How can healthcare professionals prevent inappropriate self-extraction of Foley catheters. What are the risks associated with traumatic catheter removal. Who are the patients most at risk for self-extraction. What interventions can be implemented to reduce the likelihood of traumatic removal.

Understanding the Importance of Proper Foley Catheter Management

Foley catheters are essential medical devices used in various healthcare settings. However, their improper management can lead to severe complications. Traumatic removals, whether patient-initiated or accidental, can result in urologic complications, extended hospital stays, decreased patient satisfaction, and increased catheter-associated urinary tract infections (CAUTIs).

In rare cases, these incidents can cause life-threatening hematuria, requiring invasive interventions such as pelvic arterial embolization. Therefore, healthcare professionals must prioritize the prevention of inappropriate self-extraction and early identification of catheter malposition.

Identifying Patients at Risk for Foley Catheter Self-Extraction

Recognizing patients who are at higher risk for traumatic Foley catheter removal is crucial for implementing preventive measures. The following groups of patients are considered high-risk:

• Patients with delirium or dementia, especially elderly nursing home residents with recently placed catheters
• Individuals recovering from anesthesia, procedures, or sedation
• Patients with head injuries or brain trauma
• Those exhibiting constant pulling or tugging on their catheters
• Patients with a history of agitation due to brain injury, medications, or other illnesses
• Individuals admitted for mental status changes with unclear confusion levels
• Patients being transferred between units or facilities

Healthcare providers should be particularly vigilant when caring for these high-risk patients, implementing appropriate interventions to minimize the risk of traumatic catheter removal.

Interventions to Reduce the Risk of Traumatic Foley Catheter Removal

Implementing effective interventions is key to preventing inappropriate self-extraction of Foley catheters. Here are some strategies healthcare professionals can employ:

1. Frequent monitoring and assessment of high-risk patients
2. Proper securement of the catheter using appropriate devices
3. Education of patients and family members about the importance of catheter care
4. Use of distraction techniques for agitated patients
5. Consideration of alternative catheterization methods when appropriate
6. Prompt removal of catheters when no longer medically necessary

By implementing these interventions, healthcare providers can significantly reduce the incidence of traumatic catheter removals and associated complications.

The Controversy Surrounding Larger Balloon Foley Catheters

The use of larger balloon Foley catheters (30 mL) to minimize unintended self-extraction is a topic of debate among healthcare professionals. While these catheters are more resistant to being pulled out while inflated, they pose their own set of risks:

• Potential for increased urethral damage if forcefully extracted
• Possible stimulation of the bladder, leading to increased attempts at removal
• Risk of bladder spasms and patient discomfort

Due to these concerns, larger balloon catheters are not routinely recommended for preventing self-extraction. However, they may be considered in specific cases, such as newly placed suprapubic tubes, where the benefits may outweigh the risks.

Early Recognition and Management of Malpositioned Foley Catheters

Identifying and correcting malpositioned Foley catheters is crucial for preventing complications and ensuring patient comfort. Healthcare providers should be aware of the following signs that may indicate a malpositioned catheter:

• Persistent leakage around the catheter
• Inability to drain urine despite proper placement
• Patient complaints of discomfort or pain
• Visible kinking or twisting of the catheter
• Resistance when attempting to irrigate the catheter

When a malpositioned catheter is suspected, prompt assessment and repositioning or replacement should be performed to minimize the risk of complications.

The Role of Healthcare Team Collaboration in Preventing Catheter-Related Complications

Effective prevention of inappropriate self-extraction of Foley catheters requires a collaborative effort from the entire healthcare team. Each member plays a crucial role in ensuring patient safety and comfort:

Nurses

• Regularly assess patients for risk factors
• Implement preventive measures as needed
• Educate patients and families about catheter care
• Monitor for signs of catheter malposition or complications

Physicians

• Evaluate the need for catheterization and order removal when appropriate
• Provide guidance on alternative catheterization methods
• Address complications promptly when they arise

Physical Therapists

• Assist with mobility while ensuring catheter security
• Provide input on positioning to minimize catheter strain

Pharmacists

• Review medications that may contribute to confusion or agitation
• Suggest alternatives to reduce the risk of self-extraction

By working together, the healthcare team can significantly reduce the incidence of traumatic catheter removals and improve patient outcomes.

Addressing the Impact of Traumatic Foley Catheter Removal on Patient Care

Traumatic Foley catheter removal can have far-reaching consequences on patient care and hospital performance. Understanding these impacts can help healthcare providers prioritize prevention efforts:

Patient-Related Consequences

• Increased pain and discomfort
• Higher risk of urinary tract infections
• Potential for long-term urethral damage or strictures
• Psychological distress and decreased trust in healthcare providers

Hospital-Related Consequences

• Extended length of stay
• Increased healthcare costs
• Lower patient satisfaction scores
• Potential legal implications

By focusing on prevention, healthcare facilities can improve patient outcomes, reduce costs, and maintain higher quality scores.

