Indwelling catheter management: from habit-based to evidence-based practice.

Indwelling urinary catheters are used in the care of more than five million patients per year. Prevalence rates range from 4% in home care to 25% in acute care. Catheter-associated urinary tract infections account for more than 40% of all nosocomial infections and can be associated with significant complications. Clinical practices in catheter management vary widely and frequently are not evidence-based. Effective nursing measures include: identifying patients who no longer need indwelling catheters, discussing appropriate catheter alternatives, and providing patient and caregiver education. Many catheter-associated problems can be avoided by selecting a closed catheter system with a small size catheter (14 to 18 French with a 5-cc balloon), following manufacturer's recommendations for inflation/deflation, maintaining a closed system, securing the catheter, and properly positioning the drainage bag. Practices such as routine catheter irrigation should be avoided. Current recommendations related to the management of encrustation and blockage also are discussed. Providing evidence-based catheter management strategies may reduce the rate of catheter-associated urinary tract infection, catheter encrustation, and leakage as well as the discomfort and costs associated with these complications.