Foley care is the daily routine of cleaning, maintaining, and monitoring an indwelling urinary catheter to prevent infection and keep it working properly. A Foley catheter is a flexible tube inserted through the urethra into the bladder to drain urine into an external collection bag when a person can’t urinate on their own. The care itself is straightforward, but doing it consistently and correctly matters because prolonged catheter use is the single most important risk factor for catheter-associated urinary tract infections.
Why a Foley Catheter Is Used
A Foley catheter is placed when a medical condition makes it difficult or impossible to urinate. That includes situations like recovery after surgery, urinary retention from an enlarged prostate or neurological condition, or the need to accurately measure urine output in critically ill patients. The catheter stays in place using a small balloon inflated inside the bladder, which is why it’s called “indwelling” rather than being inserted and removed each time.
Daily Cleaning
The core of Foley care is keeping the area where the catheter enters the body clean. This should happen at least once a day during regular bathing and again after every bowel movement. Use plain soap and water. The CDC specifically recommends against using antiseptic solutions around the catheter site, as they don’t reduce infection rates and can irritate the skin.
During cleaning, check the urethral opening for redness, irritation, or unusual drainage. Look at the tubing near the insertion site for any crusty buildup and gently remove it. One important detail: make sure the tubing doesn’t slide in and out of the urethra while you’re cleaning. Hold it steady with one hand while wiping with the other. For women, always clean front to back to avoid introducing bacteria from the bowel.
Keeping the Drainage Bag in the Right Position
Gravity does the work of moving urine from the bladder into the collection bag, so the bag must always hang below the level of the bladder. When walking, hold the tubing so the bag stays below your waist. When sleeping, hang the larger bedside bag on the side of the bed frame. You can sleep in any position as long as the bag stays lower than your hips.
Two things to avoid: never place the bag on the floor, where it can pick up bacteria, and never let the bag get high enough for urine to flow backward through the tubing into the bladder. Backflow is a direct route for infection.
Emptying the Bag
Empty the collection bag when it reaches about half to two-thirds full. Letting it get heavier than that creates a pulling force on the catheter that can irritate or even damage the urethra. Use a separate, clean container to catch the urine, and avoid letting the drainage spigot touch the container or any other surface. Splashing should be minimized. After draining, close the spigot securely. If you’re tracking output, note the amount before discarding it.
Most people with a daytime leg bag switch to a larger bedside drainage bag at night so they don’t have to wake up to empty it. The leg bag should also stay below your waist at all times.
Securing the Catheter
The CDC recommends properly securing the catheter after insertion to prevent it from shifting and pulling on the urethra. A catheter that moves around causes irritation, tissue damage, and increases infection risk. Securement devices, which are adhesive straps or clips that attach the tubing to the thigh or abdomen, keep everything stable. This is especially important for people who are mobile or who move frequently in bed. Using the smallest catheter size that still drains well also helps minimize trauma to the bladder neck and urethra.
Hydration and Catheter Function
Drinking enough fluid is one of the most effective things you can do to prevent two common problems: urinary tract infections and catheter blockages. The general recommendation is 2 to 3 liters per day, roughly six to eight large glasses. This keeps urine dilute, which reduces the mineral deposits that can crust inside the tubing and eventually block it.
Citrate-containing drinks like lemon water or certain fruit juices can help further by changing the urine’s acidity, making it harder for crystite crystals to form. However, drinking very large volumes can dilute your sodium levels, so people with heart failure, kidney disease, or other fluid-restricted conditions should check with their doctor about an appropriate target.
Signs of Infection
Catheter-associated urinary tract infections are the most common complication of Foley catheter use. The warning signs include burning or pain in the lower abdomen, fever, a burning sensation during urination (which can happen even with a catheter in place), and an increased urge to urinate. Changes in urine appearance also matter: cloudy urine, a strong or foul odor, or visible sediment can signal a developing infection.
The most effective way to prevent infection is simple: remove the catheter as soon as it’s no longer medically necessary. Every extra day a catheter stays in place raises the risk. Other prevention measures include maintaining the closed drainage system (never disconnecting the tubing from the bag unless replacing it), using sterile technique during insertion, and performing the daily cleaning routine described above.
What Happens When the Catheter Comes Out
When it’s time to remove the catheter, healthcare providers typically perform what’s called a voiding trial to make sure the bladder can function on its own. This involves either letting the bladder fill naturally after removal or filling it with a set amount of saline (usually 150 to 300 milliliters) beforehand. You’ll then be asked to urinate and may be assessed on how strong your stream feels and how much urine you’re able to pass.
A successful trial generally means voiding at least two-thirds of the bladder’s volume with less than 100 milliliters left behind. Some facilities use a simpler approach where patients rate the strength of their stream on a scale, and those reporting adequate force are discharged without further measurement. If the trial isn’t successful, the catheter may be reinserted temporarily while the bladder recovers more function.