Urethral Catheters

Urethral catheters are small tubes inserted through the urethra to drain urine. These

devices are often linked with high rates of urinary tract infections (UTI) and are frequently used

in the older population. This contributes to lengthier hospital stays leading to increased medical

costs. In 2008, the Centers of Medicare and Medicaid Services (CMS) included catheterassociated

bacteriuria (CAB) as one of the preventable hospital-acquired conditions (HAC) that

will affect reimbursement if contracted by a patient in the acute and long-term setting. This paper

focuses on three best evidence-based practices and nursing strategies to prevent CABs.

Background

Van Buren is the second largest city in the Fort Smith, Arkansas (AR)-Oklahoma (OK)

metropolitan statistical area and is the county seat of Crawford County, AR. The city of Van

Buren has numerous subsystems dedicated to the well-being of the community, which includes

one medical facility, five medical clinics, three nursing homes, three ambulance services, and the

Crawford County Health Department (Yellow Pages, 2010).

The medical facility, Summit Medical Center, provides full-service general acute care to

approximately 160,000 residents annually in Crawford, Franklin, and Sebastian Counties in AR

and Sequoyah County in OK. The facility has 103 beds, has more than 100 nurses on staff, and

has over 140 physicians in the medical clinics (Summit Medical Center, 2011).

In 2009, the medical facility emergency department (ED) treated 170 residents from

nursing homes, 70 of which were hospitalized after examination and treatment in the ED, 58

were treated as “ED outpatient” visits, and 42 were direct hospitalization visits (Summit Medical

Center, 2011). The majority of...

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...See Figure I). The decision tree is used as a guide for clinicians in

making clinical decisions to either continue or discontinue indwelling urethral catheters.

Conclusion

Urethral catheterization in the older population should be considered as a last option

because it can lead to catheter-associated bacteriuria, bloodstream infection, sepsis and death. It

should not be used for staff convenience, or to manage urinary incontinence manageable by other

means. CAB is a condition that can be prevented with the application of evidence-based best

practice strategies. These include criteria for catheter placement and discontinuation, use of

silver-alloy catheters for short-term catheterization, and limiting bladder irrigation. An algorithm

for urethral catheter insertion, care and removal is used as a tool to help prevent CABs and

achieve better patient outcomes.