The document discusses urinary catheters, including their history, uses, types, insertion procedures, care, and complications. It notes that urinary catheters were developed in the 1920s and are now used in 15-25% of hospitalized patients. However, 40-50% of catheterized patients do not have a valid medical need for the catheter. The summary discusses appropriate indications for catheter use and emphasizes removing catheters promptly once the need has passed to reduce the risk of urinary tract infections.

1. Dr.T.V.Rao MD
URINARY CATHETER
SKILLS AND SAFE PRACTICES
IN HEALTH CARE
DR.T.V.RAO MD 1

2. • Urinary catheter
is any tube
placed in the
body to drain
and collect urine
from the bladder
WHAT IS A URINARY CATHETER
DR.T.V.RAO MD 2

3. • Developed in the 1920s
by Dr. Frederick Foley
• The urinary catheter was
originally an open system
with the urethral tube
draining into an open
container.
• In the 1950s, a closed
system was developed in
which the urine flowed
through a catheter into a
closed bag.
URINARY CATHETER
DR. FREDERICK FOLEY
3

4. • About 15-25% of patients
during their hospitalization
will have an urinary
catheter placed
• Many are placed either in
the intensive care or
Emergency Department
• 40% - 50% of these
patients do not have a valid
indication for urinary
catheter placement
URINARY CATHETER UTILIZATION
4

5. WHAT IS A FOLEY'S CATHETER
DR.T.V.RAO MD 5

6. PURPOSE OF CATHETERIZATION
Catheterization is carried out for a number of
reasons and can either be a temporary or
permanent solution to a number of problems.
Problems include physical disease and damage,
psychological issues and a way to help to improve
the quality of life to someone who is bed ridden.
Good regular catheter care involves good hygiene,
observation, monitoring well-being and prevention
of problems associated with catheterization.
DR.T.V.RAO MD 6

7. URINARY CATHETER-RELATED INFECTION:
BACKGROUND
• Urinary tract infection (UTI) causes over 40% of
hospital-acquired infections
• Most infections due to urinary catheters
• 25% of inpatients are catheterized
• Leads to increased morbidity and costs

8. • The ability to insert a urinary
catheter is an essential skill in
medicine.
• Catheters are sized in units called
French, where one French equals
1/3 of 1 mm. Catheters vary from 12
(small) FR to 48 (large) FR (3-
16mm) in size.
They also come in different varieties
including ones without a bladder
balloon, and ones with different
sized balloons - you should check
how much the balloon is made to
hold when inflating the balloon with
water!
CATHETERIZATION IS A SKILL IN
MEDICINE
DR.T.V.RAO MD 8

9. • The potential for contact with a
patient's blood/body fluids while
starting a catheter is present and
increases with the inexperience
of the operator. Gloves must be
worn while starting the Foley, not
only to protect the user, but also
to prevent infection in the patient.
Trauma protocol calls for all team
members to wear gloves, face
and eye protection and gowns.
CAUTION ON CATHETERIZATION
DR.T.V.RAO MD 9

10. • Povidone-iodine (PI) is
currently the most widely
used agent for site
disinfection
• Chlorhexidine gluconate
(CHG) has been compared
to PI with mixed results
• We performed a formal
meta-analysis of published
and unpublished studies to
clarify relative efficacy
WHICH DISINFECTANT SHOULD BE
USED FOR CATHETER SITE CARE?

11. CHLORHEXIDINE FOR SITE DISINFECTION:
CR-BSI
Risk ratio
.1 .2 .5 1 2 5 10
Study Risk ratio (95% CI)
0.18 (0.02,1.46)Maki et al,
7
1991
1.05 (0.07,16.61)Sheehan et al,
8
1993
0.97 (0.20,4.77)Meffre et al,9
1995
0.64 (0.15,2.81)Mimoz et al,10
1996
0.13 (0.01,2.45)Legras et al,11
1997
0.75 (0.20,2.75)Humar et al,13
2000
0.36 (0.14,0.95)Knasinski et al,14
2000
0.49 (0.28,0.88)Overall (95% CI)
Favors CHG Favors P-I
(Chaiyanupruk et al. Ann Intern Med 2002)

