Tubes and Drains: Foley Catheter
Tubes and Drains: Foley Catheter
Tubes and Drains: Foley Catheter
FOLEY CATHETER
Length of male urethra is 20-25 cm, female urethra is 3.5-4 cm. 1 French gauge = 0.3 mm and this is
used to measure the diameter of the urethra for the circumference of the catheter. The appropriate
size can be chosen based on the age of the patient:
14-18 10-14
12-16 (clear urine)
>18
18-20 (pus, blood)
Measure the size of the urethral meatus to decide which one to use exactly.
Indications
Diagnostic Therapeutic
1. obtain urine sample (in retarded 1. to relieve urine retention
patients, or for clean-catch) 2. chronic use in debilitated patients (use condom
2. monitor urine output in males if possible, intermittent self-
3. voiding cystourethrography catheterization in females)
4. urodynamic studies 3. irrigation of bladder
5. measurement of post-void 4. instillation of chemotherapy or immunotherapy
residual volume 5. postoperative (hypospadias) or preoperative (to
prevent bladder injury)
In chronic retention drain 250-500 cc of urine every hour to avoid hematuria.
Contraindications
1. trauma to urethra
2. complete stenosis (shown by retrograde urethrography)
3. bladder neck contracture
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Complications
Early
1. failure to insert, usually due to inadequate anesthesia (insert 10 cc and wait for 10 minutes;
if not useful insert 20 cc), or may be due to stricture
2. trauma to bladder neck, hematuria, urethral injury, creation of false passage
3. allergy (not with silicon catheters) and anaphylaxis
Late
1. CAUTI → 80% of nosocomial infections; risk factors are improper technique, females,
immune compromised, pre-existing UTI, open draining system; usually established from day
6; take a sample, remove the catheter, if needed you can put another catheter or insert
silicon catheter (less chance of infection), but if stricture present do not remove catheter;
can give prophylactic antibiotics (nitrofurantoin 100 mg nightly) to avoid this but it increases
resistance of the bacteria and changes the flora of the urethra
2. obstruction
3. stone formation if left for long duration
4. squamous cell CA
5. failure to remove, if due to clot irrigate with saline, if not follow these steps:
a. inject some water then re-try deflation as this may reshape the contour of the
balloon and facilitate deflation
b. cut the channel externally since the obstruction may be at that point
c. insert a guidewire into the channel and puncture the balloon by the rigid tip
d. US-guided puncture by 22-gauge spinal needle percutaneously or transvaginally
SUPRAPUBIC CATHETER
Indications
Contraindications
1. scar of previous operation in suprapubic region since there may be adhesions and cause
injury to bowel
2. bleeding diathesis
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3. suspected bladder tumor
Complications
NEPHROSTOMY
Indications
1. failure to insert retrograde stenting in distal obstruction (stone, PUJO, etc); if bilaterally
needed or if single kidney then go straight to nephrostomy rather than JJ stenting
2. adjunct to PCNL
3. obtain urine sample
4. palliative measure in inoperable pelvic tumors
5. pyonephrosis
6. injection of contrast (nephrostogram)
7. instillation of chemotherapy
Complications
Early
Late
CHEST TUBE
Chest tubes are generaly inserted into the pleural cavity for two reasons: to drain fluid, thereby
preventing pleural fluid accumulation, and to evacuate air if an air leak is present
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Indications:
Indications for tube thoracostomy ( chest tube insertion) include the following:
I. Emergency
II. Nonemergency
Site of insertion:
1. Safety triangle: This is the triangle bordered by the anterior border of the latissimus dorsi,
the lateral border of the pectoralis major muscle, a line superior to the horizontal level of the
nipple, and an apex below the axilla.
Contraindications
There are no absolute contraindications for drainage by means of a chest tube except when a lung
is completely adherent to the chest wall throughout the hemithorax.
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coagulopathies and platelet defects should be corrected with the infusion of blood
products, such as fresh frozen plasma and platelets
2. suspected diaphragmatic rupture
A. the tube has been on water and air seal for ≥24 hours
B. the chest tube output is < 150 ccs over a 24 hour period and
C. the chest radiograph demonstrates that the lung is expanded
TRACHEOSTOMY
1. Intubation failure
2. Bilateral Vocal Cord Paralysis
3. Trauma (laryngeal, maxillofacial fractures)
4. Edema (tongue, laryngopharynx)
5. Foreign body obstruction
6. Subglottic or tracheal stenosis
Surgical techniques
1. Open procedure
2. Percutaneous procedure
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Types of tracheostomy tubes
1. Cuffless tubes
2. Cuffed tubes
Tracheotomy care
DRAINS
1. Rubber vs Silicone
2. Active vs Passive
3. Closed vs Open
Active or passive
Passive drains: have no suction; work according to the differential pressure between body cavities
and the exterior
Types of open drains drain fluid on to a gauze pad or into a stoma bag
1. Corrugated Drain
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3. Yeates drain (series of approx 2mm diameter PVC tubes attached side by side)
Drains may be
2. deep:
3. Urinary Catheter
4. Intercostal Catheter
1. Bellovac®
2. Blake® drain
3. Exudrain®
4. Hemovac® (Davol, redivac)
5. Jackson-Pratt®
6. Sump Suction Drains
7. 'Shirly' wound drainage (suction drain with an intake tube supplying air to the bottom of the
main tube)
General guidance
If active, the drain can be attached to a suction source and set at a prescribed pressure
Ensure the drain is secured (dislodgement is likely to occur when transferring patients after
anaesthesia).
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Use measurements of fluid loss to assist intravenous replacement of fluids.
Closed
Open
Problems of drains
1- Mechanical
1. Trauma to tissues
2. Erosion of adjacent tissues- may lead to perforation or fistula formation ,haemorrhage
3. Herniation of viscera through the drain tract.
2-Physiological
3-Drain malfunction
3. Inflamed exit site, high output, atypical Drainage Fluids; anastomotic leaks, or drain erosion into
adjacent structures e.g. bowel, bladder, or blood vessels.
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When to remove
Removal