Improving outcomes in foley catheterization: A retrospective review with a proposed protocol

Urologists are commonly consulted regarding difficult and traumatic urethral catheterizations. Complications surrounding Foley catheterizations represent a significant burden to the healthcare system.

To assess the demographic and patient characteristics surrounding urological consultation for difficult and traumatic Foley catheterizations at our institution across multiple hospitals.

This is a single-institution, multi-hospital, 263 patient, retrospective chart review from Jan 2020-December 2023.

The majority of consultations (80.2%) did not require heroic measures by the urology service. A Foley catheter placement was determined not difficult in the majority 191 (72.6%) of patients. Sub-group analysis of "difficult by urology" vs "not difficult by urology", showed a significant difference between those with zero attempts, one attempt, and greater than one attempts (P = 0.004). Those patients specifically with greater than one attempts were more likely to be seen as a difficult insertion by urology assessment (60.6%) compared to not difficult (38.6%). Likewise, those patients with a history of difficult urethral catheter (DUC)/traumatic urethral catheterization (TUC) (25.8%) were more likely to be difficult compared to those without a history of DUC/TUC (14.2%) (P = 0.038).

The study found that majority of consultations received did not require heroic measures by the urology service to place a catheter. Patients who had a history of DUC/TUC and those who had greater than one catheter attempts were statistically more likely to be a DUC based on urology assessment. At our institution we hope to propose a protocol in which nursing staff and non-urologic clinicians will utilize a troubleshooting checklist and an algorithm when difficult or traumatic urethral catheters are encountered in order to improve patient care and decrease healthcare costs. For example, this protocol would ideally address complications of multiple catheter attempts such as urethral trauma, development of urethral strictures, and infection risk. Additionally, future trainings and availability of additional resources will be provided and assessed with a goal of reducing healthcare cost surrounding these complications.