Urinary Catheters and Tubes
If stents/PCNs/Chronic ...

Urinary Catheters and Tubes

If stents/PCNs/Chronic Foley or SPT/ileal conduit or neobladder – UTIs should be treated only if symptomatic, NOT based on UA/UCx

Foley Catheter: externally placed tube which travels through urethra and into bladder

 • Placement: lay patient flat, sterile prep, hold penis upright, instill 10cc’s of 2% viscous lidocaine (order “UroJet”) into urethra, always insert Foley catheter to the hub. Inflate balloon only after return of urine with 10 cc’s of sterile water; gently withdraw catheter to bladder neck and feel the balloon settle. May need to flush catheter with 60cc’s to verify position: easy flush w/ drainage = in bladder

 • Foley Size: Hx BPH → large Foley (18 Fr Coudé or larger). Keep curve up / nub on hub pointed toward umbilicus. Hx instrumentation or urethral stricture → small Foley (14 Fr or smaller)

 • Use Coudé catheter for elderly men/BPH or difficult placement—has a gentle upward curve to pass through the prostate

 • Urethral trauma: leave catheter in for at least 5 days to allow for urethral healing

Suprapubic Tubes (SPT): externally placed tube which travels through the overlying skin and directly into the bladder

 • Placed by GU IR. Once tract formed (after 1-2 changes by IR), change q6-12wks similar to Foley

 • Staph aureus becomes a more common organism involved in infections

Percutaneous nephrostomy tube (PCN): externally placed tube which travels through the overlying skin directly into the renal pelvis

 • Placed by GU IR usually under local anesthesia. Cannot be coagulopathic, thrombocytopenic, or on ASA/Plavix

 • Urine collects in external bag. If low UOP into bags, passage of blood or concern for malposition - obtain CT A/P, call GU IR

Ureteral stent: internally placed stent which maintains ureteral patency from level of renal pelvis to bladder

 • Placed by Urology in OR with general anesthesia, requires change every 3-6 months. May cause urinary urgency. Is NOT changed in setting of infection

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Account created for the MGH Internal Medicine Housestaff Manual "White Book" - https://stk10.github.io/MGH-Docs/WhiteBook-2019-2020.pdf
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