Indwelling Catheter Definition & Types

What is an Indwelling Catheter?

An indwelling urinary catheter (IUC), generally referred to as a “Foley” catheter, is a closed sterile system with a catheter and retention balloon that is inserted either through the urethra or suprapubically to allow for bladder drainage. External collecting devices (e.g. drainage tubing and bag) are connected to the catheter for urine collection 

Indwelling urinary catheters are recommended only for short-term use, defined as less than 30 days (EAUN recommends no longer than 14 days.) The catheter is inserted for continuous drainage of the bladder for two common bladder dysfunction: urinary incontinence (UI) and urinary retention.

Two Types of Indwelling Catheters

Indwelling urinary catheters are either inserted:

1. Transurethrally
2. Suprapubically

Suprapubic catheterization is usually used for bladder drainage following in bladder, urethral or pelvic surgery, or following genitourinary trauma. Both methods of indwelling catheterizations are associated with complications.

In practice, transurethral catheterization is the typical approach because the procedure can be organized and managed by nurses whereas suprapubic catheterization requires a more complex procedure. However, if in place long-term, defined as more than 30 days, the insertion, changing and management are done by nurses (registered nurses, licensed practical nurses). 

Transurethral Catheterization

Transurethral indwelling catheterization or urinary catheterization is defined as passage of a catheter into the urinary bladder via the urethra (urethral catheter). Transurethral indwelling catheterization is also called urethral catheterization. In this site, we only use the term urethral catheterization.

Suprapubic Catheterization

Suprapubic catheterization is the insertion of a catheter into the bladder via the anterior abdominal wall.  The catheter is inserted through an incision made above the pubic bone and below the umbilicus. The insertion of this type of catheterization is done by a urologic specialist. Long term catheterization can be associated with many serious problems including urinary tract infections, urethritis, bladder spasms with pain and urinary leakage, and other bladder complications.

Use Patterns

Short Term

Short-term uses include:

• Management of acute urinary retention.
• Postoperative bladder decompression following GU surgery or pelvic trauma.
• Monitoring urinary output in acutely ill patients.

Long Term & CAUTI

Long-term use, defined as greater than 30 days, is discouraged because it provides access for bacteria from a contaminated environment into a vulnerable body organ and system. 

As a result, catheter-associated urinary tract infection (CAUTI) is the most common type of infection acquired in hospitals and  nursing homes. At least 15% to 25% of patients may have an indwelling catheter inserted sometime during their hospital stay, with most only used for the short-term (defined as < 30 days).   Prevalence is greater in high acuity patient units, with critical care and intensive care units having the highest prevalence.  CAUTIs are associated with multiple complications and side effects, can lead to increased length of stays, mortality rates, and ultimately higher hospital costs.  

Closed Drainage System

A closed catheter drainage system is an aseptic system in which the path from the tip of the catheter inserted into the bladder, to the bag which catches urine, is closed and should not be disconnected. This structure is designed to eliminate inoculation of the urinary tract with bacteria via the catheter drainage tubing and from the collection bag. The term ‘closed drainage’ is, however, not entirely accurate as there are often numerous portals of entry of pathogens and the system must be opened to allow emptying and be disconnected when the drainage bag is changed 

This resource center provides in-depth information on the indwelling Foley catheter from the indication through the complications and prevention strategies. It also has resources that offer tools and on-demand education webinars on appropriate use of the catheters to understanding CAUTI.

