Reduce catheter associated
urinary tract infections (CAUTI).
infection that can develop in patients with
an indwelling urinary catheter.
Patients meeting specific
assessment criteria will have the urinary
catheter removed by a nurse.
need to continue urinary catheter as
part of their ongoing assessment using the
Driven Urinary Catheter
If none of the specified indications for continued
catheter use are met, the catheter will be
discontinued by the nurse.
to reevaluate and assess the need to
reinsert the urinary catheter following removal
of the urinary
the patient’s physician for further
orders if patient is unable to void following
Patient and/or family will be educated on:
Risk of complications associated with urinary
Importance of adequate fluid intake after removal
of urinary catheter .
Measurement of intake and output to be done to
assess the patient’s ability to empty bladder after
removal of urinary catheter.
: Nurse to document
assessment and removal of urinary catheter
and continued reassessment post
Accurate monitoring of
Management of urinary
incontinence in patient
with Stage III or greater
End of life/comfort care
Gross hematuria within
last 24 hours
Urologist involved in
case/catheter placed by
Post op/post procedure
(less than 48 hours prior)
Presence of epidural
Chronic long term
History of urinary
MD order to continue
Indications present? Yes or No
Assess Patient for Indications
for Continued Catheter Use
Continue catheter care per policy.
Ensure compliance with catheter “bundle”:
Securing device used. (example: stat
No dependent loops in tubing.
Secure tubing to bed.
Bag not overfilled or touching floor.
If spinal cord injury, assess readiness for bladder
evaluate need at each
subsequent SBAR Handoff
Are any indications present?
Patient care to include:
men, consider external (condom) cath.
scan if unable to void in 6 hours.
< 300 ml, recheck in 4 hours.
If > 300 ml, straight cath X1.
if unable to void in 6 hours.
>300 ml, call MD for catheter reinsertion order
RN may remove catheter without
74 yo female
ED admission to Med/surg nursing unit
Dx: ALOC, Laceration to forehead due to fall at
Hx: Diabetes type II, osteoarthritis, mild HTN,
lives alone & independent.
Labs: normal CBC, Na
UA: normal, obtained from urinary cath while in
CAT Scan: Negative for stroke
Admission to nursing unit from ED
Received on unit @ 1900
Lethargic, c/o of headache, oriented to self
Unsteady gait, hands tremulous
Urinary catheter in place
The next day on Med/surg
Awake, alert x4
Gait slow but balanced
Classified as a high fall risk due to
medication and age.
Able to rise from chair w/o help
Asking, “why do I still have this tube?”
Does the patient’s condition warrant a urinary
Is the patient able to make needs known?
Does patient have history of retention?
Does the patient have a Stage III or greater
pressure ulcer and is incontinent?
Is the patient receiving large doses of diuretics?
Do you have an order for urinary catheter?
According to the policy,
Nurse Driven Urinary Catheter Removal
you can discontinue the catheter without the
need of calling the Physician, for a d/c
urinary catheter order.
Instruct patient and family of the:
Importance of calling for
assistance for toileting
Importance of fluid intake as
Importance of activity: up in
chair, ambulating in room and
Reinforce safety precautions:
“Call don’t Fall”
Patient education post catheter removal
, J.E. & Kent, B. (2004). Short
catheters (a systematic review): Evidence for a primarily nursing
Worldviews on Evidence
Based Nursing, 1,
, P., Carr, C.,
, L., Epperson, C.,
Bynum, D. (2008). A quality improvement project to reduce the
complications associated with indwelling urinary catheters.
Urologic Nursing, 28
Griffiths, R., & Fernandez, R. Strategies for removal of short
indwelling urethral catheters in adults.
Systematic Reviews 2007,
Issue 2, Art. No.: CD004011.
, J., Conklin, S., Camp, K., Morris, V.,
, T., &
Herbert, P. (2005). Prevention of nosocomial catheter
urinary tract infections through computerized feedback to
physicians and a nurse
directed protocol. American Journal of
Medical Quality, 20, (3), 121
Greenspan, Robert E MD, MEDICINE: Perspectives in History and
Art | ISBN
10 0972448608 | ISBN