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
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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
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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”.
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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. http://www.cdc.gov/ncidod/dhqp/gl_catheter_assoc.html.
Wound, Ostomy and Continence Nurses Society. Clinical fact sheet: Indwelling
catheters:http://www.wocn.org.
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