Implementing a Comprehensive Foley Catheter Management Protocol

To effectively prevent inappropriate self-extraction of Foley catheters, healthcare facilities should consider implementing a comprehensive management protocol. This protocol should address various aspects of catheter care, including:

1. Risk assessment procedures
2. Standardized insertion and maintenance techniques
3. Regular reassessment of catheter necessity
4. Staff education and training programs
5. Patient and family education materials
6. Documentation and reporting requirements
7. Quality improvement initiatives

By establishing a structured approach to Foley catheter management, healthcare facilities can create a culture of safety and reduce the incidence of traumatic removals.

Exploring Alternative Catheterization Methods for High-Risk Patients

For patients at high risk of self-extraction, healthcare providers should consider alternative catheterization methods that may reduce the likelihood of traumatic removal. Some options include:

Intermittent Catheterization

This method involves inserting and removing a catheter at regular intervals, reducing the time a catheter remains in place and potentially decreasing the risk of self-extraction.

External Condom Catheters

For male patients, condom catheters can provide an alternative to indwelling catheters, eliminating the risk of internal trauma from self-extraction.

Suprapubic Catheters

In some cases, a suprapubic catheter may be appropriate, particularly for long-term catheterization needs. This method bypasses the urethra, reducing the risk of urethral trauma.

When considering these alternatives, healthcare providers should weigh the benefits and risks for each individual patient, taking into account their specific medical needs and risk factors.

The Importance of Continuous Education and Training in Catheter Care

Ongoing education and training for healthcare professionals are essential components of an effective Foley catheter management program. Key areas of focus should include:

• Proper insertion techniques
• Recognition of risk factors for self-extraction
• Implementation of preventive measures
• Early identification of complications
• Effective communication with patients and families
• Documentation and reporting procedures

By investing in continuous education, healthcare facilities can ensure that their staff remains up-to-date on best practices in catheter care, leading to improved patient outcomes and reduced complications.

Leveraging Technology to Enhance Foley Catheter Management

Advancements in medical technology offer new opportunities to improve Foley catheter management and reduce the risk of traumatic removal. Some innovative approaches include:

Smart Catheters

These devices incorporate sensors that can detect changes in urine flow, temperature, or other parameters, alerting healthcare providers to potential issues before they become serious complications.

Electronic Monitoring Systems

Specialized software can track catheter insertion dates, prompt for regular assessments, and remind staff when catheters are due for removal, reducing the risk of prolonged unnecessary catheterization.

Virtual Reality Training

VR simulations can provide healthcare professionals with realistic, hands-on training in catheter insertion and management techniques without risking patient safety.

By embracing these technological advancements, healthcare facilities can enhance their catheter management practices and potentially reduce the incidence of traumatic removals.

Addressing the Psychological Impact of Foley Catheterization on Patients

The psychological aspects of Foley catheterization are often overlooked but can significantly impact patient well-being and the risk of self-extraction. Healthcare providers should consider the following:

Anxiety and Discomfort

Many patients experience anxiety or discomfort related to catheterization. Addressing these concerns through education and supportive care can reduce the likelihood of patients attempting to remove their catheters.

Loss of Dignity

Some patients may feel a loss of dignity or control due to catheterization. Empathetic communication and efforts to maintain privacy can help alleviate these feelings.

Cultural Considerations

Cultural beliefs and practices may influence a patient’s acceptance of catheterization. Healthcare providers should be sensitive to these factors and adapt their approach accordingly.

By addressing the psychological impact of Foley catheterization, healthcare providers can improve patient cooperation and reduce the risk of self-extraction attempts.

Developing a Standardized Protocol for Managing Traumatic Catheter Removals

Despite best prevention efforts, traumatic catheter removals may still occur. Having a standardized protocol in place for managing these incidents can help minimize complications and ensure appropriate care. Key elements of such a protocol should include:

1. Immediate assessment of the patient for injury or bleeding
2. Evaluation of the need for catheter replacement
3. Guidelines for catheter reinsertion or alternative management
4. Monitoring requirements for potential complications
5. Documentation and reporting procedures
6. Follow-up care and patient education

By implementing a standardized approach to managing traumatic removals, healthcare facilities can ensure consistent, high-quality care and minimize the risk of long-term complications.

The Role of Quality Improvement Initiatives in Reducing Catheter-Related Complications

Continuous quality improvement is essential for reducing the incidence of traumatic Foley catheter removals and other catheter-related complications. Healthcare facilities should consider implementing the following initiatives:

Data Collection and Analysis

Regularly collecting and analyzing data on catheter use, duration, and complications can help identify trends and areas for improvement.

Root Cause Analysis

When traumatic removals occur, conducting a thorough root cause analysis can provide valuable insights into prevention strategies.

Benchmarking

Comparing performance metrics with other facilities or national standards can help set meaningful improvement goals.

