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Urologic Catheters (Includes CAUTI)

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CAUTIs Continue To Be A Challenge!

Diane K. Newman | May 04, 2022

Catheter-associated urinary tract infections continue to be an issue for clinicians and institutions, particularly hospitals.  The Agency for Healthcare Research and Quality (AHRQ) released many documents that clinicians and infectious disease experts will find useful in fighting this problem.  One is a Toolkit for Preventing CLABSI and CAUTI in ICUs that offers customizable tools and training resources to prevent central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI) in intensive care units (ICUs).

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diane k newman

Diane K. Newman, DNP FAAN BCB-PMD is a Urologic Nurse Practitioner, Adjunct Professor of Urology in Surgery, Research Investigator Senior, Perelman School of Medicine, University of Pennsylvania, and Former Co-Director of the Penn Center for Continence and Pelvic Health. She is the author of several books. The most recent is as lead editor of the 1st edition of the SUNA Core Curriculum for Urologic Nursing and of Clinical Application of Urologic Catheters, Devices and Products.

Videos
Clinical Conversations by Experts
Urogynecology Controversies: Female Pelvic Medicine and Reconstructive Surgery - Briana Walton
Single-Use Disposable Cystoscopy - Roger Dmochowski, David Chaikin, & Vijay Goli
Gentamicin Bladder Irrigation to Reduce UTIs - Anne Cameron
Male UCPPS is NOT Prostatitis - Jeannette Potts
Driving Excellence in the Management of Nocturia - Scott MacDiarmid
A Legend and His Contributions to Urology Perspectives On His Journey - Ananias Diokno
The International CURE-UAB Initiative - Michael Chancellor
Management of Nocturia- Mikel Gray
Nocturia: Physiology and Pathophysiology - Mikel Gray
Research Outcomes in Urinary Tract Infections in Woman - Jean Wyman
Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium - Tamara Bavendam
The Use of Acupuncture in Women with Incontinence - Sandy Engberg
Overview of Catheter Associated Urinary Tract Infections and Prevention Strategies - Shannon Novosad
Group Learning Achieves Decreased Incidence of Lower Urinary Symptoms - Interview with Tomas Griebling
Surgical Interventions for Stress Urinary Incontinence and Pelvic Organ Prolapse - Ariana Smith
A Midwife Perspective on Preserving the Pelvic Floor - Lisa Kane Low
A Paradigm Shift in the Treatment of Nocturia - David Sussman
Evolution in the Treatment of Patients with Prostatitis - Jeannette Potts
Surgical Management of Female Stress Urinary Incontinence: 22-Year Population-Level Trends - Christopher Wallis
Demographics of the Nocturia Patient - Jeffrey Weiss
What to Look Forward to - 48th Annual International Continence Society ICS - Alan Wein
Defining Bladder Health - Ariana Smith
Female Urology, Incontinence, LUTS, Voiding Dysfunction - Christopher Payne
Welcome to the Pelvic Health Center of Excellence - Diane Newman
Causes and Treatments of Nocturia - Jeannette Potts
The State of BPS/IC: "The Emperor Has No Clothes" - Christopher Payne
Physician-Scientist Review Articles
State of the Evidence Review Articles
Intermittent Catheters
Written by Diane K. Newman, DNP, ANP-BC, FAAN
March 30, 2021
Intermittent catheterization is the method of bladder management in patients with urinary retention caused by a neurogenic bladder.  Neurogenic bladder can be caused by 1) upper motor neuron disease (for example, central nervous system lesions, including stroke, Parkinson’s disease, and multiple sclerosis [MS]);
Written by Diane K. Newman, DNP, ANP-BC, FAAN
March 30, 2021
Intermittent catheterization (IC) is the “gold standard” for individuals with bladder dysfunction caused by neurologic or non-neurologic causes, a significant and growing population in the United States.  Intermittent catheterization is the recommended method for individuals who are unable to void or completely empty the bladder.
Written by Diane K. Newman, DNP, ANP-BC, FAAN
March 30, 2021
Intermittent catheterization (IC) is the insertion and removal of a catheter several times a day to empty the bladder. This type of catheterization is used to drain urine from a bladder that is not emptying adequately or from a surgically created channel that connects the bladder with the abdominal surface
Written by Diane K. Newman, DNP, ANP-BC, FAAN
March 30, 2021
Intermittent catheterization (IC) is the preferred procedure for individuals with incomplete bladder emptying from non-neurogenic or neurogenic lower urinary tract dysfunction (NLUTD). IC is now considered the gold standard for bladder emptying in individuals following spinal cord injury (SCI) who have sufficient manual dexterity (Groen et al., 2016; Wyndaele et al, 2012).
Written by Diane K. Newman, DNP, ANP-BC, FAAN
March 29, 2021
Patients may be concerned about the discomfort associated with intermittent catheterization(IC), the need to maintain privacy, the fear of performing the catheterization, and the inability to find a clean and appropriate toilet or bathroom for catheterization when traveling outside their home. Clinicians need to consider these patient concerns in their teaching and recommend possible strategies.
Written by Diane K. Newman, DNP, ANP-BC, FAAN
March 29, 2021
The number of catheter types and designs has increased with the advancement of new technology. This has added complexity to the catheterization process for both the nurse and the patient. Catheter types are now gender specific, acknowledging the anatomical differences in urethral length between men and women.
Indwelling Catheters
Written by Diane K. Newman, DNP, ANP-BC, FAAN
November 16, 2021

