Indications for Catheter Placement

Best practice guidelines provide us with some very specific indications for appropriate indwelling urinary catheter use--and they are listed here. For those of you who have Foley catheters in your “House”, are they used for one of the indications listed on here?

 

Acute urinary retention.   Bladder outlet obstruction.   Accurate measurement of urinary output in critically ill.   Perioperative use with urological or surgeries near GU tract structures. Catheters can be appropriate and useful when the anticipated time in the OR is expected to be prolonged, there is a need to infuse large volumes and/or diuretics in the OR, or there is a need for intraoperative monitoring of urinary output.   If the incontinent patient has sacral and/or perineal wounds.   If there is expected to be a prolonged state of immobility related to prolonged surgery, or multiple traumas.   They can be used to provide comfort at end of life.

 

Inappropriate Indications for Catheter Placement

Just as important as knowing the appropriate reasons for catheter use, it is equally important for all health care providers to know and understand the inappropriate indications.

 

•Incontinence management •Urine sample collection when patient can void •Prolonged post-operative use without an appropriate indication for continued use

 

Best Practices: Recommendations

Proper hand hygiene and use of gloves are paramount to preventing infections. Careful and routine hygiene when bathing and especially after episodes of fecal incontinence is important to preventing CAUTIs. And it should be noted that cleansing of the catheter-urethral junction does not require the use of special antiseptics or antimicrobial agents.

•Hand hygiene before and after insertion and before and after any manipulation of catheter or site •Periurethral hygiene QD at bath/shower and after fecal incontinence episode(s)

Proper maintenance for an indwelling urinary catheter is described in several practice guidelines and includes the following:

•Continuous closed drainage system •Unobstructed flow: kink-free •Drainage bag below level of       bladder and  drainage bag       not lying on floor •Empty drainage bag      regularly •Secure catheter to inner       thigh to prevent movement       & traction on urethra

 

Maintaining unobstructed, gravity dependent flow is an important intervention for CAUTI prevention. Securing the catheter can help prevent microbes from traveling up the catheter to the bladder. A study at an acute care hospital, 95% of the nurses surveyed stated that anchoring the catheter can help prevent infections, yet only 4.4% of the indwelling catheters were found to be stabilized. (Siegel, TJ 2006: Do Registered Nurses Perceive the Anchoring of Indwelling Urinary Catheter as a Necessary Aspect of Nursing Care JWOCN March/April 2006 140-144). If you have Foleys in your “house”, are you 100% confident that these “proper maintenance recommendations” are being performed all the time?

 Rick Fields-Gardner