PDSA Cycles

Implementing Plan-Do-Study-Act cycles can facilitate rapid testing and refinement of improvement strategies.

By incorporating these quality improvement initiatives, healthcare facilities can create a culture of continuous improvement in catheter management, leading to better patient outcomes and reduced complications.

In conclusion, preventing inappropriate self-extraction of Foley catheters requires a multifaceted approach involving risk assessment, preventive interventions, staff education, and continuous quality improvement. By implementing comprehensive management protocols and leveraging technology, healthcare facilities can significantly reduce the incidence of traumatic catheter removals and improve overall patient care. The collaborative efforts of the entire healthcare team are essential in achieving these goals and ensuring the best possible outcomes for patients requiring catheterization.

Prevention of Inappropriate Self-Extraction of Foley Catheters – StatPearls

Stephen W. Leslie; Hussain Sajjad; Sandeep Sharma.

Author Information and Affiliations

Last Update: May 30, 2023.

Continuing Education Activity

Prevention of painful, traumatic Foley catheter removals and early identification of catheter mal-positioning can minimize pain, urinary tract infections, discomfort, and hematuria as well as eliminate long-term complications of urethral strictures and incomplete bladder emptying. It also allows for the early removal of the Foley catheter. Traumatic, unintended Foley catheter extractions, whether patient-initiated or accidental, can cause permanent urologic complications, affect hospital length of stay, decrease patient satisfaction grades, increase catheter-associated urinary tract infections (CAUTIs), and lower hospital quality scores. These injuries are usually managed with catheter replacement for 10 to 14 days (optimal) or with just observation. Rarely, they can cause severe, even life-threatening hematuria that may require pelvic arterial embolization to control. This activity reviews the prevention of inappropriate self-extraction of Foley catheters and highlights the role of the interprofessional team in minimizing this event.

Objectives:

• Explain why it is important to avoid traumatic Foley catheter removal.

• Describe the treatment required if traumatic Foley catheter removal occurs.

• Summarize tips on early recognition of malpositioned Foley catheters.

• Outline the prevention of inappropriate self-extraction of Foley catheters and describe the role of the interprofessional team in minimizing this event.

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Introduction

Prevention of painful, traumatic Foley catheter removals and early identification of catheter mal-positioning can minimize pain, urinary tract infections, discomfort, and hematuria as well as eliminate long-term complications of urethral strictures and incomplete bladder emptying. It also allows for the early removal of the Foley catheter.[1]

Traumatic, unintended Foley catheter extractions, whether patient-initiated or accidental, can cause permanent urologic complications, affect hospital length of stay, decrease patient satisfaction grades, increase catheter-associated urinary tract infections (CAUTIs), and lower hospital quality scores. These injuries are usually managed with catheter replacement for 10 to 14 days (optimal) or with just observation. Rarely, they can cause severe, even life-threatening hematuria that may require pelvic arterial embolization to control.[2]

The following guidelines will help prevent such events by early identification of patients at risk and reasonable steps that nursing services can then initiate and perform on their own without specific physician orders. Tips on early recognition of mal-positioned Foleys are included so that these painful and potentially dangerous conditions can be identified and corrected more quickly.  

The use of a larger (30 mL) balloon Foley to minimize unintended self-extraction is controversial. While the 30 mL balloon is certainly much larger and therefore more resistant to being pulled out while inflated, it would do more damage to the urethra if a determined patient manages to extract it. Also, larger catheter balloons may be more stimulating and increase an at-risk patient’s attempts to remove the catheter. For that reason, it is not routinely recommended. However, it may be reasonable to use a larger balloon initially for new suprapubic tubes.[3]

Issues of Concern

Interventions to Reduce Traumatic and Inappropriate Self-Extraction of Foley Catheters

Identify Patients at Risk

Every patient with a Foley catheter who has delirium or dementia is potentially at risk of a traumatic Foley catheter removal. This would include patients recovering from anesthesia, procedures, or sedation and particularly if the Foley catheter is new. Patients with head injuries are at particular risk. Often these patients are in the recovery room or intensive care unit (ICU) settings, but this may not always be the case. Other patients at risk include:

• Any patient with delirium or dementia, particularly an elderly nursing home patient with a recently placed Foley catheter or one who has a prior history of traumatic self-extraction of catheters.

• Patients who are constantly pulling or tugging on their Foley catheters.

• Patients with a history of agitation from brain injury, medications, or other illnesses.

• Patients admitted for mental status changes whose degree of confusion is unclear, and their tolerance of the new Foley catheter is not yet known.

• Patients with newly inserted Foley catheters who are just waking from anesthesia and may become agitated.

• Any patient being transferred where the catheter may become caught and accidentally pulled or tugged.

• Patients with a history of prior Foley catheter self-extractions. [4]

Be Suspicious of a Possible Malpositioned Catheter

• Minimal or no urine output while the bladder scan shows the bladder is full or distended despite the Foley.

