What are the Foley catheter care orders?

Foley Catheter Care Orders

Foley catheter care orders should include daily meatal cleansing with soap and water, maintenance of a closed drainage system, secure catheter fixation, daily assessment for continued need with prompt removal when no longer indicated, and avoidance of routine irrigation or prophylactic antimicrobials.

Essential Daily Care Components

Meatal Care

• Cleanse the urethral meatus daily using soap and water or perineal cleanser 1
• Perform meatal care as part of routine hygiene, not as a separate sterile procedure 1
• Do NOT apply antiseptic solutions or ointments to the meatus during routine care, as these do not reduce infection rates and may promote antimicrobial resistance 1

Closed Drainage System Maintenance

• Maintain a closed urinary drainage system at all times to prevent catheter-associated urinary tract infections (CAUTI) 1
• Keep the drainage bag below the level of the bladder to prevent reflux, but never place it on the floor 1
• Empty the drainage bag regularly using a separate, clean collection container for each patient 1
• Do NOT place antiseptic solutions in the drainage bag, as this does not reduce infection rates 1

Catheter Securement

• Secure the catheter to the patient's thigh or abdomen to prevent urethral trauma and reduce movement 1
• Use appropriate securement devices rather than tape alone when possible 1

Daily Assessment Requirements

Monitoring for Continued Need

• Assess daily whether the catheter is still medically necessary and remove promptly when indications no longer exist 1, 2
• Implement a reminder system or stop-order protocol, which reduces CAUTI rates by 53% 2
• Common appropriate indications include: acute urinary retention, accurate measurement of urine output in critically ill patients, perioperative use for specific surgeries, and comfort care in terminally ill patients 2

Inspection for Complications

• Inspect the catheter insertion site and drainage system daily for signs of infection, obstruction, or malfunction 3, 1
• Monitor for fever, suprapubic tenderness, cloudy or malodorous urine, or catheter bypassing 3

What NOT to Do (Critical Pitfalls)

Avoid Routine Interventions Without Evidence

• Do NOT perform routine bladder irrigation unless there is specific obstruction from blood clots or debris 1
• Do NOT change catheters on a routine schedule in short-term catheterization; change only when clinically indicated (malfunction, obstruction, or infection) 1
• For long-term catheterization (>30 days), routine changes every 4-6 weeks may reduce CAUTI incidence 1
• Do NOT administer prophylactic systemic or topical antimicrobials to prevent catheter colonization, as this promotes resistance without reducing symptomatic infections 2

Insertion Technique Standards

• Use aseptic (not necessarily sterile) technique for catheter insertion 1
• Use adequate lubrication and smallest appropriate catheter size 3
• Ensure proper balloon inflation only after urine return confirms bladder placement 3

Staff Education and Monitoring

Implementation Strategy

• Provide staff education about appropriate catheter indications, insertion technique, and maintenance combined with regular monitoring of CAUTI incidence 1
• Designate trained personnel for catheter insertion and maintenance 1
• Implement a facility-wide program ensuring catheterization only when indicated 1

Key Outcome Considerations

The primary goal of Foley catheter care orders is to reduce catheter-associated urinary tract infections, which remain one of the most common hospital-acquired infections and significantly increase morbidity, mortality, and healthcare costs 4. The most effective strategy is prompt catheter removal when no longer medically necessary, as duration of catheterization is the single greatest risk factor for CAUTI 2. When catheters must remain in place, meticulous attention to closed system maintenance and daily assessment provides the best protection against complications 1.