Urinary Catheter Care and CAUTI Prevention

Indwelling urinary catheters carry a high risk of catheter-associated urinary tract infection (CAUTI). This note covers the daily care, drainage-system management, complication recognition, and safe removal practices a nursing student must know.

Definition

• Urinary catheter care refers to the daily cleaning and maintenance of an indwelling urinary catheter (Foley catheter) to prevent catheter-associated urinary tract infection (CAUTI).
• Catheter care includes perineal cleaning, securing the catheter, maintaining a closed drainage system, and ensuring proper urine flow.

Indications for Urinary Catheters

• Appropriate indications:
  • Acute urinary retention
  • Strict output measurement in critically ill patients
  • Prolonged surgery
  • End-of-life comfort
• Do not insert catheters for incontinence, convenience, or routine monitoring without a valid indication.

Daily Catheter Care

Perineal Cleaning (Pericare)

• Perform perineal cleaning at least once daily and after each episode of incontinence. Use soap and water or a perineal cleanser.
• Clean front to back (urethra to anus). Clean around the meatus in a circular motion moving outward. Do not pull on the catheter.
• Rinse thoroughly and dry completely. Apply barrier cream if needed, but avoid getting cream on the catheter.

Securing the Catheter

• Secure the catheter to the patient's thigh or abdomen using a securement device to prevent traction and urethral trauma.
• Leave slack in the tubing to allow for patient movement. Do not secure too tightly.

Maintaining the Closed Drainage System

• The drainage system must remain closed at all times. Do not disconnect the catheter from the drainage tubing.
• Disconnecting breaks sterility and introduces bacteria into the bladder.

Managing the Drainage Bag

Positioning the Bag

• Keep the drainage bag below the level of the bladder to prevent backflow. Do not place the bag on the floor.
• Ensure the tubing is not kinked or twisted — kinks obstruct urine flow.

Emptying the Bag

• Empty the bag when half full or at least every 8 hours. Wash hands and put on clean gloves before emptying.
• Do not let the outlet port touch the container or the floor. Close the port tightly after emptying.

Promoting Urine Flow

• Encourage adequate fluid intake (1.5–2 L per day) unless contraindicated.
• Ensure tubing is free of kinks and dependent loops.
• Keep the drainage bag below the bladder. Do not elevate the bag without clamping the tubing first.

Signs of Catheter Problems

Signs of CAUTI

• Fever or chills
• New confusion in older adults (often the only sign)
• Foul-smelling or cloudy urine
• Suprapubic pain or tenderness

Signs of Catheter Obstruction

• Decreased urine output with a distended bladder
• No urine in the bag for 4–6 hours despite adequate fluids

Signs of Catheter Trauma

• Hematuria (blood in the urine)
• Patient reports pain or burning

Notify the provider for any of these signs. Do not irrigate the catheter without an order.

Catheter Irrigation

• Catheter irrigation requires a provider order.
• Use sterile technique and normal saline (not sterile water).
• Never irrigate routinely to prevent infection — routine irrigation increases CAUTI risk.

Catheter Removal

• Removal requires a provider order. Remove the catheter as soon as it is no longer medically necessary.
• Deflate the balloon completely before removal. Use a syringe to withdraw all fluid from the balloon port.
• If resistance is felt, do not pull forcefully — notify the provider.
• After removal, assess for voiding within 6–8 hours. If the patient does not void, perform a bladder scan.

CAUTI Prevention Bundle

• Insert catheters only for appropriate indications; remove as soon as possible.
• Use sterile technique during insertion. Use the smallest appropriate catheter size.
• Maintain a closed drainage system. Keep the bag below the bladder.
• Perform daily perineal care. Do not routinely irrigate or change catheters.
• Secure the catheter to the leg to prevent traction. Ensure unobstructed urine flow.

Common Exam Traps

• Do not disconnect the catheter from the drainage tubing — this breaks the closed system.
• Do not place the drainage bag on the floor — the outlet port becomes contaminated.
• Do not elevate the bag above the bladder — urine flows back into the bladder.
• Do not routinely irrigate catheters — increases infection risk.
• Do not ignore new confusion in an older adult with a catheter — sign of CAUTI.
• Do not pull on the catheter without fully deflating the balloon.
• Do not forget to secure the catheter to the leg — traction causes urethral trauma.

Key takeaways

• Daily care: pericare front to back in a circular motion, secure to thigh/abdomen, maintain a closed drainage system.
• Keep the bag below the bladder, off the floor; empty when half full or every 8 hours.
• New confusion in an older adult with a catheter is a key sign of CAUTI.
• Never routinely irrigate; irrigation requires an order and uses sterile normal saline.
• Remove the catheter ASAP; after removal, expect voiding within 6–8 hours or perform a bladder scan.
• Always deflate the balloon completely before removal; never pull against resistance.