12. WHAT IS INDWELLING CATHETER
• In indwelling urinary catheter is one that is left in place
in the bladder. Indwelling catheters may be needed for
only a short time, or for a long time. These catheters
attach to a drainage bag to collect urine. A newer type
of catheter has a valve that can be opened to allow
urine to flow out, when needed. An indwelling catheter
may be inserted into the bladder in two ways:
• Sometimes, one may insert a tube, called a suprapubic
catheter, into your bladder from a small hole in your
belly. This is done as an outpatient surgery or office
procedure.
DR.T.V.RAO MD 12

13. • Condom catheters are most
frequently used in elderly
men with dementia. There
is no tube placed inside the
penis. Instead, a condom-
like device is placed over
the penis. A tube leads from
this device to a drainage
bag. The condom catheter
must be changed every
day.
CONDOM CATHETERS
DR.T.V.RAO MD 13

14. • Some people only need
to use a catheter on
occasion. Short-term, or
intermittent, catheters
are removed after the
flow of urine has
stopped. For more
information on this type
of catheter, see: Clean
intermittent self-
catheterization.
INTERMITTENT (SHORT-TERM) CATHETERS
DR.T.V.RAO MD 14

15. EXPLAIN THE PATIENT BEFORE DOING THE
CATHERITIZATION
• Before you start tell the person what you are going to
do and why. This is important for everyone, but
especially if the person is confused, has memory
problems as in Alzheimer's disease or dementia. If you
can, assist the catheterized person with their hygiene,
rather than doing it yourself. It is important to try to help
the person / patient keep their skills rather than just
take over for them. There are so many advantages but
it can just take that bit longer.
DR.T.V.RAO MD 15

16. • Wash your hands
before and after
handling the drainage
device. Do not allow the
outlet valve to touch
anything. If the outlet
becomes obviously
dirty, clean it with soap
and water.
HAND WASHING THE MOST IMPORTANT
PREPARATION BEFORE CATHETERIZATION
DR.T.V.RAO MD 16

17. ANTISEPTIC HAND RINSES
MANY USING ALCOHOLS
• 60-70% alcohol
solutions
• Effective against most
bacteria, viruses, fungi
• Protective against hand
drying
• Faster, increased
compliance

18. • Wash around the
catheter entry site with
soap and water twice
each day. Clean the top
several inches of the
catheter too.
Always wash the site
after a bowel
movement.
CARING BEFORE THE INSERTION OF
CATHETER
DR.T.V.RAO MD 18

19. • Introduction Female
urethral catheterization, the
insertion of a catheter
through the urethra into the
urinary bladder to permit
drainage of urine, is a
fundamental skill Insert the
catheter completely into
the urethra, and do not
inflate the balloon until
there is return of urine, to
avoid trauma …
HEALTH CARE WORKERS SHOULD DEVELOP
SKILLS IN INTRODUCTION OF CATHETER
DR.T.V.RAO MD 19

20. PRINCIPLES OF PLACEMENT OF
CATHETER AND COLLECTING BAG
DR.T.V.RAO MD 20

21. THE URINE COLLECTING BAG SHOULD BE AT A
LOWER LEVEL TO THE PATIENT
TO PREVENT RETROGRADE FLOW
DR.T.V.RAO MD 21

22. • Criteria for insertion and
continuation of a F/C includes:
a. Retention
b. Critical I&O
c. Comatose
d. Paralyzed
e. Neurogenic Bladder
f. Pre-op placement
g. Wound with incontinence
h. Bladder Irrigation
i. Physical trauma/pain with bedpan/incontinence brief
j. Terminal illness/comfort measures
DR.T.V.RAO MD 22

23. COMPLICATIONS OF CATHETERIZATION
DR.T.V.RAO MD 23
• The main complications are tissue trauma and infection. After 48
hours of catheterization, most catheters are colonized with
bacteria, thus leading to possible Bacteriuria and its
complications. Catheters can also cause renal inflammation,
nephro-cysto-lithiasis, and pyelonephritis if left in for prolonged
periods.
• The most common short term complications are inability to
insert catheter, and causation of tissue trauma during the
insertion.
• The alternatives to urethral catheterization include suprapubic
catheterization and external condom catheters for longer
durations.

