Urinary Catheter Management

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