Fact sheet 6: Foley Catheter Care: Urethral or Suprapubic

Reader: Family, Professional

Although the goal is usually to remove catheters whenever possible, for many patients a catheter may still be the safest or most practical method of bladder management. If a patient is to be discharged home with a catheter, it is very important to train the patient or a family member to change the catheter. A sterile catheter kit should always be available at home for emergency changes.

A. How Often to Change It?

Recommendations vary from weekly to "as needed," and there is no agreement among doctors about this. It depends partly on whether the patient can change it himself or is dependent on a home health nurse. Some individuals can use the same catheter for 6-8 weeks with no difficulty. Follow whatever your doctor recommends.

B. Fluid Intake

Ideally, the urine should always be clear (not cloudy or full of sediment) and a pale yellow color with very little odor. The best way to achieve this is to drink over three quarts of liquid per day. Individuals should be instructed to monitor the urine appearance whenever the leg bag is emptied and pay attention to any changes.

Carbonated drinks should be avoided because they make the urine alkaline, which encourages stone formation and bacterial growth. Preferred fluids are water, tea, Kool-aid and juice.

C. Infection

It is essential to distinguish between a true infection and just the presence of bacteria in the urine. Normal urine is always sterile (no bacteria at all), but anyone who uses a catheter continuously will always have bacteria in the urine. Physicians who treat non-SCI patients are accustomed to ordering a urine culture to diagnose an infection. However, when they get a urine culture on someone with a catheter (who is not sick), they may order antibiotics unnessarily just because of a positive urine culture!

Continuous use of antibiotics to try to prevent infections is very seldom effective or indicated. This only results in the growth of resistant bacteria which will not respond to single antibiotics and more powerful ones will be needed when an infection does occur.

D. How to Recognize an Infection

The most common symptoms:

1. Fever: If less than 101F, the infection may be only in the bladder which is less serious. The sudden onset of temperature over 101F (more commonly 102-104) means an infection in the kidneys which should always be taken seriously! A good rule of thumb is that fever in an SCI individual is a urinary infection until proven otherwise!
2. Nausea and Vomiting: Usually occurs only with a kidney infection.
3. Cloudy Urine: Especially if the urine changes from clear to cloudy. This alone does not require antibiotics. Many individuals can prevent a serious infection by drinking more water when they notice a change in urine cloudiness. If there is no improvement after 24 hours, starting antibiotics for 5-7 days may prevent a more serious infection from developing.
4. Urinalysis: An increase in white blood cells in the urine may be a better indication of infection than a culture.

E. Treatment of Infection

1. Be sure the catheter is draining well! If there is any doubt at all, change the catheter!
2. Increase fluid intake.
3. Antibiotics, if temperature is over 101F or if fever lasts more than 2-3 days.
4. A urine culture may be helpful in knowing what kind of antibiotics to order, but is not helpful in diagnosing infection. (See Section C. Infection).

F. Prevention of Infection

Urinary infections should never be taken for granted. Most of them can be prevented with good management. Each time an infection occurs you should carefully investigate what the cause might have been so you know what to avoid next time. The most common cause of infection is obstruction of the catheter, but the full symptoms may not develop until 1-2 days later. Therefore, it is necessary to review all of your activities for the 2-3 days before you noticed an infection.

Things to Consider when Dealing with Infection:

1. Obstruction of the catheter or just poor drainage of the catheter (which may occur for several days before complete blockage occurs) is the most common cause of acute urinary infection.
2. Check for a decrease in fluid intake.
3. Check for too many carbonated drinks.
4. Bladder stones should always be considered a possibility with recurrent infections. When suspected, see your doctor about getting an x-ray.

Other Fact Sheets that may be of interest:
Fact Sheet #5 - Common Urological Problems: Frequent Catheter Changes.