Wednesday, July 28, 2010

Trick of the Trade: Foley balloon be gone!

An urethral Foley catheter can sometimes become retained in the bladder, because of its balloon being unable to deflate. A malfunctioning inflation valve or obstructed channel along the length of the catheter is the cause.

How can you deflate the balloon so that the Foley catheter can be removed?

Option 1
Cut the Foley catheter's balloon port. This should remove the one-way valve device of the balloon port, and the balloon's contents should spontaneously drain. The Foley can then be easily removed.

Option 2
If option 1 fails, gently pass a thin guidewire into the inflation channel along the length of the Foley catheter. This should push away any foreign material (exudate, crystals) that have formed along the path. This should allow the balloon to drain spontaneously.

Option 3
Instill 10 mL of mineral oil into the inflation channel and wait 15 minutes. This should chemically dissolve the thin balloon. Repeat once if unsuccessful. This yields a 85-90% success rate of Foley removal.

I learned this from our urologist recently, who managed to pull out a retained catheter by using the guidewire trick.

Reference
Shapiro AJ, Soderdahl DW, Stack RS, & North JH Jr (2000). Managing the nondeflating urethral catheter. The Journal of the American Board of Family Practice / American Board of Family Practice, 13 (2), 116-9 PMID: 10764193

4 comments:

  1. Don't forget the suprapubic needle insertion by ultrasound guidance to puncture the balloon if all else fails. Not my first choice but when the other fail and you have to go invasive US guidance is key.

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  2. Ah, excellent point (pun intended). Scary and not my first choice either. Thanks for the reminder.

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  3. A down side of option 3 Is that mineral oil can lead to balloon fragmentation. After any of these methods the IDC and balloon should be examined to see if fragments are missing - otherwise cystoscopy may be needed.

    Chris Nickson
    http://lifeinthefastlane.com/2011/04/urological-entanglement-001/

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  4. Excellent point. I've only done this once -- fortunately all of it got out! Thanks for the tip.

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