NEWARK BETH ISRAEL MEDICAL CENTER



NEWARK BETH ISRAEL MEDICAL CENTER

POLICY: (Numbered)

(DEPARTMENT OR MANUAL NAME) POLICY AND PROCEDURE

Nurse Driven Protocol for Adult Foley Catheter Removal

EFFECTIVE DATE: ___________(Dated two weeks after final approval signature)

Approved By: _______________________________ Date:___________________

Mary Fuhro, RN

Approved By: _______________________________ Date:___________________

John Brennan, MD

Approved By: _______________________________ Date:___________________

Alan Lapa, MD

Approved By: _______________________________ Date:___________________

Jeremias Murillo, MD

Approved By: _______________________________ Date:___________________

Jennifer LaRosa, MD

ATTACHMENTS:

PURPOSE:

The purpose of this policy is to implement a nurse-driven protocol for the removal of foley catheters in adult patients that no longer have an indication for ongoing use.

POLICY:

The Centers for Disease Control (CDC) publishes guidelines that recommend when it is appropriate to use foley catheters and when such catheter use should be discontinued. It is the intent of this policy to implement a nurse-driven protocol which will increase compliance with these guidelines and thereby improve patient comfort and reduce complications related to IUCs.

QUALIFICATIONS:

Registered nurses and nurse supervisors with staff privileges at Newark Beth Israel Medical Center

PROCEDURE:

As part of the initial patient assessment at the beginning of each shift, the nurse will assess the following parameters.

1. Presence of a foley catheter.

a. If present, determine if the catheter meets at least one of the following indications.

2. A foley catheter is acceptable for at least one of the following reasons.

o Urinary retention including obstruction and neurogenic bladder: the patient is unable to pass urine because of an enlarged prostate, blood clots or an edematous scrotum/penis or unable to empty the bladder because of neurologic disease / medication effect.

o Short perioperative use (within 48 hours and/or when ambulatory)

o Placed by urology service (must check with urology service before discontinuing the foley).

o Strict need for precise output measurements in critical care areas

o Assist healing of perineal and sacral wounds in incontinent patients to avoid further deterioration of wound and skin (stage 3 or greater)

o Hospice/comfort care or palliative care, if requested by patient

3. If no appropriate (acceptable) indication(s) for use are present, the nurse will discontinue the foley catheter. Efforts will be made to remove foley catheters at or around 12 midnight so that if urinary retention occurs, appropriate consultants can be present for potential reinsertion.

4. Post discontinuation, observe the patient and consider reinsertion of the foley catheter if either of the following are present

a. Bladder distention

b. No spontaneous voiding within 6 hours if symptomatic

5. If the patient has an indication for reinsertion of the foley catheter, the Nursing Supervisor will be responsible for coordinating and assigning a nurse to perform the task. This will include traditional foley catheters and coude catheters.

6. The Nursing Supervisor will contact the primary physician and the Urology service if there are any concerns related to patient’s assessment or if successful placement cannot be achieved as above.

EQUIPMENT:

none

DOCUMENTATION:

Document the following, every shift, in the EMR for the patient with an indwelling urinary catheter.

o Presence of the catheter

o Indication for continued use of the catheter

o Date and time of removal, when applicable

o Tolerance of catheter removal, including

▪ Any significant findings (ie bleeding, pus, etc.)

▪ Date/time of first void post catheter removal

INFECTION CONTROL:

Standard precautions

SAFETY:

Standard safety measures

REFERENCES:

Gould CV et al. Guideline for Prevention of Catheter Associated Urinary Tract Infection. CDC 2009.

On the CUSP: Stop HAI. .

ORIGINAL DATE:

12th February 2014

INITIATED BY:

Jennifer A. LaRosa, MD, FCCM, FCCP

REVIEWED:

REVISED:

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