There are other non-infectious IUC-related adverse effects that occur the longer an indwelling urinary catheter (IUC), particularly a transurethral IUC, is used for bladder drainage. They include catheter blockage, urine bypassing, bladder spasms, accidental catheter dislodgement, and non-deflating balloons.

Written by Diane K. Newman, DNP, ANP-BC, FAAN
April 5, 2020

Adherence to general infection control principles: Hand hygiene - the most important factor in preventing nosocomial infections, Aseptic catheter insertion, Proper Foley catheter maintenance, education, and care by nursing staff, Foley catheter use surveillance and feedback.

Written by Diane K. Newman, DNP, ANP-BC, FAAN
April 28, 2019
The 2009 Centers for Disease Control and Prevention (CDC) guidelines for the prevention of catheter-associated urinary tract infections (UTIs) recommends catheter use only for appropriate indications.
Written by Diane K. Newman, DNP, ANP-BC, FAAN
April 28, 2019
Catheter related problems due to an indwelling urinary catheter (IUC) have existed as long as urinary catheters have been utilized.
Written by Diane K. Newman, DNP, ANP-BC, FAAN
April 28, 2019
Indwelling urinary catheters (IUCs) are semi-rigid, flexible tubes. They drain the bladder but block the urethra. IUCshave double lumens, or separate channels, running down it lengthwise.
Written by Diane K. Newman DNP, ANP-BC, FAAN
October 21, 2021
Written by Diane K. Newman, DNP, ANP-BC, FAAN
April 28, 2019
In this resource article, Diane Newman, DNP, ANP-BC, FAAN provides best practices for the management of indwelling urinary catheters starting with documenting in the patient’s medical record all procedures involving the catheter or drainage system.
Written by Diane K. Newman, DNP, ANP-BC, FAAN
April 28, 2019
In this resource article, Diane K. Newman, DNP, ANP-BC, FAAN provides techniques and procedures for use of indwelling catheters including appropriate urinary catheter use, examples of appropriate indications for indwelling urethral catheter use and more.
Written by Diane K. Newman, DNP, ANP-BC, FAAN
April 28, 2019
Catheters are semi-rigid but flexible tubes. They drain the bladder but block the urethra.

