#POCUS Here is the "story of Foley" #tweetorial about diagnosing misplaced Foley catheter using #IMPOCUS #MedEd #nephrology
1. Normal urinary bladder 👇
1. Normal urinary bladder 👇
2. Urinary bladder decompressed by Foley catheter. As the Foley balloon is filled with water, it appears as a well-defined cystic structure on #POCUS
Asterisk (*) indicates the tiny bit of urine around the balloon.
Asterisk (*) indicates the tiny bit of urine around the balloon.
3. The sonographic image demonstrates the transverse view of the bladder distended with urine(*) despite having a Foley in place. Indicates obstruction of the catheter by a blood clot or debris. Treatment is to flush the catheter, not page #nephrology for dialysis! 🤐
4. In this #POCUS image of long axis of the urinary bladder, Foley balloon is in the prostatic urethra resulting in urinary retention. Note the urine filled bladder (B) & prostate gland (P) surrounding the Foley. This can be quite painful, but a sedated patient cannot complain!
5. This #POCUS image of transverse view of the 'full' bladder shows Foley balloon posterior to the bladder wall in a female patient. The anatomic illustration of female pelvis shows that the vaginal canal is posterior to the bladder, where Foley can be mistakenly placed.
6. Here is the recent image tweeted by @PhilippeLeConte showing Foley balloon in the urethral diverticulum in a female. A decompressed bladder with large ovarian cyst posterior to it might appear similar but note that there is no evidence of bladder tissue/urine around Foley.
7. Not every anechoic thing in the pelvis is urine! In this #POCUS image, Foley balloon appears to be located outside the bladder suggesting catheter malposition. However, the fluid collection anterior to Foley is actually pelvic ascites and the Foley is in appropriate position.
7 continued - In such cases, perform long axis scan - shows that this fluid collection is in continuity with the peritoneal cavity. Moreover, patient's medical history should alert to the presence of pelvic ascites. Here is a related #POCUS scenario
8. Finally, an interesting fact about Foley: Dr. Frederic Foley first described the use of a self-retaining balloon catheter in 1929, to be used to achieve haemostasis after cystoscopic prostatectomy! (not to drain urine)🧐
