EVIDENCE-BASED PRACTICE PROTOCOL

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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


EVIDENCE
-
BASED PRACTICE PROTOCOL


Management of Long
-
Term Indwelling Urinary Catheters

Definitions

Long
-
term
:
>

30 days

Indwelling
: drainage tube inserted into the urinary bladder through the urethra, left in place,
and connected to a drainage system

Cat
heter
-
related

urinary

tract

infection

(CAUTI)
:

M
ust 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 AN
D urinalysis/culture
done


-
Fever* or chills


-
Flank pain OR suprapubic pain OR tenderness


(re: urinalysis/culture: b
acteriuria


positive culture or positive nitrite assay
;

p
yuria


10 or more wbc/hpf on u
rinalysis or positive leukocyte esterase assay
)

Indications

-
Bladder outlet obstruction or retention

-
Healing sacral wound (pressure ulcer on trunk) in incontinent pts.

-
Palliative end
-
of
-
life

Types of catheters

-
Antimicrobial catheters not supported fo
r effectively preventing CAUTIs

-
Use smallest size (caliber)

-
Silicone may be preferred in long term catheterized patients to prevent

obstruction

Maintenance



Maintain closed system


minimize disconnections; if change to leg bag, disinfect
tubing with 7
0% 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

Chang
ing the catheter
(or drainage bag)



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

Cleaning the drainage
bag



Bleach solution method preferred (decrystalizes sediment and inhibits bacterial
growth) (mix daily):

MUST TEACH SAFE HANDLING OF BLE
ACH

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
2


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 close
d container



Vinegar solution method if cannot use bleach

safely
:

Follow directions above;
instead, use ½ c. vinegar to 1 ½ cups tap water

Infection Related



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



C
hange catheter, then get urine specimen


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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 h
ealthcare provider

Patient/family
Education



Wash hands with soap & running water



Avoid tension on the catheter and kinks
; anchor catheter appropriately



Drainage bag below level of bladder



Fluids


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-
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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



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>

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-
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-
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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
3


References:

Association of Professionals in Infection Control and Epidemiology (APCI). (2008).
Guide to the Elimination of Catheter
-
Associated Urinary Tract Infections (CAUTIs)

Developing and Applying Facility
-
Based Prevention Interventions in Acute
a
nd Long
-
Term Care Settings
. APIC: Washington, DC.


Healthcare Infection Control Practices Advisory Committee (HICPAC). (2009). Guidelines for the Prevention of Catheter
-
Associated Urinary Tract Infections. CDC: Atlanta, GA.

Hooton, T. M., Bradley, S. F., C
ardenas, 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 cli
nical practice guidelines from the infectious diseases society of America. CID, 50, 625
-
663.

National Association for Continence. (2010).
When The Drainag
e System Is Changed Frequently. Accessed from
http://www.nafc.org/bladder
-
bowel
-
health/urinary
-
catheterization
-
of
-
men
-
and
-
women/#Care%20of%20Leg%20Bags%20and%20Night%20Drainage%20Systems
.

National Gu
ideline 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
-
habit
-
based
-
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).

W
ound Ostomy and Continence Nurses Society. (2009). Indwelling urinary c
atheters: Best practices for clinicians. Mt.
Laurel, NJ: WOCN.