Foley Catheter Placement in DNR Patients with Consent
Yes, you can and should place a Foley catheter in a DNR patient who has given consent—DNR orders specifically address cardiopulmonary resuscitation and do not restrict other medical treatments or routine care procedures. 1
Understanding DNR Orders
A DNR order is not a blanket refusal of medical care. DNR (Do Not Resuscitate) or DNAR (Do Not Attempt Resuscitation) orders are narrowly focused directives that specifically address whether to perform CPR and advanced cardiac life support if the heart or breathing stops. 1
DNR orders do not affect treatments other than CPR and intubation for cardiac arrest. They do not preclude access to any appropriate treatment including surgery, antibiotics, supportive care, or palliative interventions. 1
The presence of a DNR order does not remove a patient's right to reasonable and proper care, including all other forms of treatment that are appropriate in the circumstances. 1
Foley Catheter as Routine Medical Care
Foley catheter insertion is a standard medical procedure, not a resuscitative measure. When a patient with capacity consents to catheterization, this represents informed consent for a specific intervention that falls entirely outside the scope of DNR restrictions. 1
Appropriate Indications for Catheterization
Place the Foley catheter if clinically indicated for:
- Accurate urine output monitoring in critically ill patients requiring hemodynamic assessment 2
- Prolonged immobilization or inability to void 2
- Urinary retention requiring bladder decompression 1, 2
- Post-operative bladder drainage 3
- Facilitation of fluid management and prevention of skin breakdown 1
Important Management Principles
Remove the catheter within 24-48 hours whenever possible to minimize the risk of catheter-associated urinary tract infection (CAUTI), which increases dramatically with duration of catheterization. 1, 2, 3
Consider intermittent catheterization over indwelling catheters when feasible, as it reduces infection risk while providing adequate drainage. 2
Use silver alloy-coated catheters if prolonged catheterization is necessary, as they reduce infection risk. 1, 3
Standard adult sizing is 14-16 Fr, with 16 Fr being most commonly used for routine catheterization. 3
Common Pitfalls to Avoid
Do not assume DNR means "do not treat." This is a fundamental misunderstanding that can lead to inappropriate withholding of beneficial care. DNR patients should receive all medically indicated treatments consistent with their goals of care, excluding only CPR for cardiac arrest. 1
Do not confuse DNR orders with advance decisions to refuse specific treatments. If a patient has an advance decision specifically refusing catheterization (which would be unusual), that would need to be honored separately from the DNR order. 1
Avoid routine prophylactic antibiotics with catheter placement unless specifically indicated, as this promotes multidrug-resistant organisms without clinical benefit. 3