What is the proper protocol for reporting urine output in a patient with an indwelling Foley (urinary) catheter, considering their age, sex, and underlying medical conditions?

Reporting Urine Output via Indwelling Foley Catheter

Urine output from an indwelling Foley catheter should be measured and documented hourly in critically ill patients or those requiring close monitoring, with measurements taken directly from the drainage bag using graduated markings, and totals reported at regular intervals (typically every 8-12 hours for stable patients). 1

Measurement Frequency and Documentation

Intensive Monitoring Protocol

• Hourly measurements are indicated for critically ill patients, those at risk for acute kidney injury, or requiring very close monitoring of urine output 1, 2
• Intensive monitoring (hourly recordings with no gaps >3 hours) is associated with improved detection of acute kidney injury and reduced 30-day mortality in patients experiencing AKI 2
• Patients with intensive monitoring also demonstrate less cumulative fluid volume and less fluid overload over the first 72 hours 2

Standard Monitoring Protocol

• For stable, non-critically ill patients, measure and document urine output every 4-6 hours minimum 1
• Total urine output should be calculated and reported at regular intervals, typically every 8-12 hours or per shift 1
• All measurements must be documented in the medical record with time, date, and volume 1

Measurement Technique

Direct Measurement from Drainage Bag

• Measure urine directly from the graduated markings on the drainage bag at eye level for accuracy 3
• Electronic continuous urine output monitoring devices show significantly better accuracy (8% deviation) compared to manual urinometers (26% deviation) when available 3
• Never obtain specimens from the drainage bag for culture purposes; use catheter port aspiration instead 1

Recording Requirements

• Document the exact volume in milliliters 1
• Record the time of measurement 1
• Note any abnormalities in urine appearance (color, clarity, presence of blood or sediment) 1
• Calculate hourly rates when indicated (total volume divided by hours since last measurement) 2

Clinical Thresholds and Alerts

Critical Values Requiring Immediate Reporting

• Urine output <0.5 mL/kg/hour for more than 6 hours suggests acute kidney injury and requires immediate physician notification 2
• Urine output <30 mL/hour (or <240 mL per 8-hour shift) in average-sized adults warrants clinical assessment 2
• Complete absence of urine output (anuria) requires urgent evaluation for catheter obstruction or renal failure 1

Post-Catheter Removal Monitoring

• After Foley removal, measure post-void residual (PVR) volume using bladder scanner or in-and-out catheterization 4
• PVR >100 mL indicates need for intervention 4
• Never allow bladder to fill beyond 500 mL to prevent detrusor muscle damage 4

Documentation Standards

Required Elements

• A physician's order must be present in the chart before catheter placement, with at least 95% compliance as a quality target 1
• Document the procedure including time and date of catheter insertion 1
• Confirm sterile technique was used during insertion 1
• Record appropriate indication for catheter placement (urinary retention/obstruction with need for close monitoring, patient unable to use urinal/bedpan, neurogenic bladder, emergent surgery, hospice/palliative care) 1

Ongoing Documentation

• Daily assessment of continued need for catheterization should be documented 1
• At least 90% of indwelling catheter-days should be for appropriate indications as a quality measure 1
• Any deviations from standard protocols should be documented with rationale 1

Important Caveats

Infection Prevention

• Indwelling catheters should be removed as soon as feasibly possible, as catheter-associated bacteriuria increases approximately 5% per day 1
• Daily catheter rounds should prompt evaluation for continued need or removal 1
• Do not perform routine urinalysis or urine cultures on asymptomatic catheterized patients 1
• Routine daily bacteriologic monitoring is not efficient for preventing symptomatic catheter-associated UTI 5

Special Populations

• In newborns with spina bifida, catheterization every 6 hours is performed initially to determine residual bladder volumes, with frequency adjusted based on volumes (<30 mL on majority of catheterizations for 3 consecutive days) 1
• In long-term care facilities with indwelling catheters, evaluation is indicated only if there is suspected urosepsis (fever >100.3°F, shaking chills, hypotension, delirium), especially with recent catheter obstruction or change 1

Alternatives to Consider

• Intermittent catheterization every 4-6 hours is preferred over indwelling catheter reinsertion for urinary retention 4
• External collection devices should be considered when appropriate to reduce infection risk 1