EVIDENCE-BASED PRACTICE PROTOCOL
Management of Long-Term Indwelling Urinary Catheters
Definitions
Indications
Types of catheters
Maintenance
Changing the catheter
(or drainage bag)
Cleaning the drainage
bag
Long-term: > 30 days
Indwelling: drainage tube inserted into the urinary bladder through the urethra, left in place,
and connected to a drainage system
Catheter-related urinary tract infection (CAUTI):
Must meet one of the following criteria:
1) 2 of the following AND urinalysis or culture not done
-Fever (2-4 degrees F or 1 degree C above baseline) or chills with no other source
-Flank pain OR suprapubic pain OR tenderness OR frequency OR urgency
-Worsening mental or functional function
-Changes in character of urine (blood, foul odor, increase sediment, etc.)
2) One of the following AND urinalysis/culture done
-Fever* or chills
-Flank pain OR suprapubic pain OR tenderness
(re: urinalysis/culture: bacteriuria – positive culture or positive nitrite assay;
pyuria – 10 or more wbc/hpf on urinalysis or positive leukocyte esterase assay)
-Bladder outlet obstruction or retention
-Healing sacral wound (pressure ulcer on trunk) in incontinent pts.
-Palliative end-of-life
-Antimicrobial catheters not supported for effectively preventing CAUTIs
-Use smallest size (caliber)
-Silicone may be preferred in long term catheterized patients to prevent obstruction
 Maintain closed system – minimize disconnections; if change to leg bag, disinfect
tubing with 70% alcohol
 Routine hygiene (daily bathing; no antiseptics; see patient/family education)
 Keep drainage bag &connecting tubing below level of bladder and off the floor
 Proper securing to prevent movement & urethral traction
 Empty bag regularly when 1/3-1/2 full making sure not to touch the spigot to the
container or toilet – clean spigot with alcohol
 Empty bag before bedtime
 No regular use of topical antiseptic or antibiotics, chronic antibiotic suppressive
therapy, routine cultures, saline irrigation
 Antiseptic conditions
 Adequate lubricant
 Inflate balloon with sterile H20 and amt. determined by manufacturer’s
recommendations
 Routine changing of catheter monthly based on Medicare beneficiaries and/or
physician order; note that changing the catheter at regular intervals is not fully
supported – need to adapt to individual patient based on infection, obstruction or
when closed system compromised
 Change drainage bag when catheter changed or more frequently for clouding, odor,
or discoloration
 Bleach solution method preferred (decrystalizes sediment and inhibits bacterial
growth) (mix daily): MUST TEACH SAFE HANDLING OF BLEACH
Wash hands before & after; disconnect bag from catheter; rinse tubing with tap water
Urinary catheters; Sue Fowler & Kim Druist, 4/15/10; input from Anne Lefferts & VNAA clinical-qi listserve;
reviewed, revised and approved by NRC 4/15/10
Approved by NRC 4/15/10 with minor changes; shared with NCP 6/2/10; shared with NCC 6/10/10
Page 1
Infection Related
Patient/family
Education
Other
Documentation
using a soft, plastic squirt bottle or turkey baster; mix 4 oz. bleach with 1 gallon tap
water; pour solution into tubing/bag; avoid wetting the air vent located at top of
drainage bag; agitate for 30 seconds; drain; air dry; store in closed container
 Vinegar solution method if cannot use bleach safely: Follow directions above;
instead, use ½ c. vinegar to 1 ½ cups tap water
 Most S&S for CAUTI are nonspecific; only obtain specimens if patient exhibits S&S
since treatment should target symptomatic patients
 No prevention for biofilm (layer resistant to acidic irrigants & antibiotics
 Change catheter, then get urine specimen – 1) disinfect port with 70% alcohol & pat
dry prior to withdrawing specimen; 2) can obtain specimen from newly inserted
catheter by letting urine drain directly into cup before connecting tubing; 3) if
catheter already connected to tubing, and no port, disconnect and disinfect with 70%
alcohol; Do not obtain urine culture from drainage bag
 Transport urine culture according to recommendations (room temperature with
chemical preservation and test within 24-72 hours)
 Urine culture before antibiotics
 Treatment is based on symptoms (criteria) and organism
 Use SBAR-CUS when communicating assessment findings to healthcare provider
 Wash hands with soap & running water
 Avoid tension on the catheter and kinks; anchor catheter appropriately
 Drainage bag below level of bladder
 Fluids – 6-8 glasses/liquid/day – keep urine yellow
 Avoid irritants such as caffeine, ETHO, etc.
