INDWELLING URINARY CATHETER (IUC) PROTOCOL
Objective
To reduce/prevent the incidence of catheter-associated infections and other complications
associated with indwelling catheter usage.
Policies
1. Refer to A-1: Nursing Guidelines Common to All Procedures.
Indications for Indwelling Urinary Catheters:
 Placed by urologist/gynecologist (with consultation as appropriate).
 Palliative care for hospice or terminally ill patients
 Management of incontinence in patients with a Stage III – IV pressure ulcer of
the perineal/sacral/trunk area
 Urinary retention unresolved by other interventions
 Treatment is actively titrating diuretics and/or fluids, however
strict I&O is not an absolute indication for an IUC.
 Chronic history of indwelling or supra pubic catheter
 Specific orders written for operative procedures
 Trauma patient who needs to be immobilized
2. If patient meets above criteria:
a. Ensure there is a documented physician’s order that should include the
clinical indication for use of the device.
b. Include IUC on plan of care (Problem list)
c. Monitor and plan to discontinue as soon as clinically appropriate.
3. If the patient does not meet the above criteria, 24 hours after admission:
a. Write a nursing order to remove IUC in early AM when totaling night
shift output.
b. Document removal and time
4. Post Indwelling Urinary Catheter Removal Plan of Care
a. Encourage PO fluid intake as allowed by diet.
b. Encourage ambulation to bathroom/bedside commode/stand to urinate
c. Monitor patient for first void after IUC removal and document
d. Continue to monitor for adequate output
e. If patient unable to void after 6-8 hours, or if patient is uncomfortable;
perform bladder scan; notify physician of results.
References
Agency for Health Care Policy and Research. Clinical Practice Guideline – Urinary incontinence in adults.
Washington, DC, Dept HHS, 1992.
Capezuti,E., Zwicker, D., Mezy, M., Fulmer, T., Gray-Miceli, D., Kluger, M. (2008). Evidence based
geriatric nursing protocols for best practice. Springer: New York, NY.
Center for disease control and prevention: Guidelines for prevention of catheter associated urinary tract
infections. (accessed April 2, 2008).
National Association of Wound, Ostomy and Continence Nurses. Clinical Fact Sheet Indwelling Catheters.
Downloaded from website, April 14, 2008.
Gokula, R., Hickner, J., Smith, M., (2004) Inappropriate use of indwelling urinary catheters in elderly
patients in medwest teaching hospital. American Journal of Infection Control, 32(4), 196-199.
Inelmen, E.M., Guiseppe, S., Giuliano, E. (2007). When are indwelling urinary catheters appropriate in
elderly patients? Geriatrics, 62(10), 18-22.
Saint,S., Kowalski, C.P., Kaufman, S.R. (2008). Preventing hospital acquired urinary tract infections in the
United States. A national study. Clin Infect.Dis., 46:243-250.
Topal, J., Conklin, S., Camp, K., Morris, V., Balcezak, T., Herbert, P. (2005) Prevention of nosocomial
catheter-associated urinary tract infections through computerized feedback to physicians and a nursedirected protocol. American Journal of Medical Quality, 20(3), 121- 126.
Wald, H., Kramer, A. (2007) Nonpayment for harms resulting from medical care: Catheter associated
urinary tract infections. JAMA, 298(23), 2782-2784.
Findings from 2006 retrospective chart review at Akron General Medical Center of indwelling urinary
catheter use for patients >64 admitted from home through the Emergency department to one of three
medical units.