A Foley catheter is a thin, flexible tube inserted into the bladder, typically through the urethra, to drain urine into an external collection bag. The tube is held securely in place by a small balloon inflated with sterile water once inside the bladder. A blockage can occur, preventing urine from draining, which requires immediate and safe action.
Recognizing the Symptoms of a Blockage
The most immediate sign of a potential blockage is a significant reduction or complete absence of urine flow into the drainage bag over several hours, despite normal fluid intake. This lack of drainage causes urine to back up, leading to noticeable physical discomfort. A common indicator is the sudden onset of bladder pain or a feeling of pressure and fullness in the lower abdomen.
Leakage of urine around the insertion site, known as bypassing, occurs because the bladder is trying to push urine out around the blocked catheter. The urine itself may appear cloudy, contain visible sediment, or show signs of blood clots, any of which could be contributing to the obstruction. Recognizing these signs quickly is essential for resolving the issue.
Safe Initial Steps for Clearing the Obstruction
Before considering any internal procedure, perform non-invasive checks to address external factors preventing urine flow. This involves a thorough inspection of the entire drainage system, from the insertion site to the collection bag, for any kinks, twists, or loops in the tubing. Straightening the tubing can often resolve a flow interruption caused by mechanical compression.
Ensure the collection bag is positioned lower than the patient’s bladder to utilize gravity for continuous drainage. Check the bag’s straps to ensure they are not too tight, which can compress the tubing and obstruct the flow. Gently repositioning the patient, or having them change from a lying to a sitting position, can sometimes shift the catheter tip within the bladder and restart drainage. Also, look closely at the collection bag for any thick sediment or clots that may be contributing to the obstruction.
Step-by-Step Catheter Irrigation
Catheter irrigation, or flushing, is a procedure used to clear an obstruction, but it should only be performed after receiving professional training or guidance. The process requires meticulous hand hygiene. Necessary supplies include a sterile catheter-tip syringe, normal saline solution, and antiseptic wipes.
Draw up the prescribed volume of normal saline, typically between 10 and 30 milliliters, into the syringe. The catheter is then carefully disconnected from the drainage tubing. Since this breaks the closed system, the ends of both the catheter and the drainage tubing must be kept sterile. The connection site should be cleansed with an antiseptic wipe before separation to minimize the risk of introducing bacteria.
The tip of the syringe is gently inserted into the catheter’s drainage port. The saline solution is slowly and gently pushed into the catheter; never force the fluid against resistance. Forcing the solution can damage the bladder lining. If resistance is met, stop and try to gently pull back on the plunger to aspirate any obstructing material. After injecting the solution, attempt to gently withdraw the saline, which may bring out the mucus plug or clot.
The irrigation process may need to be repeated until the fluid withdrawn is clear. Once the catheter is clear, the syringe is removed, and the end of the catheter and the drainage tubing connector are wiped with a fresh antiseptic wipe. The pieces must then be reconnected with a gentle twisting motion to re-establish the closed drainage system. If urine flow does not resume within 10 to 15 minutes after one or two irrigation attempts, seek professional assistance.
Urgent Situations and Medical Contact
Recognize signs that necessitate immediate contact with a healthcare provider or emergency services. If the catheter remains blocked after one careful attempt at irrigation, do not repeat the procedure without professional instruction. Persistent abdominal pain, especially if severe or accompanied by a new feeling of fullness, suggests a continuing, potentially dangerous buildup of urine in the bladder.
Signs of systemic infection require urgent medical attention. These symptoms include a high fever, chills, or the sudden appearance of visibly bloody urine with large clots. If the catheter falls out completely, it should not be reinserted by an untrained individual, as this can cause urethral trauma.