Policy Name: URINARY CATHETERIZATION AND CAUTI PREVENTION POLICY
Policy Purpose: To identify approved indications for urinary catheterization and describe proper
insertion, catheter care and prompt removal of a urinary catheter to reduce patients’ risk for a catheterassociated urinary tract infection (CAUTI).
Policy Statement(s):
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II.
Insertion of a sterile catheter in to the urinary bladder may be completed by a licensed nurse
after a physician’s order has been obtained.
It is the responsibility of registered nurses to evaluate the necessity for urethral catheterization,
monitor urinary drainage each shift reporting changes, review catheter necessity daily, and
remove urethral catheters as soon as possible.
Equipment:
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Catheter tray with drainage bag
Catheter securement device
Procedure:
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Insertion and removal – Refer to Lippincott Nurses guide to Clinical Procedures/Insertion Policy
_______________ Bundle to Prevent Catheter-Associated Urinary Tract Infections (CAUTI)
a. Catheterize only when necessary
i. To relieve acute or chronic urinary retention or bladder outlet obstruction;
ii. To obtain accurate measurements of urinary output in critically ill patients (i.e.
ICU with I&O every 2 hours or urometer bag with I&O every 2-4 hours)
iii. For perioperative use in patients undergoing the following surgical procedures:
1. Urologic surgery or other surgery on contiguous structures of the
genitourinary tract
2. Prolonged duration of surgery (remove catheter in PACU)
3. Large-volume infusions or diuretics during surgery
4. Intraoperative monitoring of urinary output
iv. To promote healing of sacral or perineal wounds in incontinent patients.
v. For patients who require prolonged immobilization
1. Unstable thoracic or lumbar spine injuries
2. Multiple traumatic injuries (e.g., pelvic fractures)
vi. Spinal and/or epidural anesthesia (removal within 48 hours)
vii. To improve comfort for end of life care if needed
b. Consider alternatives to indwelling catheters when appropriate
c. Emphasize good hand hygiene
d. Insert catheter using aseptic technique and sterile equipment
e. Use smallest bore catheter possible
i. Use catheter sizes of 14 FR and 16 Fr with 10cc balloon when appropriate
1 URINARY CATHETERIZATION AND CAUTI PREVENTION POLICY
ii. Use a coude catheter in elderly male patients with known or suspected prostate
enlargement
f. Use a generous amount of sterile lubricant for catheter insertion
i. MAY use urologic lidocaine jelly prior to catheter insertion (if no allergy) for
male patients of an attending urologist or unless otherwise ordered.
g. Use portable ultrasound device to assess urine volumes in patients with intermittent
catheterization to help reduce unnecessary catheter insertions
h. Maintain system properly
i. Secure catheter appropriately
ii. Keep drainage bag lower than patient’s bladder at all times, including during
transport, avoiding contact with the floor
iii. Maintain a closed sterile drainage
iv. Empty the urinary drainage bag frequently enough to prevent reflux
v. Use a separate and clean container for each patient
vi. Avoid contact between the urinary drainage tap and the container when
emptying the drainage bag
vii. Obtain urine samples from a sampling port using aseptic technique
i. Provide perineal care daily and after bowel movements, ensuring external catheter is
also cleaned
j. Observe and document the clarity of urine every shift. Report changes immediately.
k. Review daily for catheter necessity and remove as soon as possible. (Refer to Algorithm
for Removal of Foley Catheter).
Documentation:
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Electronic Health Record (EHR) nursing documentation
a. Date and time
b. Type and size of catheter, cc’s used for filling balloon
c. Amount and color of urine
d. Patient tolerance
e. Daily catheter necessity
Record on Intake and Output record the amount of urine output every 8 hours or as indicated.
References:
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Lippincott Nurses Guide to Clinical Procedures, 3rd Edition, Jean Smith-Temple and Jayce Young
Johnson. Lippincott-Raven Publishers, Philadelphia 1998, pages 264-282
Guideline for Prevention of Catheter-Associated Urinary Tract Infection, 2009.
http://www.cdc.gov/hicpac/pdf/CAUTI/CAUTIguideline2009final.pdf
Spencer Municipal Hospital URINARY CATHETERIZATION AND CAUTI PREVENTION POLICY
2 URINARY CATHETERIZATION AND CAUTI PREVENTION POLICY
ALGORITHM FOR REMOVAL OF FOLEY CATHETER
Assess patient upon admission/transfer and each shift for one of the following indicators for
urinary catheterization:
Urinary Tract Obstruction (i.e., enlarged prostate, blood clots)
Neurogenic bladder dysfunction
Urinary retention not manageable by other means (i.e. intermittent catheterization)
Stage III or Stage IV decubitus ulcer in an incontinent patient
Urological or gynecological surgery or urinary catheter placed by urologist
Aggressive treatment with diuretics or fluids which requires accurate output
measurement
Prolonged immobilization due to spine or traumatic injury
Immediate post-op (Day 1 or Day 2)
Patient is terminally ill
If none of the above indicators is selected, continue daily assessment.
None of the above indications apply, contact physician for order to REMOVE URINARY
CATHETER
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