An indwelling urinary catheter, often called a Foley, is a flexible tube temporarily placed into the bladder via the urethra to drain urine continuously after surgery. Post-surgery, its immediate function is to monitor fluid balance with precision, which is important during recovery from anesthesia and intravenous fluid administration. The catheter also manages the temporary inability to urinate that can occur due to general anesthesia or required immobility, preventing the bladder from becoming over-distended.
Standard Timelines for Post-Surgical Removal
For many non-urological and less invasive surgeries, the catheter is removed as soon as it is no longer necessary, often within 24 to 48 hours post-operation. This early removal is a core component of enhanced recovery after surgery (ERAS) protocols, prioritizing rapid mobilization and complication prevention. Patients are assessed for removal once the effects of anesthesia have worn off, they are awake and alert, and the need for continuous monitoring of fluid output has diminished.
Early removal significantly reduces the primary risk associated with the device: a Catheter-Associated Urinary Tract Infection (CAUTI). The risk of infection begins to increase after two days of catheterization. If a patient is mobile and able to void naturally, the catheter is removed to prevent bacteria introduction into the urinary tract. This decision is balanced against the risk of the patient developing urinary retention after removal, which requires careful clinical judgment.
Surgical Contexts Requiring Extended Duration
Certain procedures necessitate a longer duration for the indwelling catheter, sometimes extending the time from days to weeks. Surgeries involving the urinary tract itself, such as Transurethral Resection of the Prostate (TURP) or bladder repairs, require the catheter to remain in place. This allows the surgical site to heal without the stress of bladder filling and emptying. In these urological contexts, the catheter may also be used to irrigate the bladder and flush out blood clots that could form.
Complex pelvic surgeries, including extensive colorectal resections, total abdominal hysterectomies, or some orthopedic procedures, also often require extended catheterization. The catheter protects the delicate surgical area from urine exposure and manages expected temporary nerve dysfunction or swelling that can impair bladder emptying. For patients undergoing procedures with a high risk of prolonged retention, a catheter may remain for three to seven days, or longer, to ensure successful recovery and minimize the need for re-catheterization.
Essential Care and Infection Prevention
The most significant risk with an indwelling catheter is a Catheter-Associated Urinary Tract Infection (CAUTI), which happens when bacteria travel along the outside or inside of the tube into the bladder. Proper hand hygiene is the first line of defense; the patient and any caregiver must wash their hands thoroughly before and after handling the catheter system. The skin around the insertion site should be gently cleaned daily with mild soap and water to prevent the buildup of microorganisms.
The closed drainage system must be maintained to prevent outside contamination. The urine collection bag must always be kept below the level of the bladder to use gravity for drainage and prevent urine from flowing backward (reflux). The tubing should be secured to the patient’s leg with a strap or specialized device to prevent tugging, which can cause pain, urethral trauma, and move bacteria into the bladder.
Monitoring for Complications
The drainage bag should be emptied when it is about half to two-thirds full, taking care not to let the drain spout touch the toilet or collection container. Patients and caregivers must monitor for signs indicating a problem:
- Cloudy, dark, or foul-smelling urine.
- Fever or chills.
- Pain in the lower abdomen or side.
- Sudden lack of urine drainage or urine leaking around the catheter.
Blockage requires immediate medical attention.
What Happens After Catheter Removal
The removal process is simple: the small water-filled balloon inside the bladder is deflated, followed by a gentle, quick pull to slide the tube out. The primary concern immediately following removal is Post-Catheter Urinary Retention (POCR), where the bladder temporarily loses its ability to empty completely after relying on the tube for drainage. The bladder muscle (detrusor) needs time to regain function, which is affected by recent surgery, anesthesia, and the catheter’s presence.
After removal, medical staff monitor the patient closely, asking them to notify a nurse when they feel the urge to urinate. The first voiding attempt is observed, and patients are expected to void a sufficient amount within six to eight hours. If a patient is unable to urinate within that timeframe, or experiences significant lower abdominal discomfort, a bladder scan measures the volume of retained urine. If the retained volume is too high, temporary re-catheterization may be necessary to prevent damage to the bladder muscle from overstretching.