Name of the Procedure:

Placement of an Indwelling Catheter, Foley Type, Two-Way, All Silicone (HCPCS Code A4344)

Summary

An indwelling catheter, commonly known as a Foley catheter, is a flexible tube inserted into the bladder to drain urine. The catheter remains in place for an extended period, making it suitable for patients who need continuous urinary drainage.

Purpose

This procedure addresses various medical conditions, such as urinary retention, postoperative urine drainage, or chronic bladder issues. The goal is to ensure proper urine output and prevent complications related to urinary retention.

Indications

• Acute or chronic urinary retention
• Monitoring urine output in critically ill patients
• Pre and post-surgical bladder management
• Urinary incontinence in bedridden or immobile patients
• Certain medical conditions like neurological disorders affecting bladder function

Preparation

• No specific fasting or dietary restrictions; however, follow any instructions given by your healthcare provider.
• Inform your healthcare provider about any allergies or current medications.
• A urinalysis or urine culture may be required to check for existing infections.

Procedure Description

1. The patient is positioned comfortably, usually lying down.
2. The genital area is cleaned and sterilized to prevent infection.
3. A lubricated Foley catheter is carefully inserted into the urethra and advanced into the bladder.
4. Once urine flow is observed, the catheter's balloon is inflated with sterile water to keep it in place.
5. The external end of the catheter is attached to a drainage bag.

Tools and Equipment:

• Foley catheter (silicone, two-way)
• Sterile gloves and drapes
• Lubricant
• Antiseptic solution
• Sterile water
• Drainage bag

Anesthesia:

• Typically, no anesthesia is needed, but a topical anesthetic may be applied for comfort.

Duration

The insertion takes approximately 10-15 minutes.

Setting

The procedure is usually performed in a hospital, outpatient clinic, or sometimes at home by a trained healthcare provider.

Personnel

• Nurse or trained healthcare provider
• Physician (in some cases)

Risks and Complications

• Infection (urinary tract infection, UTI)
• Bladder spasms
• Urethral injury or discomfort
• Blood in urine (hematuria)
• Blockage of the catheter

Benefits

• Immediate relief from urinary retention
• Accurate urine output measurement
• Reduced risk of bladder complications associated with urine retention
• Improved patient comfort for those with urinary incontinence

Recovery

• Maintain cleanliness around the catheter area.
• Drink plenty of fluids to help keep the urinary system flushed.
• Follow any specific instructions provided by your healthcare provider.
• Regularly empty and clean the drainage bag.
• Avoid pulling on the catheter to prevent dislodgment.

Alternatives

• Intermittent catheterization
• Suprapubic catheter placement
• Medication to manage underlying urinary issues
• Bladder training or pelvic floor exercises

Pros and Cons:

• Intermittent catheterization: Reduces infection risk but requires frequent insertion.
• Suprapubic catheter: Provides long-term drainage, but involves a minor surgical procedure.
• Medications: Non-invasive but may not be effective for all conditions.

Patient Experience

During the procedure, patients might feel some discomfort, particularly when the catheter is first inserted. Post-procedure, there may be a sensation of needing to urinate or mild discomfort, which usually subsides. Pain management, including over-the-counter pain relievers, may be recommended for discomfort. Regular monitoring by a healthcare provider ensures any issues are promptly addressed.