What is the recommended method for urinary catheter anchoring?

Recommended Method for Urinary Catheter Anchoring

Urinary catheters should be secured to the patient's thigh using a dedicated catheter securement device to prevent complications including urethral trauma, infection, and accidental dislodgement.

Importance of Catheter Securement

Proper anchoring of urinary catheters is essential for several reasons:

• Reduces the risk of catheter-associated urinary tract infections (CAUTIs) by minimizing urethral movement and trauma 1
• Prevents mechanical trauma to the urethra and bladder neck that can occur with unsecured catheters 2
• Decreases the risk of accidental catheter dislodgement requiring reinsertion 2
• Helps prevent meatal pressure injuries, which are significantly reduced with proper securement (RR = 0.31,95% CI [0.15,0.58]) 1
• Reduces patient discomfort and improves mobility 3

Recommended Securement Methods

Dedicated Securement Devices

• Commercial catheter securement devices specifically designed for this purpose are the preferred method of anchoring 1
• These devices should secure the catheter to the patient's thigh (either inner or outer thigh depending on patient positioning) 1, 2
• Silicone adhesive-based securement devices cause less skin damage than acrylic adhesive devices, particularly in patients with edema 4

Key Features of Effective Securement Devices

• Should provide secure but adjustable attachment for various catheter types 5
• Must be skin-friendly and not create pressure points or constriction 5
• Should allow for inspection of the catheter insertion site 2
• Must accommodate patient movement while maintaining secure positioning 2

Improper Securement Methods to Avoid

• "Do-it-yourself" approaches using adhesive tape or Velcro strapping devices are inappropriate and should be avoided 2
• Avoid methods that create tension on the catheter or restrict patient movement 2
• Never secure a catheter in a way that causes upward traction on the bladder neck 2

Special Considerations

Patient-Specific Factors

• For patients with thigh edema, silicone adhesive devices are preferred over acrylic adhesive devices to prevent skin breakdown 4
• For mobile patients, ensure the securement device allows for comfortable movement while maintaining catheter position 2
• For patients with sensitive skin or at risk of skin breakdown, consider using barrier films under securement devices 1

Timing of Securement Assessment

• Catheter securement should be assessed at least once per shift 1
• Securement devices should be changed according to manufacturer recommendations or if soiled/compromised 2

Catheter Management Best Practices

While securing the catheter is important, other aspects of catheter management are equally critical:

• Urinary catheter use should be evaluated daily, and the catheter should be removed as early as possible 3
• Early removal of catheters encourages mobility, speeds recovery, reduces length of stay, and decreases CAUTI risk 3
• For patients requiring long-term catheterization, consider alternatives such as intermittent catheterization when appropriate 3
• For male patients who are appropriate candidates, external condom catheters may be an effective alternative with lower CAUTI risk 3

Implementation Recommendations

• Institutions should develop standardized protocols for catheter securement 1
• Healthcare staff should receive education on proper catheter securement techniques 2
• Regular assessment of securement should be incorporated into routine catheter care 1
• Consider using barrier film spray at the securement site to prevent medical adhesive-related skin injury (MARSI) 1

By following these evidence-based recommendations for urinary catheter securement, healthcare providers can significantly reduce complications and improve patient outcomes.