Catheter Policy

[punkdmm, BSN, RN]

I am working on a new policy for indwelling catheters because the one we have in place is from 1998...what are the most important points to have in place? Any certain verbage to add/avoid? Of course it has to be placed only for the appropriate, documented clinical reasons, and removed asap. Any other major details?

[CapeCodMermaid, RN]

Make sure you know the diagnoses we can use for catheters. We always remove them at 6am and include in the orders: DC catheter. If no void in 8 hours reinsert catheter. Saves you a call to the MD who of course will most likely tell you to reinsert it if the resident hasn't voided. Personally, I think 8 hours is too long but that seems to be the standard.

[CoffeeRTC, BSN, RN]

Might want to include dignity covers. Some foley bags come with flap on them now or we use the bags attached to the bed/ wheelchair. You would also want an infection control plan to keep those clean.

[vampiregirl, BSN, RN]

The CDC has lots of EBP info on CAUTI prevention on it's website.

When I first read through it some of it surprised me but when I read the supporting evidence, it made sense. My employer's policies on catheters are based on the CDC recommendations.

[Mhsrnbsn]

Permanent indwelling catheters should be replaced at some level of regularity. I work in a hospital and I sometimes get patients from LTC who have terrible peri odor and when we remove the Foley to give them clean ones we find a lot of gunk stuck to the catheter and without fail are the patients that come back +UTI. Just because they need a catheter permanently doesn't mean it does not deserve to be swapped out once in a while. You should work on a peri care protocol as well, these are the patients that are most suceptible to get infections and a lot of times staff doesn't realize it until it is bad (extreme odor, sediment, hematuria) because the catheter removes the urgency, frequency, and burning aspects. I've had a few LTC patients with indwelling even show up with uro-sepsis. These are just thoughts and I am a staff nurse not on the policy end of things, but just sharing my two pennies.

[benegesserit]

Permanent indwelling catheters should be replaced at some level of regularity. I work in a hospital and I sometimes get patients from LTC who have terrible peri odor and when we remove the Foley to give them clean ones we find a lot of gunk stuck to the catheter and without fail are the patients that come back +UTI. Just because they need a catheter permanently doesn't mean it does not deserve to be swapped out once in a while.

Both facilities I've worked at have a policy to change catheters monthly, and I can tell you that catheters can get ugly much quicker than that. Many people with long-term catheters will also have chronic kidney and/or infection problems. It's a balance between the trauma and infection risk involved in the insertion process and the infection risk involved in leaving it in to long.

(Of course, the changes don't always get done as scheduled, especially at my facility that uses an eMAR system where a missed treatment won't be readily visible the next day. But I'm speaking from the viewpoint of times where I've know the date of the last change for absolute fact because I did it myself).

[NurseQT]

Our orders to change indwelling caths always come from the ordering MD. We have some that are every month and some that are every other month, and some that go out to urology for their routine changes. We have it in our standing orders to change PRN though.

We also include PVR bladder scans qshift x 72 hours after removal