• When flushed, fluid can be injected but not aspirated, cannot be injected, or simply leaks out around the Foley catheter.

• The Long Catheter Sign: In males, this refers to one-half or more of the catheter being exposed outside of the penis. Be aware that, occasionally, usually with urethral strictures,  the catheter can double back on itself, or a male patient’s urethra may be exceptionally long, giving a false impression of normalcy.

• Verify Foley positioning with a bladder ultrasound if suspicious. Try readjusting or replacing the Foley if necessary.

• A simplified cystogram can also be used to check the Foley catheter position. A small amount of contrast (3 mL) is added to the Foley catheter balloon, and about 30 mL of diluted contrast is added to the bladder through the main Foley catheter lumen so both the bladder and the Foley balloon can be easily visualized on x-ray. This simplified cystogram approach can be done at the bedside, requires minimal expertise to perform, and gives a clearer image of the anatomical situation than ultrasound which will often only show the absence of the Foley balloon in the bladder. Therefore, this technique is preferred over bladder ultrasound when possible.[2][5]

Use Standard Preventive Measures

All patients with Foley catheters should include a properly placed Foley stabilization device as well as additional observation by staff if patients appear confused or agitated. Do not use a Foley stabilization device on suprapubic catheters.

Reposition the Foley Catheter Under the Thigh, Tape and Cover it

In higher-risk patients, reposition the catheter by directing it under the thigh and then taping it directly to the skin without a gap. Leave no space under the tubing or the catheter for the patient to use his fingers to grab it. Being unable to encircle the catheter and tubing makes it much harder for the patient to secure purchase on the Foley and pull it out. The catheter needs to be completely secured with tape, starting almost at the level of the meatus and continuing as the catheter is secured underneath the thigh. Then wrap a large, wide elastic bandage around the patient’s thigh, completely covering the tape and Foley catheter. TED hose or similar anti-edema leg wraps may also be used to cover the Foley catheter and tubing. These measures should obscure the majority of the Foley catheter, making it even more difficult for the patient to get his fingers under and around the catheter as both the wrappings and the tape would need to be dislodged first. This delay will often give staff sufficient time to intervene. Additional tape or a plastic roll also may be used to cover the wrap if additional security measures are desired.

Use a Diaper or Mesh Underwear with Pads

When in place, these coverings make it a little harder for patients to reach their catheters as they will have to get past the diaper and padding to grasp and pull on the Foley.  This is particularly helpful when used together with the decoy catheters described below.

Add Decoy Foley Catheters

Decoy catheters are a greatly underutilized resource and are particularly useful as they are not only effective but can be immediately initiated by nurses for any patient identified as being at risk without waiting for a specific physician’s order. The decoy catheter can be taped to the upper thigh or just over the diaper and secured sufficiently to prevent easy removal with simple pulling. If it comes off too easily, the patient may lose interest and go looking for the real Foley. Benzoin or similar adhesive agents can be used to help fasten the tape and decoy catheter more securely to the skin or over their pants/diaper. Multiple decoy catheters can be used if necessary to keep confused patients occupied. This has proven to be a very simple and effective technique for protecting Foley catheters from even the most persistent patients who seem determined to pull out their Foleys traumatically. [6]

Consider Additional Preventive Measures

These include restraints, mitts, sedation, or constant monitoring with a sitter for the highest risk patients. The decision on which to use will need to be individualized on a case-by-case basis and is usually best determined by the primary attending physician or team. It is important to ask the physician if it appears that the patient is at risk for pulling his catheter out and other measures are insufficient. The benefits of the previously described techniques are that nursing staff can initiate them without any individual physician’s order or input.

If Trauma, Check the Foley Balloon for any Missing Pieces or Fragments

In such situations, carefully inspect the extracted Foley and make clear documentation regarding whether the Foley balloon is fully intact. Physicians may want to examine the catheter, particularly the balloon, to determine if any pieces are missing that could still be in the bladder and might require surgical removal with cystoscopy. Such fragments left in the bladder can become calcified and eventually develop into stones.[7][8]

Clinical Significance

By instituting these measures, unplanned traumatic Foley catheter removals can be minimized:

• Identify patients at risk, especially those with new Foley catheters, delirium, dementia, agitation, mental status changes, confusion, or a prior history of traumatic Foley catheter extractions.

• Increase monitoring and observation of patients identified as being at risk.

• Pay extra attention to Foley catheters during patient transfers.

• Look for signs of a mal-positioned Foley such as high bladder residuals on bladder scan, decreased urinary drainage, low urine output, new gross hematuria, or a “long catheter” sign. 

• Use Foley stabilization devices properly. 

• In higher-risk patients, add more of the following Foley catheter security measures early.

• Secure the catheter by repositioning the Foley to pass under the patient’s thigh, then secure with tape directly to the skin without leaving any gaps and cover with a wide elastic wrap.

• Diapers and mesh underpants can be placed over a taped, secured catheter and make it even harder for confused patients to grab their catheters. May also use anti-edema stockings such as TED hose and similar.