 Avoid constipation
 Daily perineal cleaning with soap and water; front to back in females; start at tip in
men; wash away from body down catheter
 Shower unless contraindicated
 Teach self-management – emptying the drainage bag; changing the drainage bag;
switching from drainage bag to leg bag; cleaning and storing drainage bag;
complications
-If urethral catheter for > 10 years, screen for bladder cancer
-Discuss possible transition to subrapubic catheter
-May consider belly bag
 Urinary NDP
 Narrative: if appropriate, catheter changed without difficulty; next change (once
individualized)
 Plan for next visit: culture results, teaching
NOTE: With silicone catheters, check the balloon inflation every 2 weeks
Urinary catheters; Sue Fowler & Kim Druist, 4/15/10; input from Anne Lefferts & VNAA clinical-qi listserve;
reviewed, revised and approved by NRC 4/15/10
Approved by NRC 4/15/10 with minor changes; shared with NCP 6/2/10; shared with NCC 6/10/10
Page 2
References:
Association of Professionals in Infection Control and Epidemiology (APCI). (2008). Guide to the Elimination of CatheterAssociated Urinary Tract Infections (CAUTIs) Developing and Applying Facility-Based Prevention Interventions in Acute
and Long-Term Care Settings. APIC: Washington, DC.
Healthcare Infection Control Practices Advisory Committee (HICPAC). (2009). Guidelines for the Prevention of CatheterAssociated Urinary Tract Infections. CDC: Atlanta, GA.
Hooton, T. M., Bradley, S. F., Cardenas, D. D., Golgan, R., Geerlings, S. E., Rice, J. C., Saint, S., Schaeffer, A. J., Tambayh, P.
A., Tenke, P, & Nicolle, L. E. (2010). Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in
adults: 2009 international clinical practice guidelines from the infectious diseases society of America. CID, 50, 625-663.
National Association for Continence. (2010). When The Drainage System Is Changed Frequently. Accessed from
http://www.nafc.org/bladder-bowel-health/urinary-catheterization-of-men-andwomen/#Care%20of%20Leg%20Bags%20and%20Night%20Drainage%20Systems.
National Guideline Clearinghouse. (2009). Catheter-associated urinary tract infections. In: Guidelines on urological
infections.
Smith, J. M. (2003). Indwelling Catheter Management: From Habit-based to Evidence-based Practice. Wound Ostomy
Management, 49(12). Access from http://www.o-wm.com/content/indwelling-catheter-management-from-habitbased-evidence-based-practice.
Urinary catheters. Accessed from http://www.nlm.nih.gov/medlineplus/ency/article/003981.htm.
VNAA genitourinary policies (i.e., Decontamination of Vinyl Urinary Drainage Bag; Sterile Urine Specimen Collection from
a Foley Catheter; Urinary Catheter Care).
Wound Ostomy and Continence Nurses Society. (2009). Indwelling urinary catheters: Best practices for clinicians. Mt.
Laurel, NJ: WOCN.
Urinary catheters; Sue Fowler & Kim Druist, 4/15/10; input from Anne Lefferts & VNAA clinical-qi listserve;
reviewed, revised and approved by NRC 4/15/10
Approved by NRC 4/15/10 with minor changes; shared with NCP 6/2/10; shared with NCC 6/10/10
Page 3