5 Interventions to Prevent Foley Trauma and Protect Patients

Each year, an estimated 30 million foley catheterizations take place in the U.S.  

Unfortunately, a large number result in catheter-related injuries. One well-known multicenter study found that 57% of foley catheterizations lead to complications.

Because Foley catheterization involves delicate anatomy, a skilled approach is essential to prevent serious injuries. Beyond causing pain, improper technique can lead to urinary retention, bladder rupture, and even systemic infection. These injuries are especially concerning for pediatric patients.

At Texas Children’s Hospital in Houston, a trend of catheter-related injuries prompted an interdisciplinary quality improvement team to take action, said project lead and quality improvement specialist Kelly Exezidis, BSN, RN, CNOR, CMLSO. Beyond the standard of catheterization injuries, pediatric patients present unique risks for injury due to their decreased ability to remain still during a catheterization, Exezidis says. Another major concern is a lack of nurse education on selecting the correct catheter size.

Improving Foley Catheter Safety

Through data analysis, evidence-based interventions, and a prevention campaign focused on best practices, Texas Children’s Hospital has made significant strides in enhancing patient safety— offering valuable lessons for any OR team.

To raise awareness about foley catheter safety, Exezidis is speaking with perioperative nurses about key risks and best practices at AORN Global Surgical Conference & Expo in April. But first, here are five changes nurses can make today to protect patients of all ages.

1. Update Your Policy
   Several important additions to a policy outlining foley catheter placement practices are essential. First, clarify catheter sizing and placement techniques. Second, always advance the catheter to the hub before inflating the balloon. “This is especially important with boys, and is part of a poster campaign we initiated as a reminder called ‘HUB It.’”


2. Ensure Proper Catheter Placement
   Beyond policy updates, ongoing education and training on correct catheter placement are essential. For example, a nurse must know the balloon should only be inflated after the catheter is inserted all the way to the hub and urine return is confirmed or until an additional irrigation step is performed.


3. Leverage Visual Cues
   Reminders are key for the initial rollout of new information in policy and practice for foley catheterization. Visuals that have proved especially helpful include foley sizing cards placed in the operating room where the supplies are kept to help nurses select the correct size. Brightly colored stickers with the reminder: “Don’t Forget to HUB It” are placed on catheter sets. Lastly, updated digital bulletin boards in every OR include safe foley catheterization practice reminders.


4. Make Education Regular Practice
   Annual foley catheter safety education is scheduled for every perioperative nurse. Training covers correct selection, hubbing and urine return before inflating balloon, and irrigation step if no urine is present. Ongoing education has been the key to sustaining best practices with foley catheter placement and management.


5. Keep a Close Eye on Injury Data
   Tracking data is essential for recognizing current catheter-related injuries and justifying the need for action, Exezidis stresses. Beyond simply looking at the numbers, she says nurses also need to share them and talk about them. “Presenting data to larger nursing groups facilitated policy approval and enabled the implementation of house-wide yearly nursing education.”

Ongoing review of their foley catheterization injury data also helps them track how interventions are offering improvements.

Join Us in Boston, April 5-8

Ready to learn more about safe foley catheterization for your own care settings? Don’t miss Enhancing Patient Safety: A Comprehensive Intervention to Prevent Foley Trauma with Kelly Exezidis at AORN Global Surgical Conference & Expo in Boston April 5–8.