at the tip that allow for urine drainage.

Drainage eyes are placed either laterally or opposed. Opposing drainage eyes generally facilitate better drainage.

Catheter Tips

The most commonly used catheter is a straight-tipped catheter.

A Coudé-tipped catheter, or Tiemann catheter, is angled upward at the tip to assist in negotiating the upward bend in the male urethra.  

This feature facilitates passage through the bladder neck in the presence of obstruction from a slightly enlarged prostate gland (e.g., in benign prostatic hyperplasia) or through a narrowed stricture in the urethra.

The Carson catheter is a slightly larger bulb to assist in negation of restrictions. 

The Council catheter features a reinforced hole at the tip of the catheter.

A whistle-tipped catheter is open at the end and allows drainage of large amounts of debris (e.g., blood clots).

Catheter Size and Length 

Each catheter is sized by the outer circumference and according to a metric scale known as the French (Fr) gauge (range is 6 to 18 Fr), in which each French unit equals 0.33 mm in diameter.

The golden rule is to use the smallest catheter size (termed bore), generally 14 to 16 Fr, that allows for adequate drainage.

The use of large-size catheters (e.g., 18 Fr or larger) is not recommended because catheters with larger diameters can cause more erosion of the bladder neck and urethral mucosa, can cause stricture formation, and do not allow adequate drainage of periurethral gland secretions, causing a buildup of secretions that may lead to irritation and infection. Also, large size catheters can cause pain and discomfort.  

Balloon Size

A retention balloon prevents the catheter from being expelled. The preferred balloon size may be labeled either 5 mL or 10 mL, and both are instilled with 10 mL of sterile water for inflation per manufacturer’s instructions. Larger balloons (30 cc – 60 cc) are generally used to facilitate drainage or provide hemostasis when necessary, especially in the postoperative period. The balloon of the catheter usually sits at the base of the bladder, obstructing the internal urethral orifice. 

A fully inflated balloon allows the catheter tip to be located symmetrically. If a 5 mL balloon is inflated with more than 10 mL of water, irritation may occur unilaterally on the bladder wall from increased pressure of the balloon.

The specified amount of inflation ensures a symmetrical shape and allows for the catheter to maintain position in the bladder while minimizing patient discomfort   Underfilling or overfilling may interfere with the correct positioning of the catheter tip, which may lead to irritation and trauma of the bladder wall.

A balloon with a fill size greater than 10 mL, such as a 30 mL balloon, is not recommended because the 10 mL size keeps residual urine minimal, thus reducing the risk of infections and irritation.

The catheterized bladder is in a collapsed state as a result of constant urine drainage. However, a 30 mL balloon will allow persistence of a small pool of undrained urine, so the bladder emptying is not complete and the undrained urine can leak around the catheter (referred to as “catheter bypassing”)..

The use of a larger balloon size is mistakenly believed by many nurses to be a solution to catheter leakage or urine bypassing around the catheter. However, a large balloon increases the chance of contact between the balloon or catheter tip and the bladder wall, leading to bladder spasms that may cause urine to be forced out around the catheter.

A 30 mL balloon is used primarily to facilitate traction on the prostate gland to stop bleeding in men after prostate surgery or to stop bleeding in women after pelvic surgery.

Routine use of larger capacity balloons (30 mL) should be avoided for long-term use as they can lead to bladder neck and urethral erosion.

Several catheter materials have been found to lose water from the inflated balloon over time in the bladder with 100% silicone catheters losing as much as 50% of their volume within 3 weeks.

In men, the catheter should be passed initially to the bifurcation (the “Y” junction where the balloon arm and catheter meet) to ensure that the balloon will not be inflated in the urethra. 

Catheter Materials

A wide range of catheter materials are available, and the material selected should be chosen by: 

1. how long the catheter will remain in place,
2. comfort,
3. the presence of latex sensitivity,
4. ease of insertion and removal, and
5. ability to reduce the likelihood of complications such as urethral and bladder tissue damage, colonization of the catheter system by microorganisms, and encrustation

Note: Prior to insertion, all indwelling catheters should be visually inspected for any imperfections or surface deterioration.

1. Latex Catheter: The possibility of a latex allergy is an important consideration as many urinary catheters are constructed from latex or a related material. 

There are reported increases in allergies and reactions in patients with long-term use of all urinary latex and rubber catheters. Patients who have asthma and other allergies are at increased risk for these allergies. Latex allergy can result in symptoms such as skin irritation, rashes, and blisters. Urethritis and urethral strictures can also result from latex allergies.  Coatings such as silicone and polytetrafluoroethylene (PTFE) are used to coat latex catheters.

