Traditional Foley Drainage Systems with Different Fixation Methods-Do They Drain the Bladder?

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Authors (including presenting author) :
Lui KL(1), Lau KY(1), Kung WC(1), Sy YW(1), Chan KH(1), Chung PH(1), Chan NH(1), Li CM(1), Tang CN(1)
Affiliation :
(1)Department of Surgery, Pamela Youde Nethersole Eastern Hospital
Introduction :
Foley catheters are assumed to drain the bladder to completion. However, catheterized patients often describe intermittent periods of the sensation of bladder fullness, especially after remaining in bed for prolonged periods. In addition, drainage characteristics of Foley catheter systems are poorly understood. In order to investigate unrecognized retained urine with Foley catheter drainage systems in 2 common fixations method, i.e. secure at inner thigh or lower abdomen, bladder volumes of catheterized patients were measured with bladder scan ultrasound volumetrics.
Objectives :
To investigate the changes in retained urine with Foley catheter drainage systems in 2 common fixations method.
Methodology :
Patients with Fr.14 silicone coated latex Foley catheter in-situ in inpatient ward were enrolled and randomly assigned into inner thigh fixation group or lower abdomen fixation group. Inclusion criteria included the presence of an indwelling Foley urinary catheter for at least 24 hours, visibly clear urine within the drainage tubing without blood clots, sediment/tissue or calculi, absence of extrinsic drainage tubing obstruction, and recorded mean urinary output of at least 30ml per hour within 12 hours of evaluation. Patients were excluded if they had a suprapubic catheter, impaired renal function or other factors that may affect the accuracy of measurement of residue urine like patient with ascitic fluid, ovarian cyst or on CAPD. Bedside bladder ultrasound volumetric studies were performed between 0700 and 0800, before first ambulation after sleep.
Result & Outcome :
A total of 75 patients in the inpatient ward (37 in inner thigh fixation group & 38 in lower abdomen fixation group) were recruited in the period of 1st Oct 2018 to 31st December 2018. Mean residual volume was 96ml (range 4ml to 226ml) in inner thigh fixation group and the mean residual volume was 102ml (range 22ml to 237ml) in lower abdomen fixation group (p>0.05) In conclusion, Contrary to long held assumptions, traditional Foley catheter drainage does not consistently or completely evacuate the bladder. However, different fixation methods do not have significant different between the volume of retained urine with Foley catheter drainage. The associated residual urine likely contributes to nosocomial urinary tract infections and myriad other problems that stem from occult incomplete catheter drainage.

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