24. RISKS / CONSEQUENCES OF
CATHETERIZATION
• UTI
• PYELONEPHRITIS
• DEATH R/T BACTEREMIA
• DAMAGE TO URETHRA (SCARRING AND
STRICTURES)
• Prostatitis and epididymitis
DR.T.V.RAO MD 24

25. • 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
DR.T.V.RAO MD 25

26. 26
Staphylococcus aureus biofilm on
an indwelling catheter.
CDC Public Health Image Library
BIOFILM: EXTRACELLULAR POLYMERS
(DONLAN, CID 2001; 33:1387–92, LIEDL, CURR OPINION UROL 2001;11: 75-9)
• Organisms attach to and
grow on a surface and
produce extracellular
polymers
• Intraluminal ascent
(48hours) of bacteria faster
than extraluminal (72-168
hours)
• Most catheters used >1
week have biofilms
• Extraluminal more important
in women

27. WHAT WE ARE DOING NOW, IS IT RIGHT
RIGHT THINGS 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.
DR.T.V.RAO MD 27

28. COLLECTION OF URINE FROM
CATHETERISED PATIENTS
• The process of obtaining a sample of urine from a patient with
an indwelling urinary catheter must be obtained from a sampling
port. The sample must be obtained using an aseptic technique.
• This port is usually situated in the drainage tubing, proximal to
the collection bag which ensures the freshest sample possible.
The use of drainage systems without a sampling port should be
avoided (Gilbert, 2006).
• Specimens should not be collected from the tap from the main
collecting chamber of the catheter bag as colonisation and
multiplication of bacteria within the stagnant urine or around the
drainage tap may have occurred.
DR.T.V.RAO MD 28

29. • Aspirating urine from a
sampling port has
traditionally been
performed using a
syringe and needle.
However, needle-free
systems are
commercially available,
which may reduce the
risk of inoculation injury.
ASPIRATING THE URINE WITH SYRINGE
AND NEEDLE
DR.T.V.RAO MD 29

30. CONTRAINDICATIONS FOR
CATHETERIZATION
DR.T.V.RAO MD 30
• Foley catheters are contraindicated in the
presence of urethral trauma. Urethral injuries
may occur in patients with multisystem injuries
and pelvic factures, as well as straddle impacts.
If this is suspected, one must perform a genital
and rectal exam first. If one finds blood at the
meatus of the urethra, a scrotal hematoma, a
pelvic fracture, or a high riding prostate then a
high suspicion of urethral tear is present.

31. EPIDEMIOLOGY OF URINARY
CATHETERIZATION
• Up to 25% of hospitalized patients
• urinary catheterization
• Catheter associated nosocomial UTI
• 5% per day !
• Nosocomial UTI
• 40% of nosocomial infection
• Bacteria ascend intraluminally into the bladder
• within 24 to 72 hours (from Harrison’s 16th)
• > 1 month of catheterization
• Nearly all will be bacteriuic
• Long-term (>30 days) and short-term (<30 days) catheterization
• 80% of patients with nosocomial UTI
• have an indwelling urinary catheter

32. • Avoid urinary catheter use if not
indicated
• Try to discontinue the catheter
promptly when not needed
• The longer the catheter is
present, the higher the risk of
infection!
• The urinary drainage system
should always remain a closed
system
REMINDER FOR APPROPRIATE URINARY
CATHETER USE
32

33. • Both nurses and physicians
should evaluate the
indications for urinary
catheter utilization.
• Physicians should promptly
discontinue catheters that
are no longer needed.
• Nurses evaluating
catheters and finding no
indication should contact
physician to promptly
discontinue catheter.
CONSTANT EVALUATION TO CONTINUE TO
USE CATHETER …….
33

34. IMPORTANT QUESTION WHEN TO
REMOVE
• Should we need to remove the urinary catheter in
48~72 hours of smoothly post op patients to
reduce the rate of catheter associated UTI?
What’s the rate of catheter associated UTI in 48~
72 hours?
• Remove urinary catheter as soon as
possible!
• Rate of Bacteriuria in indwelling catheter patient
in 48 hours post-OP: average 24%

35. DR.T.V.RAO MD 35
• Programme Created by Dr.T.V.Rao MD
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• Email
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