Start with a free account for 3 free CME credits. Already a subscriber? Sign in.

WDIDN: My Foley is Clogged

Andy Little, DO, Mike Weinstock, MD, and Matthew DeLaney, MD, FACEP, FAAEM
00:00
15:57

No me gusta!

The flash player was unable to start. If you have a flash blocker then try unblocking the flash content - it should be visible below.

Doctor Andy Little sits down to discuss how to troubleshoot a clogged catheter in the urgent care setting, including common presentations, and how to unclog the catheter.

Pearls:

  • Not everyone with a clogged Foley catheter requires a new catheter.

  • Understanding urinary catheter anatomy is critical to thinking about the various things that can cause an obstruction.

  • The 2 types of catheter obstruction are mechanical and physical.

  • As a provider, a good exam of the catheter includes manipulating it in the bladder, inflating/deflating the balloon, and irrigating with saline.

 

Foley catheters are usually placed for one of two reasons:

  • Short term placement

    • Post-surgical

    • Urinary retention

  • Indwelling/chronic

Foley anatomy 

  • Eyelet

    • where urine drains from the bladder 

    • located a few mm from the tip of the catheter (on the side)

  • Balloon

  • Neck (catheter)

  • Drainage Port (where it connects to the bag tubing)

  • Tubing between the bag and Foley

  • Bag (leg versus traditional)

    • Link to image of Foley anatomy

2 types of Foley obstruction:

  • Mechanical obstruction

    • Foley balloon may be overinflated

    • Kinking related to Foley catheter placement on the patient's leg

    • The angle at which it rests in the urethra (more a problem with men)

    • Issue with the bag attached to the Foley (consider replacing the tubing and the bag)

  • Physical obstruction

    • Sediment

    • Blood

Trouble-shooting an obstructed catheter in the UC

  • Do a “physical exam” of the catheter

    • Detach the catheter from the leg bag.

    • Manipulate the catheter into the bladder by advancing it and then pulling it out a couple of cm. This can move a blood clot or sediment in the bladder and potentially relieve the obstruction.

    • Ensure that the balloon was inflated correctly by removing a couple ccs of water and then reinjecting it. If you can drain 15 ml out of a 5 ml capacity balloon, you know it was overinflated. 

  • Replace the bag and tubing

  • Disconnect the Foley and irrigate the catheter

    • Detach the tubing and inject 10-15 ml of saline into the bladder. This may relieve an obstruction of blood or sediment blocking the eyelet.

    • If you’re able to relieve the obstruction with simple irrigation of the Foley, consider teaching the patient and/or family how to self-irrigate in the event of a recurrent obstruction.

    • If you’re unable to relieve the obstruction, consider injecting the catheter with liquid docusate (brand name Colace) to break up a “sediment clog” much like using it for an impacted ear.

  • If the above measures don’t restore flow, replace the foley.

A urinalysis is only recommended for patients with a clogged Foley if the clinical context suggests an infection (fever, flank pain, vomiting, tachycardia, hypotension, altered mental status,  etc). 

 

References:

  1. Cravens D, et al. Urinary Catheter Management. Aafp.org. https://www.aafp.org/afp/2000/0115/p369.html#afp20000115p369-b1. Published 2021. Accessed June 8, 2021.

  2. Newman D. Complications -Indwelling Catheters. Urotoday.com. https://www.urotoday.com/urinary-catheters-home/indwelling-catheters/complications/problems.html. Published 2013. Accessed June 8, 2021.

To join the conversation, you need to subscribe.

Sign up today for full access to all episodes and to join the conversation.

To download files, you need to subscribe.

Sign up today for full access to all episodes.
Hippo Urgent Care RAP August 2021 Written Summary 624 KB - PDF

To earn CME for this chapter, you need to subscribe.

Sign up today for full access to all episodes and earn CME.

0.25 Free AMA PRA Category 1 Credits™ certified by Hippo (2021)

  1. Complete Quiz
  2. Complete Evaluation
  3. Print Certificate

3.25 AMA PRA Category 1 Credits™ certified by Hippo (2021)

  1. Complete Quiz
  2. Complete Evaluation
  3. Print Certificate