Urinary Catheter

Management
Facts

• Many catheters are inserted within the

hospital setting.
• The CDC and AHCPR have guidelines for
catheter use.
• Studies have found that patients have
urinary catheters for unjustified purposes:
• 41% patient days for unjustified purposes
in Medical ICUs.
• 58% patient days for unnecessary
catheters on General Medical Units.
Facts (cont.)

• Various reasons for the foley catheters.

• Average cost of treating urosepsis is
$81.03 per day with average treatment
lasting 10 day. Total cost of $810.33 just
for medication treatment.
• Length of Stay can be increased by 3.8
days r/t f/c urosepsis.
• CDC-NHSN Top Docile Bench mark: 0 foley
related UTI in 1000 catheter days
• Indwelling foley catheters are a major source of
UTI’S.
• Direct relationship between duration a f/c is in
the patient and incidence of infection.
• Risk factors:
 Female
 Advanced age
 Duration
 Diabetes
 Renal insufficiency
Urinary Catheter Risks
Catheter:
• Breaches barrier
• Balloon prevents complete emptying
• Distends bladder
• Pool of urine
Close system:
• Never completely closed
• Travel upwards
Condom catheter:
• Warm moist conditions inside
• Travel upwards
Bacteria is a function of time with a f/c:
Single event – risk < 1%
4 days – risk increases to 30%
30 days – risk 95-100%
Risks/Consequences

• UTI
• PYELONEPHRITIS
• DEATH R/T BACTEREMIA
• DAMAGE TO URETHRA (SCARRING AND STRICTURES)
• Prostatitis and epididymitis
 What we are doing now that is the right thing to do.
Foley Catheter Bundle
What is the Foley Catheter Bundle?

 Insert using sterile technique

 Hand hygiene before and after any contact with the F/C system
 Secure catheter to thigh at ALL times
 Keep catheter bag below the level of the bladder at ALL times
 Maintain a sterile, continuously closed system
 Specified criteria for insertion and continuation of a foley
catheter
 Peri care daily and after all incontinent stool

What is “Peri Care” for a patient with a f/c? Daily wash with
warm soap & water then dry.
Criteria for insertion and continuation of the foley
catheter

• Retention
• Critical I&O
• Comatose
• Paralyzed
• Neurogenic Bladder
• Pre-op placement
• Wound with incontinence
• Bladder Irrigation
• Physical trauma
• Pain with bedpan/incontinence brief
• Terminal illness/comfort measures
• “other”
Questions:

• True or False:
A F/C UTI can occur by 30% within 4 days of
placement
• True or False:
Incontinence is a reason to place a F/C
• The F/C Bundle includes:
a. Hand hygiene before & after any contact with the
F/C system
b. Insert using sterile technique
c. Secure F/C to thigh at ALL times
d. Keep catheter bag below level of bladder at ALL
times
e. Maintain a sterile continuously close system
f. Peri care daily & after any incontinent stool
g. Specified criteria for insertion & continuation of a
F/C
h. All of the above
• Criteria for insertion and continuation of a F/C includes:
a. Retention
b. Critical I&O
c. Comatose
d. Paralyzed
e. Neurogenic Bladder
f. Pre-op placement
g. Wound with incontinence
h. Bladder Irrigation
i. Physical trauma/pain with bedpan/incontinence brief
j. Terminal illness/comfort measures
k. All of the above