The challenge is to produce a catheter that matches as closely as possible to the normal physiological and mechanical characteristics of the voiding system.
Written by Diane K. Newman, DNP, ANP-BC, FAAN
April 28, 2019
Each year, urinary catheters are inserted in more than 5 million patients in acute care hospitals and long-term care (LTC) facilities. Historically, indwelling urinary catheters (IUC) have been used in the chronically, medically compromised older adults.
Written by Diane K. Newman, DNP, ANP-BC, FAAN
April 28, 2019
A catheter is inserted for continuous drainage of the bladder for two common bladder dysfunction : urinary incontinence (UI) and urinary retention. Indwelling urinary catheters are either inserted transurethrally or suprapubically.
External Urinary Collection Devices
Written by Diane K. Newman, DNP, ANP-BC, FAAN
April 17, 2020
The shape and material of external urine collection devices (EUCD) have changed over the past 20 years. Historically, most EUCDs were made from latex that allowed for flexibility but also increased the risk of an allergic reaction. Latex-based sheath devices are still available but more recent ones are constructed from non-allergenic silicone.
Written by Diane K. Newman, DNP, ANP-BC, FAAN
April 17, 2020
An EUCD may be external and less invasive, but they are not free of risks. Complications and adverse effects include skin lesion/ulceration and breakdown from pressure necrosis and moisture, urethral fistula or very rarely, gangrene of the penis. The majority of complications involve perineal/genital skin issues, primarily occurring in 15-30% of male patients and involve external penile shaft problems.
Written by Diane K. Newman, DNP, ANP-BC, FAAN
April 10, 2020
The use of an external urine collection device (EUCD) is an effective way to manage and collect urine leakage in men and women who have urinary incontinence. However, these devices are not indicated for the management of urinary obstruction or urinary retention.
Written by Diane K. Newman, DNP, ANP-BC, FAAN
April 17, 2020
An external urine collection device (EUCD) is defined as a catheter or product that attaches to the perineum. These collection systems drain urine via tubing attached to a bag or via tubing that suctions urine to a container. EUCDs are primarily used in men or women with urinary incontinence.
Written by Diane K. Newman, DNP, ANP-BC, FAAN
April 10, 2020
External urinary catheters (EUC) are used as collection devices or systems (referred in the UroToday reference center as external urine collection devices [EUCD]) for collecting and containing urine via tubing that relies on gravity to drain urine away from the penis or perineum into a drainage bag or suction that pulls urine into a container.
Physician-Scientist Commentaries
Peer-reviewed Abstract Supplemental Commentaries
Written by Charles B. Foster, MD
Center for Pediatric Infectious Diseases, Cleveland Clinic Children’s
Catheter-associated urinary tract infections (CAUTIs) are a major cause of harm in hospitalized children.

Catheter Resource Guides

Catheter guides provided by the ANA and AHRQ
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Streamlined Evidence-Based RN Tool: Catheter Associated Urinary Tract Infection (CAUTI) Prevention

Nurse-Driven CAUTI Prevention: Saving Lives, Preventing Harm and Lowering Cost. Key Practice Strategies to Reduce CAUTI: 1) Fewer Catheters Used, 2) Timely Removal and 3) Insertion, Maintenance, and Post-Removal Care. Informed by Guidelines for Prevention of Catheter-Associated Urinary Tract Infections (CDC, 2017).

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...
AHRQ Safety Program for Reducing CAUTI in Hospitals

This guide and the appended tools are designed to support implementation of evidence-based practices and elimination of catheter-associated urinary tract infections (CAUTI) in your hospital unit.

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...
How to Use an External Male Catheter

An external catheter is used by a man to collect urine that leaks from the bladder (called “urinary incontinence”). These catheters are also called “urisheath or sheath” or “condom” or “Texas” catheters. This catheter is used on the outside of the body. It fits over the penis and connects to a drainage bag.

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AHRQ-2022 Update for clinicians
Conference Coverage
Conference Highlights Written by Physician-Scientist
Presented by Shannon Novosad, MD, MPH
Philadelphia, PA (UroToday.com) Shannon Novosad, MD, medical officer at the Centers for Disease Control and Prevention (CDC) has opened Educational Course on Clinical Directions in Continence care by providing an overview
Presented by Brian S. Schwartz, Tomas Lindor Griebling, Timothy Averch, and Ben Chew
San Francisco, CA USA (UroToday.com) Brian S. Schwartz, MD (UCSF) moderated the Plenary session on “Catheter-Associated UTIs” with Dr. Tomas Griebling (University of Kansas), Dr. Timothy Averch (University of Pittsburg), and Dr. Ben Chew (University of British Columbia) as the panelists.