How to care for an indwelling urinary catheter and prevent CAUTI
NCLEX-RN topic: Elimination
- Insert a catheter only for a CDC-approved reason, never for incontinence alone.
- Keep the system closed and the bag below the bladder, off the floor.
- Review the need every day and remove the catheter as soon as possible.
- Output under 30 mL/hr: check kinks first; notify the provider if it stays low.
- After removal, the client should void within 6 hours.
Key facts
- Appropriate reasons include urinary retention or outlet obstruction, hourly output in critical illness, selected surgeries, healing sacral or perineal wounds with incontinence, prolonged immobilization, and end-of-life care.
- Incontinence care alone, getting a culture from a client who can void, and long postoperative use without an indication are not appropriate reasons.
- Keep a closed drainage system, the bag below the bladder and off the floor, and the tubing free of kinks.
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- Clean the meatus during routine bathing; do not use antiseptics on the periurethral area, and do not irrigate or change catheters on a fixed schedule.
- Urine output should be at least 30 mL/hr; if it is lower, check for kinks first and notify the provider if it does not improve.
- Report CAUTI signs: fever above 100.4°F (38°C), new confusion or lethargy, chills, foul-smelling urine, and suprapubic or flank pain.
- After removal, the client should void within 6 hours; a post-void residual over 300 mL on bladder scan is reported to the provider.
Quick check1 question · 2 more at the end
The nurse reviews four clients who have new prescriptions for an indwelling urinary catheter. Which client has an appropriate indication for the catheter?
Correct answer: D.
CDC-approved indications include urinary retention, hourly output monitoring in critically ill clients, selected surgeries, healing sacral or perineal wounds with incontinence, prolonged immobilization and end-of-life care. When a request does not meet an indication, the nurse contacts the provider and advocates for another approach.
A Using a catheter in place of nursing care for incontinence is an inappropriate reason.
B A client who can void should give a culture specimen without a catheter.
C Prolonged postoperative use without an indication is inappropriate; catheters are removed as soon as possible after surgery.
D Correct: hourly output monitoring in a critically ill client is a CDC-approved indication.
Full lesson
Each part starts with its main idea. Open a part when you want the details.
The short answer: Insert an indwelling catheter only for a CDC-approved reason, such as urinary retention or hourly output monitoring in critical illness, never for incontinence care alone. Keep the system closed, the bag below the bladder and off the floor, and urine flowing freely. Review the need daily, remove it as soon as possible, and track the first void.
1 When does a client actually need an indwelling catheter?A catheter-associated urinary tract infection (CAUTI) is common and can be fatal, so the safest catheter is the one never inserted. 1 min
A catheter-associated urinary tract infection (CAUTI) is common and can be fatal, so the safest catheter is the one never inserted. If a client does not meet a CDC-approved indication, the nurse contacts the provider and advocates for another approach.
| Appropriate reasons | Not appropriate reasons |
|---|---|
| Urinary retention or bladder outlet obstruction | In place of nursing care for incontinence |
| Hourly output monitoring in a critically ill client | To get a urine culture when the client can void |
| Selected surgeries (perioperative use) | Prolonged postoperative use with no indication |
| Healing open sacral or perineal wounds with incontinence | |
| Prolonged immobilization | |
| End-of-life care |
2 How is a catheter inserted to lower infection risk?Aseptic technique at insertion protects the bladder from the start. 1 min
Aseptic technique at insertion protects the bladder from the start. Choose the smallest suitable catheter, usually 14 French. Use sterile gloves and equipment, perform perineal care first, and inflate the balloon only after insertion. Secure the catheter so it does not move or pull on the urethra.
3 How do you care for a catheter once it is in?Most CAUTI prevention happens during routine daily care of the catheter. 1 min
Most CAUTI prevention happens during routine daily care of the catheter.
- Closed system. Do not disconnect it. If it breaks open, leaks or is contaminated, replace the catheter and drainage system using aseptic technique.
- Free flow. Keep the tubing free of kinks and the bag below the bladder at all times, never on the floor.
- Emptying. Use a separate clean container for each client, and do not let the spigot touch it.
- Hygiene. Clean the meatus during daily bathing and the perineum after every bowel movement, wiping away from the meatus. Do not use antiseptics around the urethra while the catheter is in.
- No routines without a reason. Do not irrigate routinely, and do not change catheters or bags on a fixed schedule.
- Specimens. Disinfect the needleless sampling port, then draw small samples with a sterile syringe.
Urine output should be at least 30 mL/hr. If it falls lower, check the tubing for kinks first, then notify the provider if output does not improve.
4 Which findings suggest a CAUTI?Several signs of CAUTI need a prompt report to the provider. 1 min
Several signs of CAUTI need a prompt report to the provider. They include fever above 100.4°F (38°C), new confusion or lethargy, chills, foul-smelling urine, and suprapubic or flank pain. Cloudy, dark, bloody or sediment-filled urine also needs a report and a specimen as prescribed. In older adults, new confusion may be the main sign of infection.
5 What happens after the catheter comes out?Every catheter day raises infection risk, so the nurse reviews the need daily and advocates for removal. 1 min
Every catheter day raises infection risk, so the nurse reviews the need daily and advocates for removal. After surgery, CDC recommends removal as soon as possible, preferably within 24 hours, unless there is still a valid indication.
- Deflate the balloon fully with a syringe, and remove the catheter as the client breathes out. Stop if you feel resistance.
- Document the removal time and track the first void. The goal is to void within 6 hours. A mild burning feeling with the first void can be expected.
- If the client cannot void within 4 to 6 hours or feels bladder fullness, prompt the client to void. If the void is under 180 mL, do a bladder scan.
- A post-void residual over 300 mL is reported to the provider, who often orders a straight (in-and-out) catheterization. An indwelling catheter is avoided when possible.
6 What the nurse doesThe nurse reviews the catheter daily, acts on infection or retention, and teaches the client. 1 min
The nurse reviews the catheter daily, acts on infection or retention, and teaches the client.
- Assess daily whether the catheter still meets an indication, and check the bag position, tubing, output and urine appearance.
- Act first on infection or retention. Report CAUTI signs, and bladder scan a client who cannot void after removal.
- Teach the client to keep fluids up unless restricted, to report burning, frequency or trouble voiding, and to keep the bag below the bladder.
Common mistakes
The traps students fall into most. Read these before you practice.
Watch out: Keep the drainage bag below the bladder, not on the bed or the floor.
Watch out: Clean the meatus with routine hygiene, not with antiseptic solution, while the catheter is in place.
Watch out: Change a catheter or bag when there is a clinical reason, not on a routine fixed schedule.
Watch out: A client who cannot void after removal is prompted to void and bladder scanned, not given a new indwelling catheter right away.
Watch out: In an older adult, new confusion may be the main sign of a urinary infection, not just fever or burning.
How to remember it
Think "low, closed, flowing, and gone soon" at every catheter check. The bag stays low, the system stays closed, urine keeps flowing, and the catheter comes out as soon as it can.
Self-check:
- Name three appropriate and two inappropriate reasons for an indwelling catheter.
- List four daily care rules that prevent CAUTI.
- Describe what you do when a client has not voided 6 hours after removal.