Belinda Bonter, RN,RAC-CT

Foley catheters are inserted into the bladder to eliminate urine. The number one complication from a foley catheter is a urinary tract infection(UTI) CATHETERS

A foley catheter should only be used for a necessity reasons and not for provider convenience. Some indications for necessity are: -Acute urinary retention --Acute bladder outlet obstruction -Need for accurate measurements of urinary output in the critically ill -To assist in healing of open sacral or perineal wounds in incontinent patients -To improve comfort for end of life, if needed -Patient requires strict prolonged immobilization -During surgical interventions INDICATIONS FOR USE

-20% of catheters that are inserted physicians are not aware of % of catheters are unjustified -- Once a catheter is placed, the daily incidence of bacteriuria is 3-10% -- 10% and 30% of patients who undergo short-term catheterization (ie, 2- 4 days) develop bacteriuria and are asymptomatic. -- Between 90% and 100% of patients who undergo long-term catheterization develop bacteriuria -- About 80% of nosocomial UTIs are related to urethral catheterization; only 5-10% are related to genitourinary manipulation. FUN FACTS

Many elderly patients have preexisting bacteriuria prior to catheter placement Many elders have a low bacteria count when they have a urine culture done, but are started on antibiotics anyways Studies have shown that treatment should only start after a bacteria count of greater than 100, 000 A straight cath should be done if the first specimen was contaminated to get the whole picture of what bacteria are present. MORE FUN FACTS BMC Geriatrics 2006

The elderly are more susceptible to UTI’s due to a decrease in immunity Some risk factors that predispose the elderly to UTI’s due to catheter use are: -Poor catheter/peri care -- Improper catheratization -- History of chronic UTI’s -- Chronic foley use With bacterimia that is not caught right away and treatment provided sepsis can occur. UTI’S NCBI, 2013

The elderly population may display infection different than their younger counterparts. -Confusion --Irritability -- Personality change --Frequency -- Burning -- Low oral intake -- Sediment in urine -- Dark colored urine with foul odor -- Fever SIGN AND SYMPTOMS

Always follow policy and procedure for your organization Make sure that sterile technique is used and if anything is suspicious for a break in sterile technique reset your field with new equipment If a foley has no diagnosis and has no reason, ask for order to discontinue the foley and if appropriate start a bladder program Before starting a foley make sure that it is appropriate and all other interventions have been tried If a UTI is suspected, remember to follow policy of signs and symptoms, catching it early puts the best outcome for the elder WHAT CAN I DO AS A NURSE? CDC, 2013

Enteric pathogens (eg, Escherichiacoli) are most commonly responsible, but Pseudomonas species, Enterococcus species, Staphylococcus aureus, coagulase-negative staphylococci, Enterobacter species, and yeast also are known to cause infection. Proteus and Pseudomonas species are the organisms most commonly associated with biofilm growth on catheters. Broad spectrum antibiotic use is not recommended to start until cultures come back, the more antibiotics used, the more superbugs are likely in the future. WHAT BUGS? Medscape.com, 2013

BMC Geriatrics 2006, 6:15 doi: / indwelling-catheters.htmlhttp:// indwelling-catheters.html, 2013 REFERENCES