Dependent loops?

[MunoRN, RN]

My facility has had some issues and debate with our educatoin department's CAUTI prevention teaching, mainly around "dependent loops" and how they are defined and the best ways to reduce flow-limiting drainage tubing positioning.

After implementing facility wide education to reduce the incidence of "dependent loops" our foley audits have found a significant increase in retained urine volumes after the change of practice (it caused more problems than it solved). Has anybody come across a way of teaching tube positioning techniques that is straightforward and actually reduces the incidence of poorly draining catheters?

The main problems seems to start with the term itself; "dependent loop" has become a term for positioning of the tube that limits it's flow from the bladder, even though the positioning that most commonly causes reduced flow is neither "dependent" (below the level of the bag) or a "loop". Based on our audits, coiling the tubing on the bed is the most likely habit that will cause excessive retained urine due to tubing that goes on a downward slope and then back up, creating an section of air in the tubing that then inhibits or fully blocks drainage from the bladder. Letting the tubing hang and then return up to bag has been the most effective configuration based on our audits (and the basic principles of hydrodynamics) yet this is what many if not most nurses have been taught is the configuration that should be avoided.

Ideally, the tubing makes a continuous downward slope to the bag, although with the exception of patients on continuous paralytics, maintaining this configuration is not reliable, and will often move in such a way that an airlock is created, which is then far worse than the traditionally understood "dependent loop".

[iluvivt, BSN, RN]

This is a very interesting topic and I am looking forward to the responses.Have you looked into using a wick system such as PureWick.We just started using it and I am waiting to see how easy it is to use and how effective it is in reducing urinary tract Infections.