• Use “decoy” catheters when appropriate for extra protection.

• If the Foley is pulled out anyway, check the catheter carefully to see if the balloon is intact and chart it appropriately. Keep the old catheter for examination by the physician.

Using these measures, one might expect similar results to those reported at Creighton University Medical Center in Omaha (unpublished data) where the traumatic Foley catheter extraction rate decreased from 1 or even 2 per week to almost none.[9]

Enhancing Healthcare Team Outcomes

Prevention of patient self-mutilation and injury by reducing the likelihood of traumatic Foley catheter extractions is beneficial to hospitals and patients by reducing hospital days and avoiding urological complications. This has been hampered in the past by the need for specific physician orders for either a sitter, restraints, or sedation. These precautions are costly, require a physician’s order, use valuable resources better utilized elsewhere, and may not even be very effective. Making traumatic Foley removals a nurse-initiated program greatly facilitates its implementation and effectiveness. In particular, the nurses liked using the decoy catheters and found them particularly effective, even in the most difficult cases. Newer devices have been developed for difficult catheterizations to prevent malpositioning as well.[10][11]

The key, however, is to have a collaborative interprofessional team identifying the patients at risk for a traumatic Foley removal and implementing safety measures to prevent this occurrence. A nursing-driven risk assessment for every patient on admission or after Foley catheter insertion to identify patients at high risk for inappropriate extractions and communicating these findings with the medical provider can greatly reduce the risk. Nurses and clinicians must coordinate the care of Foley catheters so that appropriate protective measures may be undertaken. The nurse can also assist the medical provider in identifying when a patient is no longer in need of a Foley catheter. Communicating this finding with the provider will lead to the early safe removal of the catheters and prevent traumatic self-extraction by the patient. An integrated interprofessional team can greatly reduce the incidence of this troublesome problem with improved patient safety, reduced urethral trauma, increased quality, and better outcomes. [Level V]

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• Comment on this article.

References

1.

Vasilyev AO, Govorov AV, Rewa IA, Schneiderman MG, Pushkarev VA, Pushkar DY. [Alternative approaches to prevention and treatment of postoperative complications by introduction of new models urinary catheter]. Urologiia. 2016 Dec;(6):5-10. [PubMed: 28248036]

2.

Liang LM, Xue J, Erturk E. Perineal Pseudoaneurysm from Traumatic Foley Removal Leads to Recurrent Life-Threatening Hematuria. J Endourol Case Rep. 2015;1(1):50-1. [PMC free article: PMC4996550] [PubMed: 27579388]

3.

Cahill A, Pearcy C, Agrawal V, Sladek P, Truitt MS. Delirium in the ICU: What About the Floor? J Trauma Nurs. 2017 Jul/Aug;24(4):242-244. [PubMed: 28692620]

4.

Azar R, Shadpour P. In Vivo Trial of a Novel Atraumatic Urinary Catheter Design for Prevention of Catheter-Induced Trauma. J Endourol. 2016 Jul;30(7):822-7. [PubMed: 27125268]

5.

Bregman J, Iams W, Theobald C. Urethral Trauma After Foley Catheter Placement: A Teachable Moment. JAMA Intern Med. 2016 Nov 01;176(11):1606-1607. [PubMed: 27654098]

6.

Schomer NS, Mohler JL. The decoy catheter. J Urol. 1990 Jul;144(1):102. [PubMed: 2359153]

7.

Subramanian V, Soni BM, Hughes PL, Singh G, Oo T. The risk of intra-urethral Foley catheter balloon inflation in spinal cord-injured patients: Lessons learned from a retrospective case series. Patient Saf Surg. 2016;10:14. [PMC free article: PMC4875696] [PubMed: 27213016]

8.

Poola S, Mohan A. A Foley Fallacy: A Case of Bladder Rupture after “Routine” Foley Catheter Placement. Case Rep Urol. 2018;2018:7978126. [PMC free article: PMC6311248] [PubMed: 30643662]

9.

Leslie SW, Sajjad H, Sharma S. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Mar 11, 2023. Prevention of Inappropriate Self-Extraction of Foley Catheters. [PubMed: 29489183]

10.

Leuck AM, Wright D, Ellingson L, Kraemer L, Kuskowski MA, Johnson JR. Complications of Foley catheters–is infection the greatest risk? J Urol. 2012 May;187(5):1662-6. [PubMed: 22425122]

11.

Bugeja S, Mistry K, Yim IHW, Tamimi A, Roberts N, Mundy AR. A new urethral catheterisation device (UCD) to manage difficult urethral catheterisation. World J Urol. 2019 Apr;37(4):595-600. [PMC free article: PMC6469634] [PubMed: 30251050]

Disclosure: Stephen Leslie declares no relevant financial relationships with ineligible companies.

Disclosure: Hussain Sajjad declares no relevant financial relationships with ineligible companies.

