Here is an issue that has come up more than once over the past year. It sparked good discussion with some great points that we will attempt to repopulate in the comment section:
“Referring to the PFC’s R-T-H-P (Ruck-Truck-House-Plane) approach, what’s the utility of carrying a transurethral catheter in a rucksack, if the next level (‘truck’) is the first where sufficient fluids are carried to sustain a patient’s fluids requirements, an hence, allow to measure output? In other words, if no fluids get in, (almost) none will get out, so why carrying a Foley cath to measure the output? Also, even if the minimal output would be an indication of the requirement to give more fluids, if (almost) none are carried in the ruck, the utility of the catheter might be questionable.”
Another comment concerning the Foley from earlier in the year…
“A Foley… Our medic experiences must have been very different. I would have liked at least 5 tourniquets.”
Join the discussion and comment below.
Everything You Need to Know About Foley Catheters
As a PA my bag may be set up somewhat differently, but a Foley is a piece of kit that has multiple uses other than bladder drainage and resuscitation guidance. It can also be used for posterior nasal packing for epistaxis, an improvised nasogastric tube, and in my shop, we used it to tamponade a subclavian artery injury. Some say that it can be used as an improvised chest tube, I have found that it’s a wee bit flimsy, and if one needs to improvise, an ET tube is better. Foleys-don’t leave home without it—just don’t forget a means to collect and measure the urine.
Definitly! Next to the tips Greg already mentioned, you can use it in case of stabbing wounds which are too small to pack.
I think Greg hit on many of the same reasons that I carry a foley in my Aidbag or Ruck. It is multipurpose for a low weight / low cube space item. I also think that while the truck might be the first place that we carry large amounts of fluid, I also think that it bears mentioning that we have large amounts of the “Gold Standard” resuscitation fluid with us on almost any target and that is fresh whole blood. Due to FWB being my “Go to fluid” for massive hemorrhage, I can see many situations – both hypothetical and referenced in AAR’s – where a Foley and some Fresh Whole Blood kits can get you a long way.
If we are looking at the other potential problem list we provided for why we need PFC, some of the potential problems that are highlighted do not require FWB as the primary resuscitation fluid but could allow for other forms of rehydration (oral/rectal). Having the extra metric of UOP is value added for minimal weight and cube space. Many Wilderness med courses go into this topic in great detail and if you consider anything from a Recce Hide site scenario, an offeset walk into a target area, or even just some remote wilderness training gone bad, you can see that you might only have your “Ruck” while still being limited on IV fluids. As a guy who has been in a Recce overwatch site with a person who has severe vomitting (we think he over purified his water) and only 1L of crystalloids, but near a river, this event is very real to me. So this is another reason I always prefer to have one on my personal kit.
**Just to note, I don’t carry a full Foley kit. It is a 2 way catheter with a 30ML balloon and a 30 cc syringe. If I need to collect fluid for monitoring in the field, I will have to do so with improvised means.
Finally, and I don’t want to shift the discussion away from monitoring and resuscitation, but the foley has many other uses for things like hemorrhage control in non-compressible areas or even something as simple as epistaxis. Greg highlighted this too.
This is one of the things I can make fit in almost any bag or kit, has multiple uses, and takes almost zero cube space or weight. That’s my personal reasoning for carrying one as far forward as I can.
Great topic Paul.
Not only can it be used for wounds and hemorrhage control as mentioned above, but also for UOP monitoring. Not only can it be used as a “vital sign” for resuscitation monitoring, but the nature can also keep other differentials in your mind during treatment. (i.e. rhabdo, bladder/urethral/kidney injury, etc). UOP is a key point for resuscitation of burn patiens, as detailed in the CPG. For prolonged resuscitation with larger amounts of fluids and blood products, it can be used by further evacuation teams (i.e. TCCET, CCATT) to check bladder pressures.