What are the dangers of accidental self-extraction of Foley catheters and who is at risk?

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For almost a century the usage of urethral catheterization has been the most effective solution for patients suffering from bladder drainage, undergoing surgical procedures or unable to pass urine because of obstruction to the urethra.

Ever since American surgeon Frederic Foley first introduced the Foley catheter in 1927, it has become the preferred tool for draining urine. Currently some 20–25 percent of all hospitalized patients, as well as people confined to bed in hospices and nursing homes, have indwelling urinary catheters.

No wonder then that the global catheter market is booming and, according to a recent report, is expected to grow from $3.6 billion in 2018 to some $5.8 billion by 2026.

The rapid growth of the catheter market brings with it growing concerns. Catheter-associated urinary tract infections (CAUTIs) are not as common these days as they were in the days of Dr. Foley, when the urine was drained into an open bucket, but it is still one of the most common infections acquired by catheterized patients in health care facilities.

Moreover, discomfort from the catheter often leads to intentional or unintentional pulling and extraction of the catheter, which in turn increases risk of infection and severe damage to the bladder or urethra.

The elderly and very young patients tend to extract their catheter tubes, thereby causing themselves unnecessary pain, injury and increased risk of infection. Studies show that 11%–17% of all catheters are unintentionally torn out and 5% of all urological catheters are traumatically pulled.

According to new research published by Stephen W. Leslie of the Creighton University Medical Center, in Omaha, Nebraska and Sandeep Sharma of the Mercy Fitzgerald Hospital in Darby, Pennsylvania, traumatic, unintended Foley catheter extractions, whether patient-initiated or accidental, can cause permanent urologic complications. In addition, they may affect hospital length of stay, decrease patient satisfaction grades, increase catheter-associated urinary tract infections and lower hospital quality scores.

The authors note that every patient with a Foley catheter who has delirium or dementia is potentially at risk of a traumatic Foley catheter removal. This would include:

  • Patients recovering from anesthesia, surgical procedures or sedation and particularly if the Foley catheter is new
  • Patients with head injuries are at particular risk. These patients are often in recovery room or intensive care unit settings.
  • Any patient with delirium or dementia, particularly an elderly nursing home patient with a recently placed Foley catheter or one who has a prior history of traumatic self-extraction of catheters
  • Patients who are constantly pulling or tugging on their Foley catheters
  • Patients with a history of agitation from brain injury, medications or other illnesses
  • Patients admitted for mental status changes whose degree of confusion is unclear, and their tolerance of the new Foley catheter is not yet known
  • Any patient being transferred where the catheter may become caught and be accidentally pulled or tugged

The risks of unintended catheter extractions are clear. The Foley catheter has been around for almost one hundred years and now the time has come to find a solution that will improve patients’ wellbeing and comfort and will free medical teams to deal with more urgent matters.