Written by: Diane K. Newman, DNP, Continence Nurse Specialist

References

1. Hunter KF, Bharmal A, Moore KN. Long-term bladder drainage: Suprapubic catheter versus other methods: a scoping review. Neurourol Urodyn. 2013 Sep;32(7):944-51. doi: 10.1002/nau.22356
2. Newman DK, Cumbee RP, Rovner ES. Indwelling (transurethral and suprapubic) catheters. In: Newman DK, Rovner ES, Wein AJ, editors. Clinical Application of Urologic Catheters and Products.  Switzerland: Springer International Publishing; 2018,  47-77.
3. Newman DK. Devices, products, catheters, and catheter-associated urinary tract infections. In: Newman DK, Wyman JF, Welch VW, editors. Core Curriculum for Urologic Nursing. 1^st ed. Pitman (NJ): Society of Urologic Nurses and Associates, Inc; 2017, 439-66.
4. Newman DK. The indwelling urinary catheter: Principles for best practice. JWOCN. 2007;34:655-61 DOI: 10.1097/01.WON.0000299816.82983.4a
5. Meddings, J, Rogers, MA, Macy, M, & Saint, S. Systematic review and meta-analysis: reminder systems to reduce catheter-associated urinary tract infections and urinary catheter use in hospitalized patients. Clin Infect Dis. 2010, 51(5), 550-60. doi: 10.1086/655133
6. Weber DJ, Sickbert-Bennett EE, Brown V. & Rutala WA. Comparison of hospital wide surveillance and targeted intensive care unit surveillance of healthcare-associated infections. Infect Control Hosp Epidemiol. 2007,28(12), 1361-1366. doi: 10.1086/523868

Ultimate Guide to Different Types of Urinary Catheters

May 03,2019 |

Urinary catheters are hollow, flexible tubes that assist in urination. They collect urine directly from the bladder and lead it outside of the body into a drainage bag.¹ There are a number of reasons why someone might need a urinary catheter, but in general, catheters are used when someone can’t empty their bladder on their own. This is called urinary retention.²Catheters are an important medical device since when your bladder doesn’t empty, it puts unnecessary stress and strain on your kidneys, which eventually leads to kidney failure.¹ Serious and elongated cases of kidney failure often results in permanent, irreversible damage.

There are a number of different sizes, types, and materials that catheters come in. Catheters are only used until a person regains the control to urinate on their own, making them primarily short-term solutions. However, there are some cases where prolonged or permanent catheter use is needed, such as in elderly people or people with severe illnesses.¹

When to Use a Urinary Catheter

As we mentioned, the primary cause for getting a urinary catheter is in short periods of time where you may not be able to empty your bladder on your own. If you’re having difficulty controlling your urination, urinary incontinence, or urinary retention, your doctor will likely recommend a catheter. ¹

Urinary incontinence is when accidental urine loss occurs and can happen in both men and women.²Urinary retention occurs when you can’t empty your bladder without added help.

There are a number of reasons you might be experiencing these problems, but the catheter will allow your doctor to find the underlying cause and address the problem. Bladder or kidney stones, blood clots, or recent surgery in the hip area are primary culprits. Certain medications can also impair the effectiveness of your bladder muscles, making it difficult to completely empty your bladder on your own. Talk to your doctor about any and all medications you are taking if you experience problems with incontinence, retention, or overall urine control.

In more severe instances, such as nerve injuries to the brain, spinal cord, or bladder, multiple sclerosis, spina bifida, dementia or an enlarged prostate, long-term catheter use is often recommended.

Types of Urinary Catheters

If you need to get a urinary catheter, there are a few different types to be aware of. Your doctor will work with you to find the type of catheter that works for your specific condition and comfort levels, but if your doctor approves, you can test out a few to make sure you find the best fit. Typically, catheters are made from silicone, latex, or a combination of the two.³

Intermittent Catheters 

If you only need to wear a catheter for a short period of time, such as after a surgery, your doctor will recommend an intermittent catheter. Intermittent catheters are used for many bedridden or ambulatory patients. The catheter connects to a drainage bag that can then be emptied into the toilet. Using an intermittent catheter means that you will need to insert and remove the catheter multiple times throughout the day.⁵

Luckily, using an intermittent catheter is easy, effective, and safe. With some practice, most people with mobility can insert and remove the catheter on their own, without the assistance of a medical professional. This is more beneficial than using a prolonged, continuously draining catheter because it has less risk for distended bladders or infection.⁵ It also allows you to maintain a normal, active lifestyle.

Intermittent catheters come in straight tip, coude tip, or closed system kits.

