From the Guidelines
For an indwelling Foley catheter that is bypassing, typical flushing orders include instilling 30-50 mL of sterile normal saline (0.9% sodium chloride) as needed, based on the most recent guidelines from the Infectious Diseases Society of America 1. When bypassing occurs, the catheter should first be assessed for blockage from blood clots, sediment, or mucus. Flushing helps clear these obstructions and restore proper drainage.
- Key considerations for flushing an indwelling Foley catheter include:
- Using strict aseptic technique with sterile equipment to minimize infection risk
- Instilling the recommended amount of sterile normal saline (30-50 mL) as needed
- Allowing the saline to drain back out through the catheter after instillation
- Avoiding routine prophylactic flushing, as it is not recommended by guidelines due to increased infection risk 1
- According to the guidelines, catheter irrigation with antimicrobials should not be used routinely to reduce or eradicate CA-bacteriuria or CA-UTI in patients with indwelling catheters 1.
- If bypassing continues after flushing, the catheter may need to be replaced, as this could indicate the catheter is too small, malpositioned, or has a structural problem.
- Documentation should include the amount of fluid instilled and drained, appearance of any debris, and the patient's response to the intervention, to ensure proper monitoring and adjustment of the flushing procedure as needed.
From the Research
Flushing an Indwelling Urinary Catheter
To address the issue of flushing an indwelling urinary catheter that may be bypassing, it is essential to consider the amount and type of sterile fluid used.
- The evidence suggests that there is no specific guideline for the amount and type of sterile fluid to be used for flushing an indwelling urinary catheter that may be bypassing 2.
- However, it is recommended to use sterile saline solution for flushing the catheter to prevent infection 3, 4.
- The use of acidic solutions or antibiotic solutions has been compared to saline solution, but the data are too few to support any conclusions 2.
- There is no evidence to suggest that the use of a specific type or amount of sterile fluid can prevent catheter bypassing 5, 6.
Prevention of Catheter-Associated Complications
To minimize the risk of catheter-associated complications, including bypassing, it is crucial to follow proper catheter care and maintenance techniques.
- Regular flushing of the catheter with sterile saline solution can help prevent blockages and encrustation 3, 2.
- Proper securing of the catheter and regular monitoring of the catheter site can help prevent trauma and other complications 6.
- The use of silver alloy-coated catheters has been shown to reduce the incidence of catheter-associated bacteriuria 3.