2. Hydrogel coating, which remains intact when used, has demonstrated the ability to reduce the high level of cytotoxicity associated with latex catheters. However, coated latex catheters do not protect against an allergic reaction to the underlying latex because the coating wears off.

Bonded hydrogel-coated latex catheters may be longer lasting than silicone catheters because their hydrogel coating prevents bacterial adherence and reduces mucosal friction. Hydrogels or polymers coat the catheter, absorbing water to produce a slippery outside surface. This results in the formation of a thin film of water on the contacting surface, thus improving its smoothness and lubricity. These properties might act as potential barriers to bacterial infection and reduce the adhesion of both gram-positive and gram-negative bacteria to catheters. 

3. Silicone- and hydrogel-coated catheters usually last longer than PTFE-coated catheters. If the person is latex sensitive, silicone catheters should be used. Avoiding latex catheters may also decrease the incidence of encrustation. All-silicone (100%) catheters are biocompatible and are believed to have encrustation-resistant properties.  Silicone catheters are thin-walled, rigid catheters with a larger diameter drainage lumen. 

4. Antimicrobial-coating: A major problem with Foley catheters is that they have a tendency to contribute to urinary tract infections (UTI). This occurs because bacteria can travel up the catheters to the bladder where the urine can become infected. In an attempt to prevent bacterial colonization, catheters have been coated with silver alloy or nitrofurazone, a nitrofurantoin-like drug.

This has been helpful, but it has not completely solved this major problem. An additional problem is that Foley catheters tend to become coated over time with a biofilm that can obstruct the drainage. This increases the amount of stagnant urine left in the bladder, which further contributes to the problem of urinary tract infections. When a Foley catheter becomes clogged, it must be flushed or replaced.

Both nitrofurazone-coated and silver alloy-coated catheters seem to reduce the development of asymptomatic bacteriuria during short-term (< 30 days) use.
Despite their unit cost, there is a suggestion that these devices might be a cost-effective option if overall numbers of infections are significantly reduced through their use.

• Antibiotic-coated catheters were found in a meta-analysis to prevent or delay bacteriuria in short-term catheterized, hospitalized patients.   However, in 2012, nitrofurazone impregnated catheters were taken off the market.  
• Silver is an antiseptic that inhibits growth of gram-positive and gram-negative bacteria. Silver alloy-coated catheters are thought to cause less inflammation and have a bacteriostatic effect because they reduce microbacterial adherence and migration of bacteria to the bladder.
  Because they prevent bacterial adherence, these catheters also minimize biofilm formation through their release of silver ions that prevent bacteria from settling on the surface.  
  There appear to be few adverse effects, and microbial resistance to the active agent is unlikely. 

Catheter Drainage BagsDrainage bags and an anchor for the drainage tube are parts of the design of an indwelling urinary catheter system.  These may include a: leg drainage bag, overnight drainage bag, and a spare leg strap or a device to secure the catheter tubing to the leg.  Drainage bags that cannot be worn and concealed are commonly referred to as “nighttime or overnight bags,” or “large capacity bags,” or “bedside bags”. Drainage bags that can be worn and concealed are commonly referred to as “leg bags” or abdominal bags, commonly referred to as “belly bags.”  Leg bags generally hold 300- 900 cc whereas an overnight bag can hold up to 2000cc.  It is recommended that reusable drainage bag be replaced every 30 days.   

The current design of urinary drainage bags prevents the introduction of bacteria into the closed indwelling urinary catheter system.  There are anti-reflux bags, single use bags, closed urinary drainage systems, and bags with urine sampling ports.  A leg bag cannot be characterized as closed because of the need to regularly open the leg bag for drainage and connect to an overnight drainage bag in most cases.  To minimize opening of a catheter system, a leg bag can be attached to a larger bag for overnight drainage. 

