Evidence-Based Recommendations for Urinary Catheter Irrigation
Routine irrigation of indwelling urinary catheters is not recommended for preventing catheter-associated bacteriuria, urinary tract infection, or catheter obstruction in patients with long-term indwelling catheters. 1
General Principles for Catheter Management
- Routine catheter irrigation with normal saline should not be used to reduce catheter-associated bacteriuria (CA-bacteriuria), catheter-associated urinary tract infection (CA-UTI), or obstruction in patients with long-term indwelling catheterization 1, 2
- Catheter irrigation with antimicrobials should not be used routinely to reduce or eradicate CA-bacteriuria or CA-UTI in patients with indwelling catheters 1
- The best way to avoid catheter-associated infections and other complications is to avoid long-term catheter use whenever possible 3
Specific Irrigation Recommendations
When NOT to Irrigate:
- Daily irrigation with normal saline provides no benefit in preventing catheter obstruction or febrile episodes in long-term catheterized patients 2
- Routine addition of antimicrobials or antiseptics to the drainage bag of catheterized patients should not be used to reduce CA-bacteriuria or CA-UTI 1
- Randomized trials of hydrogen peroxide, chlorhexidine, povidone-iodine, or silver ions added to drainage bags have shown no benefit in reducing CA-bacteriuria rates 1
Limited Situations When Irrigation May Be Considered:
- Catheter irrigation with antimicrobials may be considered only in selected patients who undergo surgical procedures and short-term catheterization to reduce CA-bacteriuria (weak recommendation) 1
- For patients with fungal cystitis due to fluconazole-resistant species (such as C. glabrata and C. krusei), amphotericin B deoxycholate bladder irrigation with 50 mg/L sterile water daily for 5 days may be considered (weak recommendation) 1
- For patients with fungal pyelonephritis who have nephrostomy tubes, irrigation through these tubes with amphotericin B deoxycholate (25–50 mg in 200–500 mL sterile water) is recommended 1
Catheter Management Best Practices
- Elimination of predisposing factors, such as indwelling bladder catheters, is recommended whenever feasible 1, 4
- Daily meatal cleansing with povidone-iodine solution, silver sulfadiazine, polyantibiotic ointment or cream, or green soap and water is not recommended for routine use in patients with indwelling urethral catheters 1
- There is insufficient evidence to recommend routine catheter changes (e.g., every 2–4 weeks) in patients with functional long-term indwelling catheters 1
- Prophylactic antimicrobials should not be administered routinely to patients at the time of catheter placement, removal, or replacement 1
Common Pitfalls to Avoid
- Avoid routine irrigation practices that are not evidence-based, as they may increase the risk of introducing bacteria into the urinary tract 1, 2
- Avoid raising the drainage bag above the level of the bladder as this can facilitate bacterial entry into the bladder 1
- Avoid unnecessary catheterization; studies show that 21% of initial catheter placements and 47% of continued catheterization days are unjustified 4
- Avoid the assumption that routine irrigation prevents catheter blockage; randomized trials have shown no benefit 2
In conclusion, the evidence strongly indicates that routine irrigation of indwelling urinary catheters with normal saline or antimicrobial solutions does not provide benefits in terms of preventing catheter-associated bacteriuria, urinary tract infections, or catheter obstruction in patients with long-term catheters. The focus should be on appropriate catheter use, proper catheter care, and prompt removal when no longer necessary.