Urinary Catheter Guide

Resources, Tips, and Medical Product Reviews for Urinary Catheters

CAUTIs are one of the most common hospital infections, and many times these infections could be avoiding by better procedures followed by nursing staff inserting and changing the catheters. Urinary tract infections increase patient suffering, but even on a purely economical level it’s bad for hospitals because it increases the time and resources needed for care. So, in essence, everyone loses.

Regardless if an individual chooses to self-cath or is being cathed by a caretaker, good procedures should always be followed to prevent infection. And an individual needing a catheter should have a good understanding of the proper procedures for cathing – so, what can a patient do to protect themselves from improper nursing procedures and prevention of UTIs?
Educate Yourself

• Learn how Catheter-associated infections happen.
• Ask a lot of questions about the hospital’s procedures for catheterization. Understand how their process works, and ask what they do to prevent infections from happening.
• Find out the answers to how long it will be needed, why its necessary, and when it expected to be removed.
• If you don’t understand an answer, keep asking. Or perhaps you’re not asking the right questions – so talk with hospital staff who can lead you to the person who can answer your questions properly. Get family and friends involved if necessary to get the right answers.

Keeping it Clean

• Ensure any visitors, nurses, and doctors all clean their hands with soap and water. All caregivers should wash their hands before touching you, the catheter, or the tubing. Don’t touch, or let anyone else touch, the catheter and tubing without washing their hands first.
• Ensure any catheter inserted into the body is sterile and opened immediately before use.
• If you are told you have a high bacteria count on your skin, clean it with an anti-septic solution.
• Keep a stock of soaps, anti-septics, no-rinse cleansers, gels, lotions, etc. for your own personal use and for nursing care.

Getting Help

• Talk with the nurses or doctors immediately if bandages or equipment get wet or dirty.
• If there is any pain, redness, or soreness around the catheter, let the nurses and doctors know.

Catheter-associated Urinary Tract Infections are the source of the suffering of patients, extended costs, and more frequent hospital care for many patients.  In fact, CAUTIs have been on the rise in hospitals for years now.

Medline’s new catheter tray helps to improve the process of cathing patients to help prevent the costly ($4.5 – 6.65 billion dollar) healthcare-associated UTIs from cathing, most of which is due to incorrect procedure in the cathing process.  CAUTIS stand for about 40% of all healthcare-associated infections.

So whats the big idea?  Medline’s new ERASE CAUTI system helps prevent these catheter infections by helping to streamline the process of correct cathing.  Here are some of the new additions:

Photo Illustrations of Tray Contents - Easy and clear instructions for nurses and health care professionals to know exactly how to use the tray.  This is helpful not only for the health care professional, but also explaining the catheter and the tray components to the patient.

Checklist of Procedures – The instructions with the system come with a checklist of procedures for the catheter tray.  Using a checklist dramatically reduces the number of procedural errors in health care; likewise, following correct procedures can dramatically reduce incidents of incorrect cathing and infections.

Patient Education Cards – Included with the tray are materials to educate the patient for the bedside care they are receiving.  The cards are an easy, useful way of providing this information to patients.

One-Layer Tray Design – The simple design of the tray allows the caretaker to follow an easy, straightforward process that leaves little room for variance (and error).  The sequence of events followed using the ERASE CAUTI system follows the instructions from start to finish.  This helps make patient care efficient and accurate.

Visit Medline’s Website for More.

This article from the AP shows that the Catheter-associated Urinary Tract Infections (CAUTIs) have been on the rise in 2009 despite changes in policy that have failed to address the shortcomings of medical care in hospital settings.

In fact, urinary infections caused by catheterization after surgery increased in frequency by 3.6 percent last month.

CAUTIs isn’t the only lacking element of health care infections; bloodstream infections increased by 8 percent, and overall infections increased 1.6 percent.

The silver lining of the report shows that pneumonia follwowing surgery has dropped by 12 percent, but these cases are far less prevelent than CAUTIs, one of the most common forms of infection.

The study also shows us that Catheter associated urinary tract  infections are most common among the low-income patients and the uninsured, disappointing officials in the Institute of Medicine who have worked to educate about medical errors and how to prevent them, including CAUTIs.

These infections increase hospitalization time, patient suffering, and costs which puts more strain on the already complex and strained healthcare system.    Minimizing infections has the opposite effect; better care, less expenses, and one more hospital bed for a new patient.  All CAUTIs can be mediated simply by providing mindful, careful consideration for any catheter insertion.  By good nursing with sterile environments, correct procedures, and changing the catheter at the correct, recommended interval infections can be prevented and possibly eliminated.

The National Associated for Continence (NAFC), an organization that provides education about the cause, treatments, diagnosis, and management of incontinence and other urological dysfunctions, has released a new educational pamphlet for consumers who may be facing urinary catheterization as well as nurses who need to instruct patients on self catheterization.

The publication, sponsored by the Rochester Medical Corporation, outlines step-by-step instructions for self-cathing, product selection, and Medicare coverage for urinary catheters.  There’s also a focus on preventing Urinary Tract Infections, which are of course very common implications for many using catheters that increase suffering, hospital visits, and can even mean severe urological damage for some.

Catheterization is performed by hospitals, homes, or nursing facilities about 4-5 million times per year, and the estimated cost of Urinary Tract Infections (many times due to incorrect catheterization) is over $1.6 billion US dollars annually in the United States alone.

From the article:

Leslie Wooldridge, GNP-BC, editor of this publication, believes this pamphlet will help many. “I will recommend this publication to all of my patients who catheterize, many of whom may not be aware of the recent change in Medicare coverage. Other healthcare professionals will find this pamphlet useful as well.”