References: 
1. Brosnahan J, A. Jull, et al. Types of urethral catheters for management of short-term voiding problems in hospitalized patients. Cochrane Database of Systematic Reviews, 2004, (1): CD004013.
2. Gray M. Does the construction material affect outcomes in long-term catheterization? JWOCN, 2006, 33: 116-121.
3. Lawrence EL. and IG. Turner. Materials for urinary catheters: A review of their history and development in the UK. Med Engineering Phys, 2005, 27: 443-453.
4. Leuck AM, Johnson JR, Hunt MA, Dhody K, Kazempour K, Ferrieri P, et al. Safety and efficacy of a novel silver-impregnated urinary catheter system for preventing catheter-associated bacteriuria: a pilot randomized clinical trial. Am J Infect Control. 2015;43:260-5. DOI: 10.1016/j.ajic.2014.11.021.
5. Newman D. The indwelling urinary catheter: Principles for best practice. JWOCN, 2007, 24: 655-661.
6. Pickard R, Lam T, MacLennan G, Starr K, Kilonzo M, McPherson G, et al. Antimicrobial catheters for reduction of symptomatic urinary tract infection in adults requiring short-term catheterisation in hospital: a multicentre randomised controlled trial. Lancet. 2012;380:1927-35. DOI: 10.1016/S0140-6736(12)61380-4.  
7. Politano AD, Campbell KT, Rosenberger LH, Sawyer RG. Use of silver in the prevention and treatment of infections: silver review. Surg Infect (Larchmt). 2013;14:8-20. DOI: 10.1089/sur.2011.097.
8. Weissbart SJ, Kaschak CB, Newman DK. Urinary drainage bags. In: Newman DK, Rovner ES, Wein AJ, editors. Clinical Application of Urologic Catheters and Products.  Switzerland: Springer International Publishing; 2018, 133-147.
9. Zugail AS, Pinar U, Irani J. Evaluation of pain and catheter-related bladder discomfort relative to balloon volumes of indwelling urinary catheters: A prospective study.  Investig Clin Urol. 2019 Jan;60(1):35-39. doi: 10.4111/icu.2019.60.1.35. Epub 2018 Dec 6.

Urinary Catheter Types and Being Part of the Insertion Team

Slide 1: Urinary Catheter Types and Being Part of the Insertion Team

Slide 2: Learning Objectives

Upon completion of this session, licensed staff who insert or assist in the insertion of urinary catheters will be able to—

• Explain the similarities and differences between the four different types of urinary catheters;
• Prepare for and insert an indwelling urinary catheter using aseptic technique; and
• Summarize effective strategies in preventing CAUTIs.

Slide 3: Indwelling Urinary Catheters

¹

Images: Figure l. Routes of entry of uropathogens to catheterized urinary tract.
An image depicts the male and female lower urinary tract system, and the difference in placement of a catheter in the bladder.

Source: Maki DG, Tambyah PA. Engineering out the risk of infection with urinary catheters. Emerg Infect Dis. 2001 Mar-Apr;7(2):342-7.
*CMS, State Operations Manual, 2014.

^1. Maki DG, Tambyah PA. Engineering out the risk for infection with urinary catheters. Emerg Infect Dis. 2001;7(2):342-7. PMID: 11294737.

Slide 4: Alternative Catheter Types

Straight Catheters

• Inserted directly into the urethra and bladder.
• Removed after insertion and drainage of bladder.
• Used intermittently.

Suprapubic Catheters

• Placed surgically directly through skin into the bladder.
• Connected by tubing to a bag used to collect and measure urine.

External “Condom” Catheters for Men

• Does not enter the bladder.
• Four different types to adhere to the penis.
• Connected by tubing used to collect and measure urine output.
• Cannot be used to treat acute urinary retention.

Slide 5: Quiz

²

Which of the following are appropriate indications for placing an indwelling urinary catheter?

1. Bladder outlet obstruction
2. Urinary incontinence
3. Incontinence and sacral wound
4. Resident’s request for end-of-life
5. Transferred from hospital with catheter

^2. Gould CV, Umscheid CA, Agarwal RK, et al. Centers for Disease Control and Prevention. Guidelines for prevention of catheter-associated urinary tract infections 2009. Atlanta, GA: US Department of Health and Human Services, CDC; 2009. Accessed January 28, 2016.

Slide 6: Preparing to Place an Indwelling Urinary Catheter

• Review the doctor’s order and verify that the catheter is clinically indicated.
• Gather your catheter insertion kit and other supplies.
• Use the buddy system—get a second pair of hands to help!

Image: Section of AHRQ poster showing appropriate indications for a urinary catheter.

Slide 7: Catheter Insertion Kit Contents

³

• Drape with opening, sterile gloves.
• Antiseptic solution for periurethral cleaning before insertion, swabs and tongs to use for applying antiseptic solution.
• Single-use packet of lubricant.
• Single-use dose of topical lidocaine jelly.
• Sterile urinary catheter, of smallest size effective for patient (14 or 16 French) connected to tubing and bag.
• Catheter securing device.

