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ACEP Now: Vol 43 – No 10 – October 2024

Image 4: A CT image of upstream left hydronephrosis. (Click to enlarge.)

Emergency physicians commonly replace SPCs in the ED. It is important to be cautious with this procedure and recognize these potential complications. Best practices for catheter placement include the use of short-tipped catheters (avoidance of coudé tipped catheters), close observation of the patient during balloon inflation (although this may prove challenging in patients with sensory deficits), and marking the length of the old catheter to match the new one.⁴ Although imaging is not typically indicated, CT can be considered if there is difficulty in placement or flushing to confirm proper placement, if there is pain with flush, or if other infectious etiologies are suspected.⁵ Confirmation of Foley balloon in the bladder can also be confirmed by filling the Foley balloon with a radiopaque contrast solution and obtaining a pelvic X-ray or utilizing point-of-care bedside ultrasound to identify the Foley balloon within the bladder.⁶,⁷ Management of distal ureter obstruction from Foley misplacement includes changing or removing the catheter, and treatment of any infection with antibiotics.

Dr. Pelletier is an Assistant Program Director and Assistant Professor of Emergency Medicine at the University of Missouri-Columbia in Columbia, MO.

Dr. Heilmann is an Emergency Medicine physician and Medical Education fellow at Washington University in St. Louis and St. Louis Children’s Hospital, Missouri.

References

1. Jacob P, Rai BP, Todd AW. Suprapubic catheter insertion using an ultrasound-guided technique and literature review. BJU Int. 2012;110(6):779-84.
2. Ahluwalia RS, Johal N, Kouriefs C, Kooiman G, Montgomery BSI, Plail RO. The surgical risk of suprapubic catheter insertion and long-term sequelae. Ann R Coll Surg Engl. 2006;88(2):210-213.
3. Calderon Plazarte V, Taghavi M, Jacobs L, Noels J E. Ureteral Obstruction Due to Inadvertent Placement of the Suprapubic Catheter and Bladder Indwelling Catheter: Presentation of Two Clinical Cases and Review of the Literature. Nephro-Urol Mon. 2022;14(4):e122856.
4. Corder CJ, LaGrange CA. Suprapubic Bladder Catheterization. [Updated 2022 Nov 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482179/
5. Cho C, Chan WK, Chu RW, Law I. Extraluminal location of a Foley catheter balloon. Hong Kong Med J. 2017:207.e1-207.e2.
6. Vaidyanathan S, Hughes PL, Soni BM. A simple radiological technique for demonstration of incorrect positioning of a Foley catheter with balloon inflated in the urethra of a male spinal cord injury patient. ScientificWorldJournal. 2006;6:2445-2449.
7. Garagliano J, Madhok J. POCUS for Visualization and Facilitation of Urinary Catheter Placement. POCUS J. 2020;5(2):35-36.