INDWELLING CATHETER INDICATIONS AND CARE



INDWELLING CATHETER INDICATIONS AND CARE

FACTS: Indwelling urinary catheters are placed in 25% of hospitalized patients

Catheter associated UTI account for 40% of all nosocomial infections

The risk of acquiring bacteriuria is approx. 5% for each day of

catheterization

INDICATIONS SHORT TERM CATHETER PLACEMENT

• Management of acute urinary retention

• Bladder decompression during or following surgery

• Monitoring urinary output (especially in critically ill patients)

• Sudden and complete inability to void

• Need for immediate and rapid bladder decompression

• Temporary relief of bladder outlet obstruction secondary to

▪ Enlarged prostate

▪ Urethral stricture

▪ Obstructing pelvic organ prolapse

▪ Urologic or prolonged surgical procedure

• Irreversible medical conditions are present (metastatic terminal disease, coma,

other end stage conditions)

• Presence of stage III or stage IV pressure ulcers that are not healing because of

continual urine leakage

* URINARY INCONTINENCE IS NOT AN INDICATION FOR INDWELLING CATHETER PLACEMENT*

BALLOON INFLATION:

The purpose of the balloon is to retain the catheter in the bladder. Occlusion of the urethral opening or leakage prevention are not functions of the balloon. Proper inflation creates a symmetrical balloon. If a balloon is not properly inflated it could prevent bladder emptying, increase the risk of bladder spasm, bacteriuria.

NURSING MANAGEMENT:

• Use strict aseptic technique for catheter insertion

• Minimize urethral trauma during insertion: use generous amount of lubricant,

insert catheter all the way to the hub before inflating balloon (in males)

• Stabilize the catheter to minimize urethral trauma

• Maintain a closed system

• Maintain drainage bag and tubing in dependent position to facilitate urine flow

• Maintain adequate hydration (30cc/Kg body weight/day ) unless contraindicated

• Gently cleanse perineum and proximal catheter daily and after each bowel

movement

• Assess bowel function and implement measures to eliminate impaction or correct

constipation

MANAGE/PREVENT LEAKAGE

• Assess for patency, if occluded remove and replace

• Assess for signs and symptoms of UTI ( to obtain urine for culture, remove

existing catheter and replace before obtaining sample)

• If urine is concentrated, provide adequate hydration (unless contraindicated)

• Check for fecal impaction, remove if present, institute bowel management

program

• Check for proper balloon inflation

• Stabilize catheter

• For severe bladder spasms, consider MD consult for anticholinergics

CDC RECOMMENDATIONS

“Urinary catheterization should be discouraged as a means of obtaining urine for culture or certain diagnostic tests such as urinary electrolytes when the patient can voluntarily void or as a substitute for nursing care of the incontinent patient”.

REFERENCES

Cochran, S. Care of the indwelling urinary catheter: Is it evidence based? Journal of

Wound, Ostomy and Continence Nursing. 2007;34(3):282-288.

Gray, M. What nursing interventions reduce the risk of symptomatic urinary tract

infection in the patient with an indwelling catheter? Evidence-Based Report Card from the Center for Clinical Investigation. Journal of Wound, Ostomy and Continence Nursing. 2004;31(1):3-13.

Newman, DK. The indwelling urinary catheter: Principles for best practice. Journal of

Wound, Ostomy and Continence nursing. 2007;34(6):655-661.

Wong, E.S., Hooten, T.M. Guideline for prevention of catheter-associated urinary tract

infection. .

Wound, Ostomy and Continence Nurses Society. Clinical fact sheet: Indwelling

catheters:.

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