^3. Willson M, Wilde M, Webb M, et al. Nursing interventions to reduce the risk of catheter-associated urinary tract infection: part 2: staff education, monitoring, and care techniques. J Wound Ostomy Continence Nurs. 2009;36(2):137-54. PMID: 19287262.

Slide 8: Prepping for Catheter Insertion Procedure

³

• Cleanse hands and don gloves
• Get your buddy to help at the bedside
• Place resident in the supine position
• For a female—apply topical lidocaine jelly if needed for comfort
• For a male—if uncircumcised, retract foreskin. Inject 10-15 mL of topical lidocaine into urethral meatus; gently pinch tip of penis for several minutes to retain lidocaine
• Inspect catheter kit and remove it from its outer packaging to form a sterile field
• Remove gloves and wash hands!

^3. Willson M, Wilde M, Webb M, et al. Nursing interventions to reduce the risk of catheter‐associated urinary tract infection: part 2: staff education, monitoring, and care techniques. J Wound Ostomy Continence Nurs. 2009;36(2):137-54. PMID: 19287262.

Slide 9: Hygiene and Standard PrecautionsCatheter Insertion Procedure

^2,3

• Don sterile gloves.
• Cover resident’s lower abdomen and upper thighs with dignity cover.
• Organize contents of tray on sterile field
  • Pour antiseptic solution over swabs in tray compartment.
  • Squeeze sterile catheter lubricant onto tray.

^2. Gould CV, Umscheid CA, Agarwal RK, et al. Centers for Disease Control and Prevention. Guidelines for prevention of catheter-associated urinary tract infections 2009. Atlanta, GA: US Department of Health and Human Services, CDC; 2009. Accessed January 28, 2016.
^3. Willson M, Wilde M, Webb M, et al. Nursing interventions to reduce the risk of catheter‐associated urinary tract infection: part 2: staff education, monitoring, and care techniques. J Wound Ostomy Continence Nurs. 2009;36(2):137-54. PMID: 19287262.

Slide 10: Male Catheter Insertion Procedure

• Using gloved nondominant hand, grasp penis taut and perpendicular to the plane of the resident’s body.
• Cleanse the glans of penis using the antiseptic soaked swabs using tongs, in expanding circular motion. Discard used swabs away from sterile field.
• Keep nondominant hand in this position, do not remove!
• Lubricate tip of catheter with sterile lubricant jelly.
• Holding the coiled catheter in dominant hand, gently introduce the catheter tip into the urethral meatus.
  • If using coude catheter, point catheter tip upward to 12 o’clock position.
• Slowly advance the catheter through the urethra into the bladder. If substantial resistance is met, do not force the catheter!
• If tip of catheter is accidentally contaminated by touching anything that is not sterile, discard, and get a new one.

Slide 11: Female Catheter Insertion Procedure

• Using gloved nondominant hand, identify urethra by spreading the labia
  • Spread inner labia slightly with gentle traction and pull upwards toward resident’s head.
  • Clean periurethral area and urethral opening using antiseptic soaked swabs using tongs, in expanding circular motion. Discard used swabs away from sterile field.
• Lubricate tip of catheter with sterile lubricant jelly.
• Holding the coiled catheter in dominant hand, gently introduce the catheter tip into the urethral meatus.
• Slowly advance the catheter through the urethra into the bladder. If substantial resistance is met, do not force the catheter!
• If catheter is accidentally contaminated by touching anything that is not sterile, discard, and get a new one.
• If catheter is accidentally inserted in to vagina, discard, and get a new one.

Slide 12: Securing Drainage Bag

• Advance tubing another 3-5 cm once you see urine in the tubing
  • Inflate balloon with 10 cc sterile water
• Once inflated, pull gently on catheter to make sure it’s secure
• Secure catheter to medial thigh
• Place drainage bag below the level of the bladder
• Remove personal protective equipment and wash hands immediately

Slide 13: Insertion Avoiding Common Mistakes

⁴

• Wash hands BEFORE and AFTER procedure
• Put on your sterile gloves after opening catheter kit
  • If sterile, gloved hand gets contaminated or glove rips, then remove glove, wash hands, and don NEW sterile gloves
• Sterile urinary catheters can get contaminated by touching labia, being inserted into vagina, or touching any other part of body besides cleansed urethra
  • If this happens, STOP procedure and get NEW sterile catheter to use
• Use tongs to cleanse the urethral area with your sterile hand
• Do not switch hands

^4. Manojlovich M, Saint S, Meddings J, et al. Indwelling urinary catheter insertion practices in the emergency department: an observational study. Infect Control Hosp Epidemiol. 2016;37(1):117-9. PMID: 26434781.