Disclosure: Sandeep Sharma declares no relevant financial relationships with ineligible companies.

About Your Urinary (Foley) Catheter: How To Clean and Care for It

This information will help you care for your urinary (Foley) catheter.

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About your urinary (Foley) catheter

Your Foley catheter is a thin, flexible tube placed through your urethra (the small tube that carries urine from your bladder to outside your body) and into your bladder. Your Foley catheter drains your urine (pee). It’s held inside your bladder by a balloon filled with water.

How your Foley catheter works

Your urine goes from your bladder and through a drainage tube into a drainage collection bag. The drainage bag stays on your leg with a special tape called Cath-Secure^®.

You will have 2 types of drainage bags:

• A leg bag. This is the bag that you wear during the day. It holds half a liter of urine.
• A night bag. This is the bag you will put on at night before you go to bed. It holds 2 liters of urine.

The parts of the catheter that are outside your body are shown in Figure 1.

Figure 1. The parts of your Foley catheter and drainage bag

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How to take care of your Foley catheter

To take care of your Foley catheter, you will need to:

• Clean your catheter every day.
• Change your drainage bags. You will change your drainage bag 2 times a day:
  • In the morning, change the night bag to the leg bag.
  • At night before you go to bed, change the leg bag to the night bag.
• Replace your drainage bags with new bags once a week. You should also change your drainage bag if it gets clogged or blocked.
• Wash your drainage bags every day.
• Drink 1 to 2 glasses of liquids every 2 hours while you’re awake to keep you hydrated.

You may see some blood or urine around where the catheter enters your body. This may happen when you’re walking or having a bowel movement (pooping). This is normal if there’s urine draining into the drainage bag. If you do not have urine draining into the drainage bag, call your healthcare provider.

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How to comfortably wear your Foley catheter and leg bag

• The tubing from your leg bag should fit down to your calf with your leg slightly bent. If you have extra tubing, you may need to cut it. Your healthcare provider will show you how to do this.
• Always wear the leg bag below your knee. This will help it drain.
• Place the leg bag on your calf using the Velcro® straps your healthcare provider gave you. Use a leg strap to secure the tubing to your thigh.
• If the straps leave a mark on your leg, they are too tight. Loosen them. Leaving the straps too tight can lower your blood flow and cause blood clots.
• Use a water-based lubricant (such as Astroglide® or K-Y®) to keep your penis or vagina opening from getting sore.
• Keep your penis or vagina opening clean by taking a shower every day. This will help prevent infections when your Foley catheter is in place.

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How to shower with your Foley catheter

• You can shower while you have your catheter in place.
• Do not take a bath until your catheter is removed. Taking a bath while you have your catheter in place puts you at risk for infections.
• Make sure you always shower with your night bag. Your night bag is waterproof. Do not shower with your leg bag. Your leg bag has cloth on the side and will not dry as fast.
  • You may find it easier to shower in the morning before you change your night bag to your leg bag.

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How to clean your Foley catheter

You can clean your catheter while you’re in the shower. Follow these instructions.

1. Gather your supplies. You will need:
   • Mild soap, such as Dove®.
   • 1 Cath-Secure®.
2. Clean your hands with soap and water or an alcohol-based hand sanitizer.
   • If you’re washing your hands with soap and water, wet your hands and apply soap. Rub your hands together well for at least 20 seconds, then rinse. Dry your hands with a paper towel. Use that same towel to turn off the faucet.
   • If you’re using an alcohol-based hand sanitizer, cover your hands with it. Rub them together until they’re dry.
3. Using mild soap and water, clean your penis or vagina.
   • If you have a penis, pull back your foreskin (the skin around the tip of your penis), if needed. Clean the area, including your penis.
   • If you have a vagina, separate your labia (the smaller folds of skin around your vaginal opening). Clean the area from front to back.
4. Clean the area where the catheter enters your body. This is called your urethra.
5. Clean the catheter from where it enters your body and then down, away from your body. Hold the catheter at the point it enters your body so that you do not put tension on it.
6. Rinse the area well and dry it gently.
7. If you removed your old Cath-Secure, attach the catheter to your leg with a new Cath-Secure. This will keep the catheter from moving.

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When to change your drainage bags

You will change your drainage bag 2 times a day. Change it:

• In the morning after you shower, change the night bag to the leg bag.
• At night before you go to bed, change the leg bag to the night bag.

Replace your drainage bags with new bags once a week. You should also change your drainage bag if it gets clogged or blocked.

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How to change your drainage bag

This video demonstrates how to change your urinary (Foley) catheter drainage bag.