Straight Tip Catheters

A straight tip catheter is a catheter that is 100% straight, from one end to the next. Since they’re made with flexible materials, straight tip catheters can still move and bend, but without added pressure it stays straight. This is one of the most common types of catheters and come in a variety of lengths to accommodate differing lengths of the male and female urethra. People with an unobstructed pathway to the bladder will use a straight tip catheter. Straight tip catheters do not come pre-lubricated, so you will need to add an extra step to the insertion process.

Coudé Tip Catheters

A coudé tip catheter is straight for the most part but has a curved tip. The slight bend or angle allows the catheter to bypass any obstructions—such as scar tissue or an enlarged prostate—that may be blocking the urethra.³

Depending on your specific needs, there are a few variations of coudé catheters to choose from. A coudé olive tip has a bent tip with a small bulb at the end, further assisting in navigating obstructions.³ A coudé tiemann tip is longer, thinner, and more flexible, making insertion easier in smaller openings.³ Coudé tip catheters do not come pre-lubricated either.

Closed System Kits

If you’re worried about contamination, closed system kits are a good catheter to consider. These are self-contained catheters that come pre-lubricated and contain their own collection bag.⁴ The “touchless” insertion process allows you to keep contamination from being introduced into the urethra. The collection bag allows your urine to empty into a transportable bag rather than into a toilet or open receptacle. Closed system kits are great for people that travel often or need an easier way to empty their bladder throughout the day. They’re also a great alternative for people who have limited mobility.

Indwelling Catheters

An indwelling catheter is a type of internal urinary catheter, meaning that it resides entirely inside of the bladder. These include urethral or suprapubic catheter and are most commonly referred to as Foley catheters.¹

These catheters are most commonly inserted into the bladder through your urethra. However, a suprapubic catheter is inserted through a small incision or hole in your abdomen.¹ Both types of indwelling catheters are equipped with a small, water filled balloon at the end to ensure that the catheter stays in place. When the catheter needs to be removed, the balloon is deflated.

Indwelling catheters are typically used when a person needs a catheter for a prolonged period of time. Since they reside inside of your bladder, they cannot be inserted without a medical professional. The indwelling catheter is attached to a bag that can be worn on your body, similarly to a colostomy bag.

External Catheters

External catheters are placed outside the body. There are two primary types of external catheters: condom catheters and female urethral inserts. Condom catheters are primarily used for men with serious functional or mental disabilities as they are simple to use and much less invasive.¹ They slip over the head of the penis, similarly to a condom, and carry urine away from the body through a tube connected to a drainage bag.¹ 

Female urethral inserts are alternatives to catheters for women who experience urinary leakage.¹ It’s inserted into the urethra and ultimately creates a soft seal near the end of the bladder. Due to the differences in anatomy across each woman, female urethral inserts can be custom fit by a medical professional.

Urinary Catheter Complications

As with any external medical device, using urinary catheters pose a risk of complications. For example, they are the leading cause of healthcare-associated urinary tract infections.¹ To reduce the risk of any complications, it’s important to practice good hygiene during catheter insertion, removal, and maintenance.

In addition to increased risk of UTIs, urinary catheters may produce allergic reactions. If you notice any signs of an allergic reaction, it’s important to talk to your doctor immediately. Sometimes it’s a simple fix, such as alternating latex for silicone, and other times it requires a more in-depth analysis.

Urinary catheters have the potential to increase your risk for bladder stones, bloody urine, urethra injury, kidney damage, or septicemia.

To avoid any complications, make sure you clean the catheter along with the entry site with soap and water frequently. If you’re using one-time catheters, always discard them after each use. Staying hydrated is the best way to make sure that your urine is regularly expelled from your body, which removes bacteria from the urethra and reduces the risk of developing a UTI.

Conclusion

If you think you may benefit from getting a urinary catheter, talk to your doctor today. Urinary catheters are a great way to improve the lifestyle of someone with urinary incontinence, urinary retention, or problems controlling your bladder. To learn more about types of urinary catheters, urology problems, or if you need supplies or educational resources, visit our educational support page or our product selection guide. Byram is a full-service urological care supplier and offers a wide selection of high-quality urological supplies that are discreetly delivered to your home. We also offer a team of knowledgeable urological customer service specialists to help answer questions and offer you personalized, confidential services.

