CAUTI Bundle
BID and PRN
What should a nurse trial with the patient prior to inserting an IUC?
External urinary device (i.e., condom catheter, purewick)
What is the first step in the acute retention BMA if you suspect urinary retention?
Bladder scan patient
Who should be present and documented at the time of IUC insertion?
Your Insertion Buddy
How often should urinals/graduated cylinder be dated and exchanged?
q24h
What are two acceptable reasons for a red tamper seal to be missing from an IUC?
1. Continuous bladder irrigation
2. Coude catheter
3. Medication irrigation/instillation
Can you collect a urine culture from an IUC that has been in place for less than 7 days?
Yes if the catheter is newly inserted or has been in less than 7 days.
How many mL does your patient need to have on their bladder scan in order to obtain an order to perform a straight cath?
350mL
How often should purewicks be changed?
q12h and PRN
Does a nurse need an order to remove an IUC?
No, not as long as there is not an active order to "do not remove" the order.
Nurses can remove IUCs following the standard removal protocol.
How often should the securement device/stat lock be dated and changed?
q 7 days and PRN
When is it appropriate to culture urine for a patient with a urinary catheter?
If the patient reports signs/symptoms of infection:
a. flank pain
b. suprapubic/pelvic pain
c. pain with urination
d. increased urgency/frequency of urination
e. prior to a urologic surgery
f. pregnancy
How many straight caths should be performed per the BMA for retention prior to inserting an IUC?
2 straight caths
What is the protocol for culturing urine from IUC?
If the IUC has been in >7 days or high suspicion of infection, remove the IUC, insert a new IUC and draw the culture from the new IUC.
What should NOT be placed on the same side of the bed as the IUC drainage bag?
Fecal Management System (FMS)
List all six components of the CAUTI Bundle:
1. Active Order
2. Stat lock/Securement device (placed on top of the thigh and dated)
3. Red Tamper Seal intact
4. Bag below bladder/unobstructed flow (No dependent loops present)
5. Catheter Care BID/PRN
When do you culture urine for a patient with an IUC when they are not able to report signs/symptoms of UTI?
Only if patient has fever AND concern for urinary obstruction, recent GU procedure, or septic shock.
If, during your first or second straight cath, how many mL of urine output permits you to skip to place an IUC?
1000mL of urine or difficult insertion of straight cath
(If the patient has less than 350mL utilize the 3 day acute retention portion of the BMA)
(If the patient has greater than 1000mL utilize the 7 day acute retention portion of the BMA)
How often should a condom catheter be exchanged?
q24h and PRN
Per BMA protocol, how often should the nurse bladder scan a patient for suspected urinary retention?
q6h or as ordered by the provider
Name at least 5 different clinical indications for an indwelling urinary catheter?
1. Acute Retention
2. Chronic/Long-term IUC
3. Comfort Care/Hospice
4. Hourly Urine Output
5. Stage III or IV Pressure Injury w/incontinence (Consult WOCN for recommendation)
6. Post-surgery Removal Protocol/Order
7. Difficult Catheterization requiring Urology Insertion
8. Continuous Bladder/Medication Irrigation
9. Total Immobilization
If the WBCs are greater than _____ on a urine analysis, then the reflex urine culture will be ran and processed?
greater than 20
What three interventions should be ordered/initiated as part of the plan for acute retention?
1. Discuss with provider ordering alpha-blockers (i.e., Flomax).
2. Discuss with the provider to wean narcotics. anticholinergics, or other causative agents.
3. Discuss with the provider to add bowel regimen medications for patients that have not had a bowel movement for 3 days or more.
How often should a chronic/long-term IUC be exchanged?
Every 30 days
What are two available resources that nurses can use or suggest for patients with IUC to decrease the risk of getting a CAUTI?
Fecal Management System (FMS) or external rectal pouch