With the approval of the director of nursing, I provided a copy of my facilities protocol regarding residents “Indwelling foley catheter care”. It is the Registered Nurse (RN) or Licensed Practical Nurse (LPN) responsibility for providing indwelling catheter care to our residents. The purpose of this nursing services guideline is to increase our nurse’s clinical knowledge on proper care and prevention of catheter associated urinary tract infections. The nursing services guidelines are placed in a yellow 3-ring binder visible placed at each nursing station and can also be viewed via computer on the SharePoint drive under the policies and procedures tab for “Catheter care, Indwelling”. It is also the facilities practice incorporating a “skills check off” upon hiring and every 6 months to ensure we have continued education, demonstration effectiveness and any new advancements in performing such skills. In addition, upon completion of the catheter care, nurses are responsible for implementing patient education by addressing the who, what, where, why, why not and how about CAUTI and the most evidenced-based effective interventions to reduce, improve, and/or prevent CAUTI’s in our facility. I have also enclosed a copy of what the frequently asked questions pamphlet looks like from the CDC. (CAUTI guidelines 2016) Reference Centers for Disease Control and Prevention. (2016, November 5). CAUTI guidelines. Centers for Disease Control and Prevention. Retrieved September 22, 2021, from https://www.cdc.gov/infectioncontrol/guidelines/cauti/index.html. Tonya Woodward Resident Health Services Manual POLICIES AND PROCEDURES SUBJECT: CATHETER CARE, INDWELLING C- 05 Page 1 of 4 POLICY: To strive to prevent contamination and catheter associated urinary tract infections and complications. PROCEDURE: 1. An indwelling catheter should never be inserted unless there is evidence to support its use such as: a. b. c. d. Urinary retention that cannot be treated or corrected. Stage III or IV pressure ulcer contaminated with urine, despite appropriate personal care for incontinence. Terminal illness or severe impairment, which makes positioning and clothing changes uncomfortable. Intractable pain 2. Attempt to remove the catheter as soon as possible when there are no indications for its continued use. 3. Educate the resident or responsible party on the risks and benefits of the catheter use. 4. Catheter care can be given during AM or PM care as follows: a. b. c. d. e. f. Assist the resident into a supine position. Inspect the outside of the catheter where it enters the meatus. Look for encrusted material or suppurative drainage and report any findings to the nurse. Inspect the tissue around the urinary meatus for irritation or swelling and report any findings to the nurse. Wash the meatal catheter junction and catheter tubing with soap and water, rinse and dry well. Avoid using a betadine solution. Separate the labia and wash carefully around catheter of a female resident. Draw back the foreskin, wash carefully around catheter and replace the foreskin on a male resident. C-05 Page 2 of 4 g. Avoid using lotions, powders, and corn starch in the perineal area. 5. Check the urine for unusual appearance (i.e., color, blood clots, cloudy, mucous) and report any findings to the nurse. 6. Attach the catheter to the resident’s upper inner thigh using a leg strap. Avoid use of adhesive tape. 7. Ensure that the drainage tubing goes over the resident’s leg, not underneath it. 8. Prevent the catheter tubing and the drainage bag from touching the floor. 9. Attach the drainage bag to the bed or chair frame, not to side rail. Note: Cover bag to maintain resident’s dignity. 10. Check the resident frequently to ensure that he/she is not lying on the catheter and that the catheter is free of kinks. 11. Check to see that there is neither disconnection nor leaking of urine. Report any leakage to the nurse. Note: Leakage around the catheter is frequently caused by bladder spasms; therefore, leakage should not be treated by using a larger catheter size unless medically justified. 12. Obtain urine samples from a sampling port using an aseptic technique. 13. If aspiration of a urine specimen from a closed system is necessary: a. b. Clamp the drainage tubing below the port for approximately ten minutes. Clean the aspiration port with alcohol. c. 13. Aspirate approximately 10 cc of urine with a sterile needle and syringe; then put the specimen into a sterile container. Empty the drainage bag at the end of every shift and whenever necessary. Avoid contaminating the end of the emptying tube. NOTE: A closed sterile draining system is to be maintained. If the drainage tubing junction must be opened, both ends must be kept sterile C-05 Page 3 of 4 and both ends are to be cleaned with isopropyl alcohol before they are re-connected. 14. If resident has a leg urine collection bag he/she uses during the day, drain the bag every 2-3 hours following these steps: NOTE: The use of leg bags is discouraged. a. b. c. d. e. f. Wash hands with soap and water and apply clean non-sterile gloves Unfasten the lower leg strap Remove the cap and open the clamp. Drain the urine into the toilet or urine collection container. Close the clamp and refasten the lower leg strap. Remove gloves and wash hands with soap and water. NOTE: 15. Use the larger collection bag instead of the leg bag if the resident is resting in bed for more than two hours. If resident has a leg urine collection bag, remove/attach it as follows. a. b. Wash hands with soap and water and apply clean non-sterile gloves. When removing the leg bag, do the following: • • • • • • • • • • • Unfasten the leg straps Disconnect the leg bag from the catheter tubing Connect the tubing to the backup bag. Drain any remaining urine from the leg bag Close the drainage valve Pour some warm soapy water into the leg bag. Swish the soap around to get the corners of the bag. Open the drain valve to drain the soap then close the valve. Fill the bag with one-part white vinegar and three parts water (vinegar solution) or a comparable solution (such as dakins, etc.). Cap the top Gently shake the solution a bit and allow it to remain in the bag for thirty (30) minutes. Uncap the top and bottom and drain the vinegar/comparable solution. Rinse the bag with cold tap water. Place the clean bag into a clean plastic bag and store on the bottom shelf of the resident bedside cabinet. C-05 Page 4 of 4 c. When re-attaching the leg bag do the following: • • Wrap the elastic leg straps around the resident’s calf Uncap the tubing and connect tubing to leg bag. Always be sure there are no kinks in the catheter tubing. NOTE: d. When opening the drainage tubing junction, both ends must be kept sterile and both ends are to be cleaned with isopropyl alcohol before they are reconnected. Remove gloves and wash hands with soap and water NOTE: NOTE: Change leg bags every week. Retain all caps for both the leg bag and the straight drainage system in vinegar/comparable solution between uses. The vinegar/comparable solution is changed daily. 