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Urinary Catheter Management

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  1. Urinary Catheter Management

  2. Facts • Many catheters are inserted within the 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.

  3. Facts (cont.) • Various reasons for the foley catheters. • Average cost of treating urosepsis is $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

  4. Indwelling foley catheters are a major source of 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

  5. 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

  6. 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%

  7. Risks/Consequences • UTI • PYELONEPHRITIS • DEATH R/T BACTEREMIA • DAMAGE TO URETHRA (SCARRING AND STRICTURES) • Prostatitis and epididymitis

  8. 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 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.

  9. Criteria for insertion and continuation of the foley catheter • 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”

  10. 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

  11. The F/C Bundle includes: • Hand hygiene before & after any contact with 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

  12. 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

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