Karen Sasso, RN, APN, BSN, MSN, CCCN, clinical reviewer of this publication, explains the use of this pamphlet: “Catheterization should be easy and painless. This pamphlet will help many learn the correct way to catheterize and how to avoid discomfort and possible bladder infections that occur when incorrect technique is performed.”

The pamplet can be purchased from NAFC’s online Paypal store here.  For bulk orders, call them at 1.800.BLADDER (252.3337) or e-mail memberservices@nafc.org.

Last week, the Infectious Diseases Society of America has released the guidelines for the diagnosis, prevention, and mangament of catheter-associated urinary tract infections for adults. (18+) These guidelines are designed for any and all medical professionals and individuals involved directly with patient care.  These guidelines are in the March 1 issue of Clinical Infectious Diseases.

UTIs caused by catheterization is the number one cause of health care associated infections worldwide.  The guidelines aim to end unnecessary catheterization and the improper use of catheters.  For instance, removing the catheter as soon as it’s not needed, and ensuring cathing is only performed when necessary.

Cutting down on hospital infections decreases patient suffering of course, but it also lessens nursing time and the expense of treating UTIs that could have been avoided.

From the article, here are the indications for indwelling catheterization:

Indications for Urinary Catheter Use

• Clinically significant urinary retention if medical therapy is not effective and surgical correction is not indicated.
• Urinary incontinence for comfort in a terminally ill patient if less invasive measures fail and collecting devices are not an acceptable alternative.
• Need for accurate urine output monitoring in critically ill patients.
• When the patient is unable or unwilling to collect urine (ie, during prolonged surgical procedures with general or spinal anesthesia; selected urologic and gynecologic procedures in the perioperative period).

Overall, it seems the consensus is that indwelling Urinary Catheterization should not be performed in a hospital simply for urinary incontinence alone; one of the above requirements must be met. And of course, all staff should be informed of the correct policies and procedures for catheterization.

While Catheter-associated UTIs still need more research in determining the ideal information, requirements, and practices for catheterization, researchers are positive that new advances in Urological health are accelerating and future development in this area will result in fewer UTIs.

Medicare allows for up to 200 catheters per month.

Still unknown to many catheterized Medicare patients, in late 2008, Medicare made a very important & significant policy change to benefit patients regarding the re-use of Catheters and the number of Catheters provided to a patient each month.

Many patients before this policy change in 2008 only qualified for the use of 4 catheters per month.  This means catheters designed for one-time use were required to be cleaned, boiled, dried, and re-used, sometimes up to 40 times before a new catheter is used.

However, this contradicts how catheters are manufactured and how they are labeled.  All catheters are discouraged for re-use and the FDA requires that any catheters – labeled as “sterile” are required to be packaged individually and thrown away after use.  As such, they also do not offer cleaning instructions because they are intended to be disposable.

Why not re-use catheters?

Re-using catheters puts you at greater risk of Urinary Tract Infections (UTI).

For this reason, manufacturers are required to label sterile catheters for single-use only and discourage the re-using of catheters.

Both the FDA and Veterans Administration now agree that sterile catheters are designed for single-use only.

Why did Medicare change its policy?

Money is a major issue – studies began to show that the re-use of catheters was increasing Medicare costs because of the higher risk for Urinary Tract Infections.

While only 1 catheter per week on average decreases the cost of supplies, the overall increase in UTIs increases hospital visits, pain & suffering caused by infections, and disrupts the quality of life for patients.

Here are the facts:

While many patients were only allowed 4 catheters per month, under the new Medicare policy changes, you can now receive up to 200 catheters per month.

• Most catheters are designed for single-use only, as labeled on their packaging.
• The FDA and the Veterans Administration both agreed that sterile catheters are designed for single-use only.
• The old Medicare policy encouraged the re-use of catheters.
• Re-using catheters can put you at risk for Urinary Tract Infections (UTI)
• Under the new Medicare policy changes in 2009, you can now qualify to receive up to 200 catheters per month.
• 200 catheters a month means up to 6 catheterizations per day without re-using a single catheter.

Purchasing Urinary Catheters with Medicare
If you have Medicare and have been under-supplied on Catheters, you’re now eligible for up to 200 catheters per month.  Buy your supplies from a company that is accredited to accept Medicare claims.

STLMedical.com supplies your urinary catheters – now up to 200/ month – under your Medicare coverage.  Shipping is always free for all orders over $50.  While insurance companies differ in their limits to a monthly catheter supply, STL Medical is also assigned to accept Blue Cross/Blue Shield and Healthlink.

Start using a new catheter every time you cath – you will decrease the risk of Urinary Tract Infections and be re-assured every time you cath that your catheter is sterile!

Catheters are a common part of health care for many, but can also cause issues with infections. A fantastic piece written by Carol Pellowe discusses ten issues & best practices for short-term urinary catheterization.

With catheterization, there is a risk that bacteria can go into the catheter and make its way into the bladder.  This causes added discomfort and delays patient recovery.  The article provides some great information about catherization as well as tips for procedures and some statistics of patients getting CAUTI (Catheter Associated Urinary Tract Infections).

The daily risk to catheterised patients of developing bacteriuria is 3-6% and cumulatively increases the longer the catheter remains in place (Pratt et al, 2007).
Consequently, around 50% of hospitalised patients catheterised for longer than 7-10 days develop bacteriuria (Pratt et al, 2007).

Although patients with bacteriuria frequently do not present with clinical symptoms, 20-30% of them will develop symptoms of CAUTI (Pratt et al, 2007). Many of these infections are serious and lead to significant morbidity and mortality.

Carol Pellowe (EdD, MA Ed, BA, RNT, RN) also discusses:

• What catheter is best
• Insertion technique
• Documentation
• Maintenance
• Cleaning / Hygiene
• Education
• Intervention Care

If you work with patients or require catheters yourself, I highly recommend reading this well-sourced article.