Video Details

1. Gather your supplies. You will need:
   • A clean cloth (not one you’re using for bathing) or a 4 x 4 piece of gauze.
   • Your night or leg bag (whichever one you are switching to).
   • 2 alcohol pads.
2. Clean your hands with soap and water or an alcohol-based hand sanitizer.
   • If you’re washing your hands with soap and water, wet your hands and apply soap. Rub your hands together well for at least 20 seconds, then rinse. Dry your hands with a paper towel. Use that same towel to turn off the faucet.
   • If you’re using an alcohol-based hand sanitizer, cover your hands with it. Rub them together until they’re dry.
3. Empty the urine from the drainage bag into the toilet. Make sure the spout of the drainage bag never touches the side of the toilet or any emptying container. If it does, wipe it with an alcohol pad for 15 seconds.
4. Place the clean cloth or gauze under the connector to catch any leakage.
5. Pinch the catheter with your fingers and disconnect the used bag.
6. Wipe the end of the catheter with an alcohol pad.
7. Wipe the connector on the new bag with the second alcohol pad.
8. Connect the clean bag to the catheter and release your finger pinch. Make sure the catheter is tightly connected to the bag to keep it from opening or leaking.
9. Check all connections. Straighten any kinks or twists in the tubing.

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How to take care of your drainage bags

Caring for your leg drainage bag

• Empty the leg bag into the toilet every 2 to 4 hours, as needed. You can do this through the spout at the bottom of the bag. Do not let the bag get completely full.
• Do not lie down for longer than 2 hours while you’re wearing the leg bag. This can keep your urine from draining the way it should.

Caring for your night drainage bag

• Always keep the night bag below the level of your bladder.
• When you go to sleep, hang your night bag off the bed. You can do this by using a small trash can. Place a clean plastic bag inside the trash can. Hang your night bag inside of the trash can.

Cleaning your drainage bags

Clean your leg bag and night bag every day. Follow these instructions.

1. Gather your supplies. You will need:
   • White vinegar.
   • Cool water.
2. Clean your hands with soap and water or an alcohol-based hand sanitizer.
   • If you’re washing your hands with soap and water, wet your hands and apply soap. Rub your hands together well for at least 20 seconds, then rinse. Dry your hands with a paper towel. Use that same towel to turn off the faucet.
   • If you’re using an alcohol-based hand sanitizer, cover your hands with it. Rub them together until they’re dry.
3. Rinse the bag with cool water. Do not use hot water because it can damage the plastic.
4. To help get rid of the smell, fill the bag halfway with a mixture of 1part white vinegar and 3 parts water. Shake the bag and let it sit for 15 minutes.
   • If you cannot get the mixture into the bag, try putting the vinegar and water into a measuring cup with a pour spout. Then use the spout to help pour the mixture into the bag.
5. Rinse the bag with cool water. Hang it up to dry.

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How to prevent Foley catheter infections

Follow these guidelines to prevent getting infections while you have your catheter in place:

• Keep the drainage bag below the level of your bladder.
• Always keep your drainage bag off the floor.
• Keep the catheter secured to your thigh to keep it from moving.
• Do not lie on your catheter or block the flow of urine in the tubing.
• Take a shower every day to keep the catheter clean.
• Wash your hands before and after touching the catheter or bag.

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Common questions about caring for your Foley catheter

Can I place a Foley catheter myself?

No. Your catheter is placed by your healthcare provider.

How long can I wear my Foley catheter before it needs to be changed?

Your catheter should be replaced about once a month, if it stops working, or if you have an infection.

Can I poop when I have a Foley catheter?

Yes. Your catheter will not affect your pooping.

Can I get an erection with a Foley catheter?

Yes. You can get an erection with a catheter in place.

Can I drive with a Foley catheter?

You can drive with a catheter unless your healthcare provider gives you other instructions.

Can I exercise with a Foley catheter?

Ask your healthcare provider if you can exercise while you have a Foley catheter in place.

Can I swim with a Foley catheter?

No. You cannot swim with a catheter in place.

Can I fly on an airplane with a Foley catheter?

Yes. You can fly on an airplane with a catheter.

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When to call your healthcare provider

Call your healthcare provider right away if:

• Your catheter comes out. Do not try to put it back in yourself.
• You have a fever of 101°F (38.3 °C) or higher.
• You’re making less urine than usual.
• You do not have urine draining into your drainage bag.
• Your urine smells bad.
• You have bright red blood or large blood clots in your urine.
• You have abdominal (belly) pain and no urine in your catheter bag.

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American journalist James Foley’s family confirmed his death. /ITAR-TASS/. Relatives of American journalist James Foley, who was executed by Islamic State (IS) militants, confirmed the fact of his death. The corresponding statement was distributed on August 20 by his family.

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Islamic State militants posted online footage of the execution of an American journalist Foley.

On behalf of her entire family, she asked “the kidnappers to spare the lives of the remaining hostages.” “Like Jim, they are not guilty of anything. They do not control the policy of the US government in Iraq, Syria or any other part of the world,” she added.

Representatives of the American administration, in turn, reported that the video that appeared on the Internet, most likely, really captured Foley’s execution. They also added that US President Barack Obama is scheduled to issue a special statement on the matter on Wednesday.

