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SUBJECT: Nurse Driven Catheter Use Protocol
Director Approval: Natalie Smith, RN
SECTION/DEPT.: Nursing Services / Origination Date: 3/2015
APPROVAL: Natalie Smith, Interim VP Patient Care Services/CNO

Purpose:

Nurse will evaluate need for indwelling urinary catheter prior to insertion based on medical necessity and each shift. If it is determined the indwelling catheter no longer meets criteria, it will be removed.

Procedure:

  1. All patients that need or may need an indwelling catheter will have orders for the protocol.
  2. Patient will meet medical necessity criteria prior to insertion.
  3. Patients excluded from the protocol will have documentation from their physician for catheter need and time frame for utilization.
  4. Alternatives will be used if possible:
  5. External catheters in male patients without urinary retention or bladder outlet obstruction
  6. Intermittent catheterization with bladder scanning in patients with snail cord injuries or neurogenic bladder
  7. Select smallest appropriate indwelling urinary catheter (IUC)
  8. Medical Necessity Criteria:
  9. Acute urinary retention or bladder outlet obstruction
  10. Critically ill and need for accurate measurements of I & O (i.e. hourly monitoring)
  11. Perioperative use for selected surgical procedures:
  12. Urologic surgery or other surgery on contiguous structures of the GU tract
  13. Anticipated prolonged duration of surgery (remove in PACU)
  14. Anticipated to receive large-volume infusions or diuretics during surgery
  15. Need for intraoperative monitoring of urinary output
  16. Assist in healing of open sacral or perineal wounds in incontinent patients
  17. Patients that require prolonged immobilization (potentially unstable thoracic or lumbar spine, multiple traumatic injuries such as pelvic fractures)
  18. To improve comfort for end of life care
  19. Utilize aseptic technique and sterile equipment and supplies
  20. Perform hand hygiene
  21. Complete peri care, then re-perform hand hygiene
  22. Maintain strict aseptic technique throughout the actual IUC insertion procedure; re-perform hand hygiene following procedure (use sterile gloves and equipment and establish/maintain sterile field; do not pre-inflate the balloon to test it, as this is not recommended)
  23. Insert IUC to appropriate length and check urine flow before balloon inflation to prevent urethral trauma (in males insert fully to the IUC “y” connection, in females advance ~ 1 inch or 2.5 cm beyond point of urine flow)
  24. Inflate IUC balloon correctly (inflate per manufacturers instructions)
  25. After IUC insertion completion:
  26. Secure IUC to prevent urethral irritation
  27. Position drainage bag below the bladder (but not resting on the floor)
  28. Check system for closed connections and no obstructions/kinks
  29. Empty the drainage bag regularly using a separate, clean collecting container for each patient; avoid splashing and prevent contact of the drainage spout
  30. Maintain unobstructed urine flow by keeping catheter and tube free from kinking
  31. Maintain a closed drainage system.
  32. If breaks in the drainage system are noted: replace the catheter and collecting system
  33. Perform perineal hygiene at a minimum each shift and following incontinent bowel episodes
  34. Each shift will evaluate for removal using medical necessity criteria. Exclusion criteria for continuation must be documented by physician.
  35. Assess after removal and document
  36. Date and time of removal
  37. Assess for adequate bladder emptying:
  38. If patient has urinated within 4-6 hours follow these guidelines:
  39. If minimum urinated volume ≤ 180 ml in 4-6 hours or urinary incontinence present, confirm bladder emptying.
  40. Prompt patient to urinate; check for spontaneous urination within 2 hours if post-void residual (PVR) < 300-500 ml
  41. Recheck PVR within 2 hours via bladder scanner
  42. Perform straight catheterization for PVR per scan ≥ 300-500 ml
  43. Repeat scan within 4-6 hours and determine need for straight catheterization
  44. Report to provider if retention persists ≥ 300-500 ml
  45. Perform ongoing straight catheterization to prevent bladder overdistension and renal dysfunction, every 4-6 hours.
  46. If patient has not urinated in 4-6 hours and/or complains of bladder fullness, determine presence of incomplete bladder emptying:
  47. Prompt patient to urinate; if unable or urination volume ≤ 180 ml perform bladder scan
  48. Follow straight catheterization procedures above
  49. Notify physician if patient continues to be unable to void
  50. Assess, document, and notify provider of any suprapubic pain, costovertebral pain (flank), fever, dysuria, bladder discomfort, and new frequency or urgency.

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