Slide 14: References

1. Maki DG, Tambyah PA. Engineering out the risk for infection with urinary catheters. Emerg Infect Dis. 2001;7(2):342-7. PMID: 11294737.
2. Gould CV, Umscheid CA, Agarwal RK, et al. Centers for Disease Control and Prevention. Guidelines for prevention of catheter-associated urinary tract infections 2009. Atlanta, GA: US Department of Health and Human Services, CDC; 2009. Accessed January 28, 2016.
3. Willson M, Wilde M, Webb M, et al. Nursing interventions to reduce the risk of catheter‐associated urinary tract infection: part 2: staff education, monitoring, and care techniques. J Wound Ostomy Continence Nurs. 2009;36(2):137-54. PMID: 19287262.
4. Manojlovich M, Saint S, Meddings J, et al. Indwelling urinary catheter insertion practices in the emergency department: an observational study. Infect Control Hosp Epidemiol. 2016;37(1):117-9. PMID: 26434781.

Foley catheter: structure, materials, price, size

Pomerantsev’s Foley catheter has a wide scope. Used to divert urine, treat the urinary system, prepare for surgery, diagnose diseases, stimulate labor. For urinary disorders, Foley catheters are installed if long-term catheterization is necessary. Depending on the material, they can be used up to 90 days.

Foley catheter materials:

Often there are questions about which Foley catheter is better and why they have such different prices. Pricing depends primarily on the material of the catheter. The material affects the duration of use of the catheter.

Latex catheters. Foley latex catheter has great flexibility, elasticity, strength. Modern latex contains the minimum amount of proteins that can cause allergies. The catheters are also coated with silicone. This minimizes the risk of allergies. Latex catheters are used for catheterization up to 7 days. Latex catheters are cheaper than silicone ones.

Silicone catheters. Silicone biocompatible resistant material. Silicone prevents the deposition of salts on the inner opening of the catheter. Therefore, silicone catheters are used for catheterization up to 30 days. They are more expensive than latex.

Silver Foley catheters. There are also silver coated silicone catheters that can be used for 30 to 90 days. Silver prevents the growth of bacteria, the occurrence of urinary tract infections. Due to the high cost of production, the price of such catheters is higher.

For example, Foley Urethral Catheters, Silver Plated Foley Dover™ Medtronic (Unomedical)

Foley Catheter Design:

Foley catheters are available in 2-way and 3-way.

Two way channel has two ports. One to divert urine, the other to inflate the balloon.

Three-way catheter has a third port for drug administration, sampling, etc.

Foley catheters for women, men and children.

Adult catheters are available in 40 cm lengths and are a universal choice. Sometimes they are divided into male and female.

Women’s Foley catheters are shorter than men’s. After all, the female urethra is shorter than the male.

Foley catheters for men are 40 cm long.

Foley catheters for children are thinner and shorter than adults. Sometimes they have additional design features for easier insertion into the child’s urethra.

Catheters are numbered according to the Charrier scale and the size is selected according to the table:

Table, Foley catheter dimensions:

Gender	Size	Connector color	Inner diameter	OD	Length	Tank size
Child	Ch 6	pink	1. 1 mm	2.0 mm	28 cm	3-5 ml
Child	Ch8	black	1.7 mm	2.7 mm	28 cm	3-5 ml
Child	Ch 10	gray	2.3 mm	3.3 mm	28 cm	3-5 ml
Male, Female	Ch 12	white	2.8 mm	4.0 mm	39-40 cm	30 ml
Male, Female	Ch 14	green	3.3 mm	4.7 mm	39-40 cm	30 ml
Male, Female	Ch 16	orange	3.8 mm	5.3 mm	39-40 cm	30 ml
Male, Female	Ch18	red	4.5 mm	6.0 mm	39-40 cm	30 ml
Male, Female	Ch20	yellow	5. 1 mm	6.7 mm	39-40 cm	30 ml
Male, Female	Ch 22	purple	5.6 mm	7.3 mm	39-40 cm	30 ml
Male, Female	Ch 24	blue	6.2 mm	8.0 mm	39-40 cm	30 ml
Male, Female	Ch 26	pink	6.9 mm	8.7 mm	39-40 cm	30 ml
Male	Ch 28	brown	7.5 mm	9.3 mm	39-40 cm	30 ml
Male	Ch 30	gray	8.0 mm	10.0 mm	39-40 cm	30 ml

When choosing a Foley catheter, they are guided by the following:

– the duration of catheterization, with catheterization for more than a week or with latex allergy, silicone catheters can be used, they can be used up to a month or silver catheters they are used up to 90 days.