Execution and warning of Barack Obama

Read also

Islamic State terrorist organization. DossierTerror attacks of the group “Islamic state of Iraq and the Levant”. Dossier

The Islamic State, an extremist group operating in Iraq and Syria, released a video titled “Message to America” ​​on Tuesday evening. It shows footage of the execution of American journalist James Foley, who went missing in northwestern Syria on November 22, 2012. The video also shows Time magazine journalist Steven Sotloff, who went missing in Libya in August 2013. “The life of this American citizen, Obama, depends on your next decision,” IS militants said in a statement.

The authenticity of the video is being verified by US intelligence agencies. “The intelligence community is working to determine its authenticity as soon as possible,” White House National Security Council spokeswoman Caitlin Hayden said Tuesday. “If (the tape) is genuine, we are appalled by the brutal murder of an innocent American journalist and offer our deepest condolences to his family. and friends.”

US operation in Iraq

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Obama said he ordered the bombing of militants in Iraq in the interests of US national security

On August 8, US President Barack Obama authorized airstrikes against Islamists in Iraq to protect US personnel and to aid Iraqi and Kurdish forces. Since then, US aircraft have carried out about 70 strikes against Islamic State positions in Iraq.

A day earlier, ISIS threatened to attack the Americans “anywhere” at its discretion if the US does not stop airstrikes on the group’s positions in Iraq. “We will drown you in blood,” the media quoted the extremists’ laconic message in English.

10 years of Iraqi sovereignty: from America’s ambitions to terrorist victories

Journalists killed in hot spots

Journalists killed in the line of duty are traditionally published by organizations such as Reporters Without Borders and the Committee to Protect Journalists.

According to the Committee to Protect Journalists, at least 1,070 journalists have been killed since 1992, when NGOs began compiling lists of dead journalists on a regular basis. The most tragic year was 2012: according to the International Press Institute, 133 journalists were killed last year.

According to Reporters Without Borders, 43 journalists have been on the death toll lists in this incomplete year. In recent years, the most dangerous countries for press workers have been Iraq, Afghanistan, Libya, Syria, and now Ukraine, where four of our colleagues were killed this year.

Since 1992, 165 journalists have been killed in Iraq, according to statistics from the Committee to Protect Journalists. In Syria, 66 journalists were killed during the same period, in Afghanistan – 26, in Libya – 8.

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USASyrian CrisisIraq: Crisis of Statehood

Execution of American journalist Foley following failure of US covert operation in Syria

10:1121 August 2014

10:11August 21, 2014

the US staged in Syria covert operation to rescue Americans captured by Islamic State militants.

Apparently, this operation further embittered the extremists, who beheaded James Foley in front of the camera and posted the video of the execution on Youtube. The execution of an American journalist shocked the world community. US President Barack Obama called it cruel and terrible, promising to do everything necessary to ensure that justice prevails, but did not say what specific additional measures he was going to take.

The United States launched a covert operation in Syria this summer to rescue journalist James Foley and other Americans from Islamic State (ISIL) militants, the Washington Post reports, citing officials in the Obama administration.

Several dozen American commandos took part in the operation, one of which was wounded in a fierce skirmish with the militants. This failed operation was the first US ground operation in Syria engulfed in civil war.

“Early this summer, the President (ed.dp.ru – US President Barack Obama) ordered an operation to try to rescue American citizens held by ISIL,” one of two senior officials told the publication.

According to him, in order to save the captured Americans, it was necessary to act “very quickly and very aggressively.” However, the operation failed because there were no hostages at the intended location. Other sources said the captives were believed to have been there, but they were taken away a few weeks before the operation. Former US officials told the publication that the journalists were being held in eastern Syria near the city of Raqa, which is controlled by militants.

Read also:

A video of the execution of American journalist James Foley appeared on Youtube without…

US National Security Council spokeswoman Caitlin Hayden said on Wednesday evening: “We were going to never reveal this operation, primarily taking care of the safety of the hostages “.

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Pictured: James Foley

Written by Global Look Press

The Islamic State group on Tuesday posted a video of the execution of American journalist James Foley online. James Foley was beheaded on camera. In his last hour, he knelt in the sands, dressed in an orange uniform very similar to American prison suits. The journalist’s “executioner” said the execution was a response to US airstrikes in Iraq. In his last speech, James Foley named the US government as his killer. The video ends with the gunman, dressed head to toe in black, slits Foley’s throat.

The video is accompanied by the message: “We will drown you all in blood.” The militants promise to take revenge on the Americans “anywhere” at their discretion.

US President
Barack Obama called the assassination “horrible” and “brutal”. In addition to Foley, another journalist is captured in the video – Stephen Sotloff from American Time. The “executioner” warned that the man’s life depended on Obama’s next decision.

Barack Obama said on Wednesday that the United States will be “vigilant and merciless” in the fight against Islamic State extremists and will do everything necessary to ensure that justice is served and Foley’s killers are punished.