Sources:

1https://www.healthline.com/health/urinary-catheters

2https://my.edgepark.com/uro_learn

3https://www.exmed.net/blog/expressmedicalsupply/post/2016/11/07/straight-tip-vs-coude-tip-catheter. aspx

4https://www.180medical.com/blog/what-is-a-closed-system-catheter/

5https://www.healthline.com/health/intermittent-catheterization

How to care for the indwelling urethral Foley catheter

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In the article about urinary catheters, we talked about the difference between permanent and intermittent catheterization and what types of permanent urethral catheters are. In this article, you will learn how to care for a Foley catheter: who is prescribed it, whether it should be flushed, and how often to change it.

The information in the article is for reference only. Please do not self-medicate. Only your doctor can make an accurate diagnosis and choose the right treatment.

The content of the article:

• When to use indwelling catheters
• Why use a Foley catheter
• How to insert a Foley catheter
• How often to change the Foley catheter
• How to care for an indwelling urethral catheter
• Can the Foley catheter be flushed
• How to care for your urinal
• How to shower with a Foley catheter
• How to prevent infections
• When to contact a specialist

In what situations are indwelling catheters prescribed

¹

Indwelling catheters, or bladder drains, are needed when intermittent catheterization is not possible. For example, they can be prescribed to a seriously bedridden patient or a patient after surgery. The decision to install a catheter is made by the doctor.

Indwelling catheters are held in the bladder with a special balloon that is inflated after insertion. A urinal is connected to the catheter through a tube – urine flows from the bladder into it. The urinal is emptied through the drain valve as it fills up. The catheter itself does not require replacement after each emptying.

Conveen Standart urinal from Coloplast with drain valve to collect urine

Usually, permanent catheterization is used in a hospital setting or outside it for a short period, for example, after discharge. For a long time, such catheters are installed when it is not possible to use other methods of urine diversion.

A Foley catheter is a type of indwelling catheter. It is usually made from latex and coated with silicone. It can be 2-way or 3-way, with a 5–70 ml balloon.

Two way Foley catheter. Photo source – AliExpress

Why use a Foley catheter

Foley catheter in urology is used to:

• remove urine from the bladder in case of acute retention,
• administer drugs or contrast agents before an X-ray of the bladder,
• measure hourly diuresis – the amount of urine excreted per day ² ,
• to ensure a long continuous outflow of urine.

This type of catheter can be used for short-term and long-term catheterization in men and women.

Three-way Foley catheter. Photo source – AliExpress

How to insert a Foley catheter

In an article about the types and symptoms of urinary retention, we described how a permanent catheter is installed in a hospital setting for a male patient. Here is how the medical staff performs this manipulation with the Foley catheter for patients ⁶ :

• Explains the course of the procedure, obtains consent.
• Shields the patient with a screen if the procedure is performed in the ward, and lays an absorbent sheet under the pelvis.
• Helps the patient lie on her back and spread her legs bent at the knees.
• Washes hands and disinfects external genitalia with aseptic solution.
• Places the tray between the patient’s legs and prepares the instruments.
• Lubricates the catheter with glycerin or other lubricant and inserts it into the urethra 10 cm or until urine appears.
• Drains urine into a tray and fills catheter balloon with 10–30 ml of sterile saline or sterile water.
• Connects the catheter to the urinal and tapes it to the thigh or abdomen.
• Helps the patient to lie down comfortably and places the used material in the disinfectant container.
• Washes hands and makes a note of the procedure done.

How often to change the Foley catheter

There is an instruction for the Foley catheter, which in Russia is the main document regulating its use. According to it, the catheter can stay in the bladder cavity for no more than seven days.

In the article about urinary catheters, we said that on the issue of the frequency of catheter replacement, the established practice may contradict regulatory documents. Sometimes the catheter is changed once a month.