16. Change drainage system (bag and tubing) monthly. Drainage systems are dated when changed. 17. Indwelling catheters are to be removed and changed when malfunctioning or contaminated. NOTE: If the catheter is functioning properly, no routine changes are to be performed unless ordered by the physician. 18. Report any resident complaints of burning, tenderness, or pain in the urethral area to the charge nurse immediately. 19. Document the urinary output in the electronic application or if the electronic application is not available on the Intake and Output Record, as required (see Intake and Output policy (Section I06). Ensure the care plan reflects the following: 20. a. b. c. d. e. Type of catheter tubing. Routine care of catheter, tubing, drainage bag. Interventions to minimize catheter-related injury, pain, encrustation, excessive urethral tension, accidental removal, or obstruction of urine overflow. Outcomes and/or effects of goals and interventions. Complications associated with catheter usage. Issued: 6/01 Revised 3/13, 3/15 FAQs (frequently asked questions) about “Catheter-Associated Urinary Tract Infection” What is “catheter-associated urinary tract infection”? A urinary tract infection (also called “UTI”) is an infection in the urinary system, which includes the bladder (which stores the urine) and the kidneys (which filter the blood to make urine). Germs (for example, bacteria or yeasts) do not normally live in these areas; but if germs are introduced, an infection can occur. If you have a urinary catheter, germs can travel along the catheter and cause an infection in your bladder or your kidney; in that case it is called a catheter-associated urinary tract infection (or “CA-UTI”). What is a urinary catheter? A urinary catheter is a thin tube placed in the bladder to drain urine. Urine drains through the tube into a bag that collects the urine. A urinary catheter may be used: • If you are not able to urinate on your own • To measure the amount of urine that you make, for example, during intensive care • During and after some types of surgery • During some tests of the kidneys and bladder People with urinary catheters have a much higher chance of getting a urinary tract infection than people who don’t have a catheter. How do I get a catheter-associated urinary tract infection (CA-UTI)? If germs enter the urinary tract, they may cause an infection. Many of the germs that cause a catheter-associated urinary tract infection are common germs found in your intestines that do not usually cause an infection there. Germs can enter the urinary tract when the catheter is being put in or while the catheter remains in the bladder. What are the symptoms of a urinary tract infection? Some of the common symptoms of a urinary tract infection are: • Burning or pain in the lower abdomen (that is, below the stomach) • Fever • Bloody urine may be a sign of infection, but is also caused by other problems • Burning during urination or an increase in the frequency of urination after the catheter is removed. Sometimes people with catheter-associated urinary tract infections do not have these symptoms of infection. Can catheter-associated urinary tract infections be treated? Yes, most catheter-associated urinary tract infections can be treated with antibiotics and removal or change of the catheter. Your doctor will determine which antibiotic is best for you. What are some of the things that hospitals are doing to prevent catheter associated urinary tract infections? To prevent urinary tract infections, doctors and nurses take the following actions. Catheter insertion o Catheters are put in only when necessary and they are removed as soon as possible. o Only properly trained persons insert catheters using sterile (“clean”) technique. o The skin in the area where the catheter will be inserted is cleaned before inserting the catheter. o Other methods to drain the urine are sometimes used, such as • External catheters in men (these look like condoms and are placed over the penis rather than into the penis) • Putting a temporary catheter in to drain the urine and removing it right away. This is called intermittent urethral catheterization. Catheter care o Healthcare providers clean their hands by washing them with soap and water or using an alcohol-based hand rub before and after touching your catheter. If you do not see your providers clean their hands, please ask them to do so. o Avoid disconnecting the catheter and drain tube. This helps to prevent germs from getting into the catheter tube. o The catheter is secured to the leg to prevent pulling on the catheter. o Avoid twisting or kinking the catheter. o Keep the bag lower than the bladder to prevent urine from backflowing to the bladder. o Empty the bag regularly. The drainage spout should not touch anything while emptying the bag. What can I do to help prevent catheter-associated urinary tract infections if I have a catheter? • Always clean your hands before and after doing catheter care. • Always keep your urine bag below the level of your bladder. • Do not tug or pull on the tubing. • Do not twist or kink the catheter tubing. • Ask your healthcare provider each day if you still need the catheter. What do I need to do when I go home from the hospital? • If you will be going home with a catheter, your doctor or nurse should explain everything you need to know about taking care of the catheter. Make sure you understand how to care for it before you leave the hospital. • If you develop any of the symptoms of a urinary tract infection, such as burning or pain in the lower abdomen, fever, or an increase in the frequency of urination, contact your doctor or nurse immediately. • Before you go home, make sure you know who to contact if you have questions or problems after you get home. If you have questions, please ask your doctor or nurse.
