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 $ 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
Breaches barrier
Balloon prevents complete emptying
Distends bladder
Pool of urine
Close system:
Never completely closed
Travel upwards
Condom catheter:
Warm moist conditions inside

6. Bacteria is a function of time with a f/c:
Single event – risk < 1%
4 days – risk increases to 30%
30 days – risk %

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
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
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