It is common practice to insert a Foley catheter in almost all patients seen at the emergency department (ED) without stopping to ask ‘does this patient really need the indwelling catheter?’ When the rate of catheter associated urinary tract infections (CAUTIs) is taken into account, every health worker at the ED should only consider the absolute need for the catheter. Consider these statistics:
- Catheter related urinary tract infections are the leading cause of infections acquired in the hospital
- 95,000 – 387,000 cases of CAUTI afflict American patients every year.
- Most of the CAUTI cases are preventable
While a Foley catheter can play a major role in the management of critically ill patients in the input/output fluid balance charts and in relieving acute urine obstruction; more often than not medical workers insert it out of habit. Interestingly, many patients with a Foley catheter in place had the catheterization without a physician’s order for the procedure. A study on these cases reveals that up to a half of all these catheterizations are not necessary.
According to the CDC health care infection control practices advisory committee, the following situations are examples of situations where catheterization is appropriate:
- When an accurate urine output record is necessary, usually for patients who are critically ill.
- Surgical procedures on genitourinary structures.
- Patients with pelvic fractures or those who are physically incapacitated for long durations of time.
- As part of tender loving care (TLC) for terminally ill patients.
- Presence of acute urinary retention or blockage of urinary pathways.
Instances where Indwelling Catheterization is unnecessary:
- Inserting a Foley catheter to replace the assistance of a health care professional, such as a nurse.
- Catheterization for purposes of obtaining a urine sample when the patient can voluntarily urinate. Naturally, this should be avoided.
- Patients with congestive cardiac failure and who are able to pass urine for fluid input/output monitoring
- As a way of measuring post-micturition bladder volume. An ultrasound is non-invasive and very accurate for this.
- Injuries. Assessment should be done first
Successful avoidance of Foley catheterization requires teamwork. The nurse at the ED should avoid routine Foley catheter placement unless it has been ordered by a physician. Patients who ask for catheterization purely out of convenience should be made to understand the risk of infection.
Once the Foley catheter has served its purpose, it should be safely removed. Not doing so may lead to a urinary tract infection.
The cost of Foley catheter placement
The cost of the Foley catheter and the related items needed for the insertion, the charges for the emergency department and the fee associated to the healthcare professional applying it can be quite expensive. This cost would go even higher for those patients who have little or no insurance; not to mention the increase in the risk (and again cost) of a catheter-associated urinary tract infection (CAUTI) to occur.
Before a Foley catheter placement, the question should be whether it is necessary. For those already with the catheters in place, the question is ‘has it served its purpose and should it be removed?’