Best Practices for Management - Indwelling Urinary Catheters

• Document in the patient’s medical record all procedures involving the catheter or drainage system.
• Also practice hand hygiene prior to performing catheter care.
• Remove catheter as soon as possible to reduce the risk of CAUTIs. Insert the catheter using an aseptic technique.
• Use the smallest size catheter possible.
• Cleanse the catheter insertion site daily with soap and water or with a perineal cleanser.
• Use of an antiseptic or meatal care is unnecessary, use soap and water.
• Avoid routine or arbitrary catheter changing schedules in the absence of infection.
• Maintain a uniform and adequate daily fluid intake to continuously flush the urinary drainage system.
• Clamping the catheter prior to removal is unnecessary.
• Routine catheter and bladder irrigations and/or instillations are not recommended.
• Avoid routine urine cultures in the absence of infection.
• Avoid inappropriate use of antibiotics and antimicrobials.
• Maintain the acidification of urine.
• Patients and caregivers should be educated about their role in preventing CAUTIs.
• Acute and long-term care staff should be educated through quality improvement programs about the selection, insertion, and management of indwelling catheters to reduce UTI incidence.
• Patients with indwelling urinary catheters should be reevaluated periodically to determine whether an alternative method of bladder drainage can be used instead.
• Patients should undergo bladder training after catheter removal to successfully regain bladder function.
• Health-care workers and clinicians in institutions should observe their facility’s protocols for care of catheters and drainage bags. Daily catheter care should include:
  • Labeling on bag insertion date, time and place (e.g. OR, ER).
  • Maintain a closed urinary drainage system to prevent introduction of bacteria into the urinary tract.
  • Adequately secure and anchor the catheter to prevent urethral and bladder-neck tension.
  • Ensure that urine drainage is unobstructed and continuous by avoiding dependent loops, ensuring no kinks in tubing and bag is positioned below the bladder but not on the floor.
  • Scan the bladder if no urine is draining to determine if system is obstructed.
  • Use needleless sampling port for urine specimen collection
  • Anchor and secure catheter
  • Empty bag if > 400 mls to prevent tension on catheter and to prevent the migration of bacteria ascending from bag to catheter.

References:
1. Newman DK, Cumbee RP, Rovner ES. Indwelling (transurethral and suprapubic) catheters. In: Newman DK, Rovner ES, Wein AJ, editors. Clinical Application of Urologic Catheters and Products.  Switzerland: Springer International Publishing; 2018,  47-77.
2. Newman DK. Devices, products, catheters, and catheter-associated urinary tract infections. In: Newman DK, Wyman JF, Welch VW, editors. Core Curriculum for Urologic Nursing. 1^st ed. Pitman (NJ): Society of Urologic Nurses and Associates, Inc; 2017, 439-66.
3. Newman DK. The indwelling urinary catheter: Principles for best practice. JWOCN. 2007;34:655-61 DOI: 10.1097/01.WON.0000299816.82983.4a
4. Newman DK.  Wein, AJ. Mananging and Treating Urinary incontinence. 2009 Health Professional Pres, Inc. Baltimore, MD. 
5. Wang LH, Tsai MF, Han CS, Huang YC, Liu HE.Is Bladder training by clamping before removal necessary for Sshort-term indwelling urinary catheter inpatient? A systematic review and meta-analysis. Asian Nurs Res (Korean Soc Nurs Sci). 2016 Sep;10(3):173-181. doi: 10.1016/j.anr.2016.07.003.