VUMC Urinary Catheter Guidelines
VUMC Urinary Catheter Guidelines
UC Insertion
Preparation & Procedure
Indications for insertion and continued use of indwelling urinary catheters include:
Urinary retention or obstruction
o An epidural catheter is not an absolute indication for continued use of a
urinary catheter. Patients with epidural catheters should be assessed for
urinary retention on an individual basis.
Incontinence in patient with open perineal or sacral wounds
Critical illness AND a need for accurate monitoring of urinary output
Terminal illness receiving comfort care or withdrawal of care
Perioperative use for selected surgical procedures
o Surgeries of the GU tract or contiguous structures
o Anticipated prolonged duration of surgery
o Anticipated to receive large volume fluids/diuretics during surgery
o Need for intraoperative monitoring of urinary output.
UC Access/
Maintenance
UC
Discontinuation
VUMC Standards for Non-emergent Insertion and Management of Central Venous Catheters (CVCs)
CVC Insertion
Preparation
Procedure
Insertion
Site Care
CVC
Access
CVC
Discontinuation
Perform time-out.
UrinaryCatheterGuidelinesforProviders
AllProvidersShould:
BeAwareoftheVUMCIndicationsforUrinaryCatheters:
Urinaryretentionorobstruction
o Anepiduralcatheterisnotanabsoluteindicationforcontinueduseofaurinarycatheter.
Incontinenceinpatientwithopenperinealorsacralwounds
CriticalillnessANDaneedforaccuratemonitoringofurinaryoutput
Terminalillnessreceivingcomfortcareorwithdrawalofcare
Perioperativeuseforselectedsurgicalprocedures(involvingGUtractorcontiguousstructures)
BeAwareofRequirementforProviderOrdersforCatheters
Allurinarycathetersrequireanorder.
Everypatientisonthenursedrivendiscontinuationprotocolunlessspecificallyexcludedbya
providerorder.
PerformaDailyAssessmentofContinuedNeedfortheUrinaryCatheter
Patientswithurinarycathetersshouldbeassesseddailywhetherthecatheterisstillnecessary,
andunnecessarycathetersareremoved.
UnderstandtheVUMCUrinaryCatheterDiscontinuationProtocol
Nursingwillassesscatheternecessityandwillremovecathetersfrompatientswhonolonger
meettheindicationsforcontinuedneed(seeabove).
Ifpatientisunabletovoidaftercatheterremoval,theproviderwillbenotified.Unlessthereisa
knownobstruction,inandoutcatheterizationx2isrecommendedbeforetheindwelling
catheterisreplaced.
Patients must have an order for a foley (even if device was present on admission).
The patient must have one or more of the following indications for a catheter:
o Urinary retention or obstruction. If the patient has a foley placed for this reason, a provider order is needed
to remove it.
o Incontinence in patient with open perineal or sacral wounds. (e.g., Stage 3 or 4 pressure ulcer, surgical
wound, wound vac)
o Critical illness AND a need for accurate monitoring of urinary output (does not apply outside the ICUs)
o Terminal illness receiving comfort care or withdrawal of care
o Perioperative use for selected surgical proceduresthese should be removed as soon as possible after
surgery
If the patient has a foley and no order, evaluate for indications. If the foley is indicated, contact the provider to
obtain an order. If not, remove the catheter.
Foleys are placed aseptically
o A second person assists when placement may be difficult (e.g., obese, limited mobility, etc.)
o If the first attempt fails, a new kit is obtained for the next attempt. Consider asking a second person to
attempt the placement.
Maintenance
Every patient with a catheter is on the discontinuation protocol unless the provider excludes the patient by order.
Remove the foley as soon as the patient no longer needs it (based on indications for use.) No order is needed to
remove the foley unless the provider has written an order specifying so.
If the order indicates a date and time for foley removal (4/1/14 @ 1400 or POD 2 at 0600), the patient is not on the
protocol, and the foley is removed as specified.
Once the catheter is removed, the patient is assessed at least every two hours for the need to urinate. Assistance is
offered for toileting. If the patient is unable to void within six hours, assess bladder volume with the bladder
scanner.
Notify provider for next steps if
o Patient has suprapubic pain or the urge to void but is unable to do so.
o A volume of greater than 300 ml is identified with the bladder scanner, and the patient is unable to void.
o The patient has not voided and does not have significant volume in the bladder 6 hours after catheter
removal.
For more information see VUMC Guidelines for Management of Urinary Catheters and VUMC Policy CL 30-15.05 Indwelling
Urinary Catheters: Insertion, Maintenance, Discontinuation
YES
NO
Does the patient have one or more of the following
conditions?
Terminal illness receiving comfort care or
withdrawal of care;
Open perineal or sacral wounds;
Critical illness AND a need for accurate
monitoring of urinary output.
LEAVE
catheter in place
Reassess with change in shift,
caregiver, or level of care
YES
NO
Is the patient able to use one or more of
the following?
toilet
bedpan
urinal
bedside commode
adult protective garment
REMOVE
YES
catheter
NO
NO
YES
LEAVE
catheter in place
Reassess with change in shift,
caregiver, or level of care
NO
Continue to monitor
per unit standards.
YES
Notify Provider.
Consider I/O catheterization.