A Foley catheter may be used for a long period of time, but it is not the definitive method of diverting urine. The catheter can injure the urethra and cause irritation, provoke the development of infection (urethritis), so the doctor and patient discuss other options for bladder drainage. Usually, patients with a urethral catheter are offered to switch to intermittent catheterization or install a permanent cystostomy drain.

How to care for an indwelling urethral catheter

The Moscow government has developed instructions for the care of the Foley catheter ¹ for patients:

The Foley catheter cannot be removed on its own, it is removed by the medical staff. After the catheter is removed, the urologist observes the patient and evaluates diuresis within 4–5 days.

The doctor gives the patient clear recommendations on the care of the Foley catheter and the replacement of urinals. The task of the patient is to follow them, because proper care of the catheter reduces the risk of developing infections. The doctor will also tell you what to do next: how often to undergo ultrasound of the kidneys, bladder and take tests.

Can the Foley catheter be flushed

Previously, doctors recommended that patients flush indwelling catheters twice a day with a solution of furacilin. Now this practice has been abandoned in Russia and in the world. An infusion of any agent is used to treat bladder infections or to administer drugs or contrast agents before x-rays.

How to care for your urinal

An integral addition to the Foley catheter is a urinal. We talked about how to use it correctly in the article of the same name. We list the main requirements for caring for him:

• Urine bags need to be replaced every 3 days. Otherwise, they can become an additional source of infection.
• The urinal is always placed vertically. So urine cannot get back into the catheter.

Purification. Clean the bag every 3-4 hours, if necessary and before showering. It is important not to overfill the urinal.

Replacement for ³ . Before changing the urinal, the patient washes his hands with soap and treats the place where the urinal is connected with any aseptic solution. Then he attaches a new urinal to the catheter and makes sure that urine flows into it. In addition, the patient makes sure that the urinal is below the level of the bladder and the connecting tube ⁴ .

Disposal ⁵ . Urine is drained from the bag, washed with water, wrapped in paper and placed in a plastic bag. The urinal can be thrown into the trash. You can’t throw it into the toilet – it can clog the sewer.

How to shower with a Foley catheter

Patients can take a shower on the day of the catheter placement. Before starting the procedure, the urinal is emptied, and the catheter is clamped with a special clip, which is sold in a pharmacy. The skin around the catheter is washed with warm water and baby or ph-neutral soap.

How to prevent infections

Patients with a Foley catheter must observe the timing of the replacement of catheters and urinals. Catheters are changed every 7 days, urinals – every 3 days.

It is important for such patients to maintain overall good health. To do this, it is enough to eat right, get enough sleep, experience positive emotions and follow a drinking regimen that normalizes the functioning of the kidneys.

Herbal medicines and urological preparations are indicated for the prevention of infections. The best option is selected by the doctor: you need to make an appointment with him so that he writes down the regimen for taking the drugs.

We must not forget about personal hygiene: take a regular shower and wash your hands before touching the catheter or urinal.

Another way to prevent infections is to correct comorbidities in order to prevent exacerbations. For those who wear catheters for five years or more, it is recommended to have bladder cancer screening every year1. The fact is that the use of a catheter for such a long time increases the risk of oncological processes.

If the patient does not have the opportunity to undergo screening so often, then once every three years it is recommended to do cystoscopy and annually ultrasound of the bladder.

It is important that the catheter does not kink even during sleep. Otherwise, the excreted urine will not be able to enter the urinal. This is easy to follow for most patients with a Foley catheter because they are recumbent, rarely roll over, and move little in bed.

If a catheter is installed in a person without neurological pathology, for example, in a patient with prostate adenoma, then he himself controls the position of the catheter. For this you should:

• limit drinking at night;
• straighten out all kinks and twists in the tube beforehand;
• replace the foot urinal with a night one;
• wake up to check if everything is in order.

When to contact a specialist

It is important for patients with catheters to pay attention to changes in their condition. Emergency medical attention is required in the following situations:

• catheter fell out;
• after insertion of the catheter, itching, irritation or discomfort in the urethra;
• the temperature has risen;
• urine stopped flowing into the urinal;
• less urine than usual;
• stomach ache;
• urine has acquired a sharp unpleasant odor;
• blood clots or mucus appeared in the urine.

