What should be done if a patient dislodges their own Indwelling Catheter (IDC)?

Management of a Self-Dislodged Indwelling Catheter (IDC)

When a patient dislodges their own indwelling catheter, the catheter should be replaced if still clinically indicated, using aseptic technique at a clean insertion site, and the patient should be monitored for signs of urinary tract infection or trauma.

Assessment and Immediate Actions

• Assess the patient for signs of trauma to the urethra or bladder, including bleeding, pain, or discomfort 1
• Evaluate the need for continued catheterization based on the original indication 2
• If the catheter was dislodged but the exit site appears clean without signs of infection, a new catheter can be inserted using proper aseptic technique 3
• If there is significant bleeding or drainage from the catheter exit site, apply gauze dressings rather than transparent dressings until the drainage resolves 3

Indications for Catheter Replacement

• Replace the catheter only if there is a specific, well-documented indication for continued catheterization 2
• Appropriate indications include:
  • Urinary retention that cannot be managed by other means 2
  • Need for accurate measurement of urinary output in critically ill patients 2
  • Management of intractable urinary incontinence when other methods have failed 4
  • Presence of pressure ulcers that are being contaminated by urine 2

Technique for Replacement

• Use strict aseptic technique when inserting a new catheter 5
• Clean the insertion site with an appropriate antiseptic such as chlorhexidine-based solution 3
• Select the appropriate catheter size to minimize urethral trauma and risk of bypassing 6
• Secure the catheter properly to prevent tension and accidental removal 5

Post-Replacement Monitoring

• Monitor the patient for signs of urinary tract infection (fever, suprapubic tenderness, cloudy urine) 1
• Check for proper drainage and positioning of the catheter 6
• Document the event, including assessment findings and interventions 4
• Implement strategies to prevent future self-removal, such as patient education or, if appropriate, restraints as a last resort 4

Prevention of Complications

• Maintain a closed drainage system to minimize the risk of infection 1
• Perform routine care of the catheter and perineal area according to institutional protocols 5
• Consider alternatives to indwelling catheterization when possible (e.g., intermittent catheterization, external collection devices) 2
• Regularly assess the continued need for catheterization and remove the catheter as soon as it is no longer necessary 2

Patient Education

• Provide education to the patient about the purpose and proper care of the catheter 4
• Explain the risks associated with catheter manipulation or removal 5
• Address any concerns or discomfort the patient may be experiencing that led to self-removal 4

Special Considerations

• For patients with cognitive impairment who repeatedly attempt to remove their catheter, consider alternatives to indwelling catheterization 2
• If the patient has signs of infection following catheter dislodgement, obtain urine cultures and initiate appropriate antimicrobial therapy based on clinical presentation 3
• For patients with recurrent catheter dislodgement, consult with a urologist or wound/ostomy/continence nurse specialist for management strategies 6