BERKELEY, CA (UroToday.com) - This excellent review article on CAUTIs discusses the use of Foley catheters in acute care patients.
The author discusses the problem of indwelling urinary catheter (IUC) use and associated UTIs. Also presented is current information on the causes of CAUTIs, ways to prevent them, and how to reduce catheter use and alternatives. The author provides a review of the literature of nurse-driven IUC removal programs; particularly a program that involved the critical ability of critical care nurses to remove the catheter without a doctor's order. The author identifies key elements effective to prevent CAUTIs, including: clarification of policies related to the use of the catheter and active involvement of a multidisciplinary team, including staff nurses, specifically specialty practice nurses.
The author notes that nurse practitioners can play an important role in the acute care environment through standardized nursing care, to review the appropriate use of the catheter insertion, for reviewing the potential removal of the catheter 1 day or no later than 3 days after insertion, and for regular, instructive staff feedback about the results of the program. The article also provides a nice review of the different catheter materials that are available to providers, and a discussion on insertion technique and ongoing care. Alternatives to the indwelling catheter are explored and include intermittent catheterization and external collection devices. An algorithm for IUC removal is presented. The author recommends that catheterization be performed on bladder volumes > 350 ml. In our hospital, the Hospital of the University of Pennsylvania, the policy is not to catheterize a patient for volumes < 400 to 500.
AACN Adv Crit Care. 2010 Jul-Sep;21(3):247-57.
doi: http://dx.doi.org/10.1097/NCI.0b013e3181db53cb
PubMed Abstract
PMID: 20683224
