Urinary Catheter
Management
Facts
• Many catheters are inserted within the
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hospital setting.
The CDC and AHCPR have guidelines for
catheter use.
Studies have found that patients have
urinary catheters for unjustified purposes:
41% patient days for unjustified purposes
in Medical ICUs.
58% patient days for unnecessary
catheters on General Medical Units.
Facts (cont.)
• Various reasons for the foley catheters.
• Average cost of treating urosepsis is
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$81.03 per day with average treatment
lasting 10 day. Total cost of $810.33 just
for medication treatment.
Length of Stay can be increased by 3.8
days r/t f/c urosepsis.
CDC-NHSN Top Docile Bench mark: 0 foley
related UTI in 1000 catheter days
• Indwelling foley catheters are a major source of
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UTI’S.
Direct relationship between duration a f/c is in
the patient and incidence of infection.
Risk factors:
Female
Advanced age
Duration
Diabetes
Renal insufficiency
Urinary Catheter Risks
Catheter:
• Breaches barrier
• Balloon prevents complete emptying
• Distends bladder
• Pool of urine
Close system:
• Never completely closed
• Travel upwards
Condom catheter:
• Warm moist conditions inside
• Travel upwards
Bacteria is a function of time with a f/c:
Single event – risk < 1%
4 days – risk increases to 30%
30 days – risk 95-100%
Risks/Consequences
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UTI
PYELONEPHRITIS
DEATH R/T BACTEREMIA
DAMAGE TO URETHRA (SCARRING AND STRICTURES)
Prostatitis and epididymitis
What we are doing now that is the right thing to do.
Foley Catheter Bundle
What is the Foley Catheter Bundle?
 Insert using sterile technique
 Hand hygiene before and after any contact with the F/C
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system
Secure catheter to thigh at ALL times
Keep catheter bag below the level of the bladder at ALL
times
Maintain a sterile, continuously closed system
Specified criteria for insertion and continuation of a foley
catheter
Peri care daily and after all incontinent stool
What is “Peri Care” for a patient with a f/c? Daily wash with
warm soap & water then dry.
Criteria for insertion and continuation of the foley
catheter
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Retention
Critical I&O
Comatose
Paralyzed
Neurogenic Bladder
Pre-op placement
Wound with incontinence
Bladder Irrigation
Physical trauma
Pain with bedpan/incontinence brief
Terminal illness/comfort measures
“other”
Questions:
• True or False:
A F/C UTI can occur by 30% within 4 days of
placement
• True or False:
Incontinence is a reason to place a F/C
• The F/C Bundle includes:
a. Hand hygiene before & after any contact with
b.
c.
d.
e.
f.
g.
h.
the F/C system
Insert using sterile technique
Secure F/C to thigh at ALL times
Keep catheter bag below level of bladder at
ALL times
Maintain a sterile continuously close system
Peri care daily & after any incontinent stool
Specified criteria for insertion & continuation of
a F/C
All of the above
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a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
Criteria for insertion and continuation of a F/C includes:
Retention
Critical I&O
Comatose
Paralyzed
Neurogenic Bladder
Pre-op placement
Wound with incontinence
Bladder Irrigation
Physical trauma/pain with bedpan/incontinence brief
Terminal illness/comfort measures
All of the above