What are the indications for insertion of an indwelling urinary catheter?

Indications for Insertion of an Indwelling Urinary Catheter

Indwelling urinary catheters should only be inserted for specific, well-documented indications as they carry significant risks and should be used as a last resort after other options have failed. 1, 2

Appropriate Indications

• Urinary retention or obstruction that cannot be managed with intermittent catheterization 1
• Need for accurate measurement of urinary output in critically ill patients 1
• Open wounds in sacral or perineal area that could be contaminated by urine 1
• Patient too ill or incapacitated to use alternative methods of urine collection 1
• Perioperative use for specific surgical procedures, particularly urologic surgeries 1

Contraindications

• Urethral trauma or suspected urethral injury - could worsen injury and cause additional complications 1
• Acute prostatitis - may exacerbate inflammation and increase risk of bacteremia 1
• Presence of urethral stricture - could cause additional trauma 1
• When intermittent catheterization is feasible - indwelling catheters should be avoided 1

Risks and Complications

• Catheter-associated urinary tract infection (CAUTI) - risk increases approximately 5% per day 1
• Mechanical complications including urethral trauma, bleeding, stricture formation, erosion, and bladder stones 1
• Patient discomfort, reduced quality of life, and restricted mobility 1
• Increased antibiotic consumption - patients with indwelling catheters have significantly higher rates of positive urine cultures (100% vs 51.6% with intermittent catheterization) 3
• Higher post-operative complication rates (50% vs 13% with intermittent catheterization) 3
• Longer hospital stays (3 days vs 2 days with intermittent catheterization) 3

Alternative Options to Consider Before Indwelling Catheterization

• Intermittent catheterization - should be used whenever possible instead of indwelling catheters 1
• Suprapubic catheterization - may be preferable for long-term use as it has lower risk of bacteriuria, reduced risk of urethral trauma/stricture, ability to attempt normal voiding without recatheterization, and less interference with sexual activity 4
• External condom catheters - effective alternative for bladder management in some men with lower incidence of catheter-associated bacteriuria 4

Best Practices When Indwelling Catheter Is Necessary

• Remove catheter as soon as no longer needed - the best way to avoid complications is to minimize duration of use 1, 2
• Maintain a closed drainage system to reduce infection risk 1
• Ensure proper catheter care including perineal hygiene 1
• Ensure adequate hydration to maintain good urine flow 1

Common Pitfalls to Avoid

• Inserting catheters for convenience of healthcare workers rather than patient necessity 2
• Prolonged use without reassessment of continued need 1
• Using indwelling catheters for management of overactive bladder - this is not recommended due to adverse risk/benefit balance 4
• Failure to consider alternatives such as intermittent catheterization or external collection devices 1