Foley catheters are thin, flexible tubes typically used to drain urine from the bladder. However, these catheters can be repurposed to help control bleeding in injured patients. They are particularly useful for bleeding from narrow, deep wounds or at sites such as the neck or groin where it is not possible to apply a tourniquet. The foley catheter is inserted into the bleeding wound, and the balloon at the tip is inflated to generate compression in the deep space. If one catheter is not sufficient, additional catheters can be used in order to increase the amount of compression delivered by the inflated balloons.
Uncontrolled hemorrhage is a major cause of morbidity and mortality in trauma, and a large proportion of this mortality occurs in the pre-hospital setting. Foley catheters can be used to manage hemorrhage in penetrating neck injuries. A small military case series demonstrated 11 patients in whom a Foley catheter was used to control hemorrhage with a 91% success rate. The authors report that a volume of 10 ml in the foley balloon is usually sufficient to arrest bleeding without affecting the surrounding microcirculation. A recent article by Himmler et al. described the use of this technique in 29 civilian patients actively bleeding from penetrating torso trauma in a single major urban center in South America.  The 24-h mortality was 3.4%, and the 30-day mortality was 17.9%. Moreover, in 2020 Scriba et al. described a cohort of 95 patients with PNI in a South-African level I trauma center, treated with Foley catheters. Bleeding control with hemodynamic stabilization was achieved in 92 patients (96.8%). Given that many bleeding patients suffer from gunshot wounds and stab wounds, this technique, which is useful in deep, narrow wounds, could be useful for bomberos transporting patients with junctional injuries long distances.
CrashSavers has chosen the Foley Hemostatic technique because Foley catheters are easy to find, easy to use, and helpful in wounds that are difficult to manage with other hemostasis techniques. By teaching this technique to prehospital personnel, it is more likely that better hemorrhage control will be achieved from the beginning of trauma management, improving the life expectancy of patients arriving at hospital emergency rooms.
Foley placement training is not provided in Guatemala for first responders, as is any other bleeding control training. Since foley placement can be used to stop the bleeding in situations where a tourniquet cannot, we added it to our integrated module of ways to cease hemorrhage in pre-hospital care and potentially avoid unnecessary, avertable deaths in low- and middle-income countries.
How it Works
- van Oostendorp S, Tan E, Geeraedts L. Pre-hospital control of life-threatening truncal and junctional hemorrhage is the ultimate challenge in optimizing trauma care; a review of treatment options and their applicability in the civilian trauma setting. Scand J Trauma Resusc Emerg Med. 2016;24:110. doi: 10.1186/s13049-016-0301-9
- [Jose A, Arya S, Nagori S, Thukral H. Managment of life-threatening hemorrhage from maxillofacial firearm injuries using Foley catheter balloon tamponade. Craniomaxillofac Trauma Reconstr. 2019;12:301–304. doi: 10.1055/s-0039-1685461.]
- Himmler A, Calzetta ILM, Potes A, Puyana JC, Barillaro GF. The use of a urinary balloon catheter to control haemorrhage from penetrating torso trauma: a single-center experience at a major inner-city hospital trauma center. Am Surg. 2021;87:543–548. doi: 10.1177/0003134820949997
- Scriba M, McPherson D, Edu S, Nicol A, Navsaria P. An update on Foley catheter balloon tamponade for penetrating neck injuries. World J Surg. 2020 doi: 10.1007/s0026802005497z