Long term foley use

merlee · Nov 23, 2011

I've seen pts w/foleys for years and years and years. Seriously. Without major complications. Some needed to have the foley changed q2weeks to prevent infections.

Good hygiene is a must - it is imperative!

You don't mention what the dx is and whether or not it may play a role in the complications.

Be certain that the caregivers are taught about keeping the bag below the level of the bladder, how to empty the tubing, and good hygiene.

Best wishes!

Double-Helix, BSN, RN · Nov 23, 2011

When I was a CNA in LTC there was a patient (morbidly obese, no bed mobility, major skin breakdown) who had a foley for several years. I don't know the exact number of years. Foley was changed monthly and the bag weekly. She eventually ha need request issues with infection and leaking around the foley and had a supra pubic inserted.

Would a condom catheter be an option for this patient? Perhaps just frequent changing and a good skin barrier cream. Is his prognosis good enough that he would benefit from a supra pubic? It might help to remove the catheter for a week or two and then reinsert.

As you mentioned, foleys in dying patients are for comfort. It doesn't sound like this catheter is giving him comfort anymore, in fact it's the opposite. So it sounds like its time to consider pulling it.

Trekfan · Nov 23, 2011

When I was a CNA in LTC there was a patient (morbidly obese, no bed mobility, major skin breakdown) who had a foley for several years. I don't know the exact number of years. Foley was changed monthly and the bag weekly. She eventually ha need request issues with infection and leaking around the foley and had a supra pubic inserted.
Would a condom catheter be an option for this patient? Perhaps just frequent changing and a good skin barrier cream. Is his prognosis good enough that he would benefit from a supra pubic? It might help to remove the catheter for a week or two and then reinsert.
As you mentioned, foleys in dying patients are for comfort. It doesn't sound like this catheter is giving him comfort anymore, in fact it's the opposite. So it sounds like its time to consider pulling it.

You still get bladder spams and infections with a supra pubic , also the supra pubic hurt after they are put in for weeks and there is a LOT of pain where changeing them I am in tears when my is done :crying2:

FLArn · Nov 23, 2011

Check to see if the foley is the correct size and that the balloon is not overinflated. This can cause spasms, very few patients actually need the balloon to be inflated with more than 10 to 15 cc. and unless the patient is prone to passing blood clots (i.e. ES Bladder CA) the smaller the foley the better. Also suggest using Levsin for spasms, it is often helpful when other meds quit working.

tcvnurse, BSN, RN · Nov 23, 2011

The foley must be changed monthly. Bags can be cleaned with vinegar/water or diluted bleach solution. Sadly, every patient I have had with a long term foley has had issues with UTI's most of them resistant to conventional antibiotic. Many ended up with suprapubic catheters which are worse in some ways when it comes to infections.

poopprincess · Nov 23, 2011

You could take it out and see if it helps. Suprapubic catheter is not necessary if he is dying. Sometimes irrigating the catheter can help-if there is blood or sediment that is clogging it then it may be the cause the of the spasms. Also Lasix can cause bladder spasms. Hope you find a way to get your patient some peace.

seemerun · Nov 23, 2011

Foley's can stay in years. Also, evidence-based research now recommends NO routine catheter changes. Weird to get my mind around that one but my friend just did her ARNP thesis on long-term cath mgmt and they state to leave the same cath in indefinitely and only change if occluded or when you need to get a UA. Also recommending NO flushing. Apparently changing the cath is a better option if occluded then flushing. Crazy. But FYI - cath placement for comfort in dying patient is totally legit reason for cath. But you have to weight the comfort of cath vs bladder spasms.

CapeCodMermaid, RN · Nov 23, 2011

I agree.changing a catheter every month is not necessary and only serves to expose the patient to a higher risk of infection. After 5 months of a catheter, the poor man's bladder won't be working all that well. Take it out and make sure he can void without it.

mindlor · Nov 23, 2011

Foley's can stay in years. Also, evidence-based research now recommends NO routine catheter changes. Weird to get my mind around that one but my friend just did her ARNP thesis on long-term cath mgmt and they state to leave the same cath in indefinitely and only change if occluded or when you need to get a UA. Also recommending NO flushing. Apparently changing the cath is a better option if occluded then flushing. Crazy. But FYI - cath placement for comfort in dying patient is totally legit reason for cath. But you have to weight the comfort of cath vs bladder spasms.

This flies in the face of every text that I know of. I would love it if you could post a link to this evidence-based study.

Thanks

thehipcrip · Nov 23, 2011

He should be on some anticholinergic medications to both prevent painful bladder spasms and to help prevent bladder shrinkage. Just because the ditropan didn't work doesn't mean others shouldn't be tried -- some people may need a combination of meds to prevent spasms, control leaking, etc.

NEVER clean a collection bag with vinegar. Studies have shown that pseudomonas thrives in bags cleaned with vinegar. Instead, use a 10 percent bleach solution. Do two tap water rinses, swishing the water around for 15 seconds each. Then fill the bag 1/3 full with the 10 percent bleach solution and swish it around for 30 seconds. Drain and air dry without rinsing.

Why is he on antibiotics full time? The presence of bacteria in his urine alone is considered colonization and should not be treated with antibiotics. Only symptomatic UTIs should be treated -- i.e. bacteria and fever, flank pain, malaise, blood in the urine, elevated white count. Run a C&S on the first urine collected immediately after a new catheter has been put in so you're certain you're treating the bacteria that's present in his bladder and not just the bacteria colonized in the old catheter.

I'd really appreciate it if someone would post a link to the 'evidence-based research' advocating not changing indwelling catheters on a regular basis.

ETA: Are you sure the research you're talking about didn't show that there was no benefit to changing catheters at arbitrary fixed intervals -- i.e. every four weeks -- but should instead be changed as needed based on clinical symptoms [encrustations, leakage, etc.] and tailored to an individual's needs rather than actually advocating *no* cath changes? Someone who only skimmed this article might read the bullet point about no arbitrary cath changes and interpret it incorrectly to mean no changes at all.

mindlor · Nov 23, 2011

He should be on some anticholinergic medications to both prevent painful bladder spasms and to help prevent bladder shrinkage. Just because the ditropan didn't work doesn't mean others shouldn't be tried -- some people may need a combination of meds to prevent spasms, control leaking, etc.
NEVER clean a collection bag with vinegar. Studies have shown that pseudomonas thrives in bags cleaned with vinegar. Instead, use a 10 percent bleach solution. Do two tap water rinses, swishing the water around for 15 seconds each. Then fill the bag 1/3 full with the 10 percent bleach solution and swish it around for 30 seconds. Drain and air dry without rinsing.
Why is he on antibiotics full time? The presence of bacteria in his urine alone is considered colonization and should not be treated with antibiotics. Only symptomatic UTIs should be treated -- i.e. bacteria and fever, flank pain, malaise, blood in the urine, elevated white count. Run a C&S on the first urine collected immediately after a new catheter has been put in so you're certain you're treating the bacteria that's present in his bladder and not just the bacteria colonized in the old catheter.
I'd really appreciate it if someone would post a link to the 'evidence-based research' advocating not changing indwelling catheters on a regular basis.

Hey guys a request. Many folks love to use the phrase, studies have shown blah blah blah, please post a link to the study you are referring to.....

Thanks :)