– catheter size. The attending physician helps to determine the size.

The most famous manufacturers of Foley catheters in Russia:

Coloplast (Coloplast), Convatec (Konvatek), Vogt Medical (Vogt Medical), Apexmed (Apeksmed), Medtronic Medronik (Unomedical) Unomedical.

Where can I buy Foley catheters?

Foley catheters of well-known manufacturers can be bought in our specialized store mystoma.ru with delivery throughout Russia.

You can order Foley catheters in our online store or by phone, and we will carefully and quickly deliver the goods to you. In our store there is a free shipping promotion and a discount program, according to which you can purchase goods at a discount or on sale.

12/05/2018 12/07/2018 Mystoma

Foley Catheter

Foley catheter – installation, dimensions, characteristics and algorithm of operation of the urological Foley catheter

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• Foley catheter
• Varieties of
• Installation algorithm

Indwelling Foley catheter for urination is a latex or silicone device, a tube with three-way or two-way balloon catheters used in urological and gynecological practice. Main applications for this catheter:

• bladder diversion,
• treatment of pathologies and injuries of the urinary system in men and women, children of different ages,
• preparation for surgical interventions,
• labor stimulation,
• diagnostics of some pathologies.

If the patient has urinary diversion problems, the catheter is placed in a situation where prolonged emptying of the bladder is required. In some cases, depending on the characteristics, it can be used up to 90 days.

How the Foley catheter works

Let’s take a quick look at what this medical catheter looks like and how it works. This is a long tube, at one end of which there is a smooth tip with two slots through which urine is drained from the bladder, and a balloon is inflated just below them, which does not allow the product to fall out of the body by blocking the neck of the bladder from the inside. At the other end of the tube stand out:

• an opening through which urine is drained;
• separate opening through which the balloon is filled;
• special anti-reflux valve.

Three-way catheters also have an additional opening through which drugs can be injected.

These types of catheters are used for those patients who need catheterization within a week to a month (or longer). They are very effective against urinary retention. Urine begins to flow immediately after the device is installed. The basic principle of operation is the passive outflow of urine from the bladder through the holes into the tube and urinal.

What are Foley catheters?

Based on the material used to make the product, catheters are divided into three types:

1. Latex products .

They are characterized by high strength, resistance to constant contact with urine, high flexibility and elasticity. Many patients note that the introduction of latex catheters is the most comfortable, but this is an allergenic compound, so a layer of silicone is often applied over the latex.

2. Silicone Catheters .

They have been used for many years, are highly compatible with fabrics, are resistant to high temperatures and do not provoke salt deposits in the inner lumen. In addition, the products are hypoallergenic, but slightly less elastic than latex.

3. Silver plated silicone .

Products have antimicrobial properties, help in the elimination of pathogenic flora, reducing the risk of urinary tract infection during prolonged use of the catheter.

According to the design features of catheters are divided into two groups:

• Two-way is a classic version of a catheter with one common channel and two endings. One of them is needed to divert urine, and the second – to fill the fixing balloon inside the bladder. This system allows you to maintain the sterility of the system, minimizing the risk of serious complications.
• Three way – equipped with an additional port used to inject drugs. This is a modern and multifunctional model with a wide range of uses.

By age and gender, catheters are divided into three varieties, which determine how to choose a product:

1. Male version of products with a key feature – up to 40 cm in length due to the fact that the male urethra is much longer than the female.
2. Women’s item is 26 cm long because the length of the female urethra is shorter.
3. Pediatric Foley Catheters – these are products up to 28 cm long, they come with special stilettos that help facilitate their insertion.

Bladder Foley Catheter: How to Place it

When choosing a particular catheter model, it is important to consider the main indications, the expected duration of catheterization, and the age of the patient. The doctor will tell you how to determine the size and type of the product: the diameter of the tube is determined by the size of the urethra, where the catheter is inserted to pass it into the bladder cavity.