Changing catheter drainage bag...Infection risk?

[smoddra]

I have had a department director approach me about a catheter question that I was not for sure of the answer to.

Sometimes a foley cath is placed and then there are changes with the pt that require close output monitoring. The original bag for the catheters is being romoved and a bag with a urometer is put on. The question is "Is this safe practice since the closed system cathter is being opened to change the bag"? I have not really found anything that supports this topic. I thought that if it had to be done it was okay unless it was happening on every patient? Any feedback welcomed please.

[Orca, ADN, ASN, RN]

I don't see an issue. Urine is traveling in one direction - from the bladder into the collection device. With any kind of reasonable technique at all, it would be nearly impossible to introduce any kind of infection into the urinary tract simply by unhooking the bag and connecting a urometer in its place, IMO.

[studentnurse9806]

From what I understand the Foley catheter is a closed system. Any opening of the system I.e changing the drainage bag is a risk for infection

[Esme12, ASN, BSN, RN]

The risk for infection started at the insertion of the catheter. The greater risk for hourly I/O's would be opening the bag every hour to measure. Like anything else....good technique is required...but the benefit tot he patients outcome is based on the medically necessary Rx to enure the best outcome. Benefit versus risk.

'

Your DIRECTOR asked this???

I have to ask...do they have bedside experience in Neuro or critical care?

Any how...has there been an increase in catheter induced UTI's? Maybe look at technique to ensure a better "swap"

[Orca, ADN, ASN, RN]

From what I understand the Foley catheter is a closed system. Any opening of the system I.e changing the drainage bag is a risk for infection

UTIs generally aren't caused by airborne bacteria. I don't see significantly more risk in this than in changing an IV bag.

[psu_213, BSN, RN]

In the ER, we regularly place Foley and then, an hour later when the pt is being discharged, we remove the original bag to put on a leg bag. Sure there is a risk if you let the "open" Foley tubing flap around and touch something...but it can be done with almost no infection risk.

[smilingbig]

I have had a department director approach me about a catheter question that I was not for sure of the answer to.

Sometimes a foley cath is placed and then there are changes with the pt that require close output monitoring. The original bag for the catheters is being romoved and a bag with a urometer is put on. The question is "Is this safe practice since the closed system cathter is being opened to change the bag"? I have not really found anything that supports this topic. I thought that if it had to be done it was okay unless it was happening on every patient? Any feedback welcomed please.

http://www.cdc.gov/HAI/pdfs/toolkits/CAUTItoolkit_3_10.pdf

The above link to the CDC's toolkit for preventing HAIs, specifically Catheter Associated Urinary Tract Infections (CAUTIs) is a great resource if the department director is concerned about CAUTIs.

A foley catheter is supposed to be a closed system, ANY interruption in this can lead to a CAUTI. Something as small as the drain spigot becoming contaminated during emptying the foley bag can cause that bacteria to ascend (via biofilm production) the drainage tube and cause a CAUTI. Replacing the orinigal drainage bag with one that has a urometer is no different.

Below is the recommendation from the CDC and the link to their guidelines below.

"III. Proper Techniques for Urinary Catheter Maintenance A. Following aseptic insertion of the urinary catheter, maintain a closed drainage system (Category IB) (Key Question 1B and 2B)

1. If breaks in aseptic technique, disconnection, or leakage occur, replace the catheter and collecting system using aseptic technique and sterile equipment.
   

1. (Category IB) "
   

http://www.cdc.gov/hicpac/pdf/CAUTI/CAUTIguideline2009final.pdf

I hope this is helpful!

[Esme12, ASN, BSN, RN]

It absolutely needs to be carried out with aseptic technique however the benefit of the urometer far out weighs the risk in this particular case.

[TriciaJ, RN]

It's a weird question to ask "Is it a safe practice?" It is a safe practice when it is necessary and done correctly. If a urimeter bag is needed then the benefit outweighs the risk. I've had TURP pts with CBI pass so many clots that I couldn't empty the bag and had to change it. If the bladder has to be irrigated, that breaks the system too. But it's still preferable to a bladder unable to empty. Has your director ever actually practiced nursing? Or just gone from education to administration? I don't think you can make a case for never breaking the system, regardless of the UTI rate. Maybe Medicare is on their backs about UTIs.

[smoddra]

Yes they have some experience on thr floor but only in a small hospital ICU. There has been no issue in infection related to this topic. I thought it would come down to a technique issue also.

[smoddra]

The director is asking about this I think mainly to justify only getting caths with urometer in the ICU. The thing is that even if this is done a majority of caths are placed prior to ICU admit.