Urinary Catheter Removal (Foley Catheter Discontinuation)

Indications for Removal

Remove the catheter as soon as it is no longer needed. Common criteria for discontinuation include:

Patient is ambulatory and can toilet independently
Urinary output monitoring is no longer required
Urologic/surgical indication has resolved
Catheter not meeting any ongoing clinical indication (per AHRQ nurse-driven protocol)

The most effective CAUTI prevention strategy is prompt catheter removal - Goldman-Cecil Medicine emphasizes that avoiding unnecessary insertion and prompt removal offers the greatest opportunity for CAUTI prevention.

Equipment

Non-sterile gloves
10 mL syringe (to deflate the balloon)
Waterproof pad / absorbent sheet
Disposable bag for waste
Patient education materials (if applicable)

Step-by-Step Procedure

1. Verify and Prepare

Check the physician order (or confirm nurse-driven protocol criteria are met)
Explain the procedure to the patient and obtain consent
Inform the patient of expected post-removal sensations: urgency, mild burning, or frequency
Perform hand hygiene; don non-sterile gloves
Position the patient supine; place waterproof pad under the perineal area

2. Deflate the Balloon

Attach a 10 mL syringe to the balloon inflation port (the smaller side port)
Allow the fluid to passively drain back into the syringe - do not aspirate forcefully, as this can collapse the balloon walls and cause urethral trauma
Confirm the full volume has returned (typically 10 mL; verify against the label on the catheter lumen)
Never pull the catheter before fully deflating the balloon - this is the most common cause of urethral injury

3. Remove the Catheter

Ask the patient to take a slow deep breath and relax the pelvic floor
Gently and steadily withdraw the catheter in one smooth motion - do not jerk or yank
Wrap the catheter in the absorbent pad and dispose appropriately
Clean the perineal area with soap and water or wipes

4. Disconnect the Drainage Bag

Dispose of the drainage bag and tubing per your facility's waste protocol

5. Document

Time and date of removal
Balloon deflation volume confirmed
Patient tolerance of procedure
Appearance of any residual urine (color, clarity, odor)
Any resistance or patient discomfort during removal

Post-Removal Monitoring

Timeframe	Action
0-6 hours	Monitor for spontaneous voiding
First void	Record volume; note any burning, urgency, hematuria
If no void by 6 hours	Assess for urinary retention (bladder scan, palpation)
If retention confirmed	Consider bladder scan (if >400 mL) - may require re-catheterization

Per AHRQ protocol:

Choice 1: Patient voids within 6 hours with no symptoms → observe
Choice 2: Patient voids but has abdominal fullness/discomfort → bladder scan
Choice 3: Patient unable to void within 6 hours → bladder scan; re-catheterize if indicated

Special Considerations

Situation	Note
Post-prostatectomy	Catheter removal timing follows specific surgical protocol; do not remove early without urology guidance - Campbell-Walsh Urology notes removal at day 4 is not recommended even if cystography looks normal
BPH / urinary retention history	Trial of voiding should be attempted before considering surgical intervention (Pfenninger & Fowler)
Pelvic/urologic surgery	Surgeon may order suprapubic tube to remain after urethral catheter removal; voiding trial required first
Patient on anticoagulants	Be alert for hematuria post-removal
Long-term catheterized patients	Anticipate bladder instability and urgency after removal

Key Safety Points

Never remove with balloon inflated - deflate fully first
Confirm full balloon volume has returned before pulling
Assess post-void residual if the patient reports incomplete emptying
Watch for signs of UTI in the 24-48 hours after removal (dysuria, fever, cloudy urine)
Document I&O for a minimum of 24 hours post-removal per protocol

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