To make it easier to notice changes in their condition, patients with a Foley catheter are advised to keep a urination diary. It will help control diuresis.

The urination diary can be printed or downloaded as an application to a smartphone. The volume of urine is determined by divisions on the urinal.

Example of mobile app for urine output

Sources

1. Government of Moscow, Department of Health of the city of Moscow. Providing emergency care for urinary retention at the pre-hospital stage. Educational and methodological recommendations No. 30. Moscow, 2018. Date of access: 10.02.2022.

2. Mukhina S.A., Tarnovskaya I.I. “Theoretical Foundations of Nursing”. Publisher: GEOTAR — Media, 2016. P. 267. Date of access: 04/12/2022.

3. Infographic “Care of the urinary catheter”. Date of access: 14.02.2022.

4. M. Grabe, R. Bartoletti, T.E. Bjerklund-Johansen, H.M. Çek, R.S. Pickard, P. Tenke, F. Wagenlehner, B. Wullt Recommendations for urological infections. 2014, p. 45.

5. Educational and methodological development in the academic discipline “Technology for the provision of medical services. ” “Catheterization of the bladder with a soft catheter. Insertion and care of an indwelling urinary catheter. Date of access: 02/16/2022.

6. A.F. Chemodanova, O.E. Komissarova O.E. Educational and methodological development in the academic discipline PM 04. “Catheterization of the bladder with a soft catheter. Insertion and care of an indwelling urinary catheter. 2017. Date of access: 04/15/2022.

Author

Artem Valeryevich Bershadsky

Urologist, candidate of medical sciences.

14 years of experience

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Author

Artem Valerievich Bershadsky

Urologist, candidate of medical sciences.

14 years of experience

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Indwelling bladder catheter | Ida-Tallinna Keskaigla

The purpose of this leaflet is to help patients use an indwelling bladder catheter at home.

An indwelling catheter is inserted into the bladder to drain urine. An indwelling catheter does not restrict patient movement.

What must be observed?

Cleanliness is most important

• Always wash your hands before using the bladder catheter and urine collection bag.
• Avoid touching the inside of the catheter and the connection parts of the collection bag.
• Keep the catheter tube clean at all times.
• Keep the area around the catheter clean. Wash your face twice a day.
• Check daily that the catheter is in good condition and the condition of the skin.
• Check every day for any discharge from the urethra.
• It is allowed to take a shower, take a bath and visit the sauna is not recommended.
• Swimming is also not recommended.

Proper handling of the urine collection bag

• The bladder catheter is connected to a replaceable urine collection bag. The urine collection system must be hermetically sealed.
• Attach the collection bag so that the catheter is not stretched and neither the catheter nor the collection bag is kinked.
• While standing and walking, ensure that the collection bag is secured below the bladder (eg on the thigh). When you are lying down, the urine collection bag should be below body level (for example, on the side of the bed). This position ensures that urine flows freely into the collection bag and prevents urine from flowing back from the collection bag into the bladder.
• Use a urine collection bag that can be emptied through the valve (plug) at the bottom of the bag.
• Change the collection bag once a week, or more frequently if necessary (eg if the bag is damaged or clogged).

Adequate fluid intake

• If you are not contraindicated due to any other medical condition, drink plenty of fluids throughout the day.
• Abundant fluid intake ensures a constant flow through the urinary tract and catheter, thus helping to avoid sedimentation and inflammation.
• Drink at least 1.5–2 liters of fluid daily.

Possible problems

Some of the following problems may occur when using an indwelling bladder catheter:

• high fever;
• pain in the lower abdomen;
• urine becomes bloody or cloudy or begins to smell bad;
• catheter is broken or clogged.

If you experience any of these problems, contact your family doctor or nurse, or go to the emergency department of the nearest hospital.

The decision to stop or continue catheterization, change the catheter is made by the doctor in accordance with your condition.