Issue link: https://blog.providence.org/i/1541294
Indwelling Urinary Catheter (IUC) Algorithm and Alternative Options (Adult) Name/Genesis # Anatomy Image Details Condom Catheters- Spirit: Small # 619955 Med# 619956 Large # 619958 ü Male • Available in small, medium, and large • Does not use suction • Do not use with any other alternative (e.g., Purewick male) Condom Catheters- Style 3: Small # 619998 Medium # 619999 ü Male • Available in small and medium • Does not use suction • Do not use with any other alternative (e.g., Purewick male) Surestep ep Male External Catheter: Kit with urine meter# 841087 Kit without urine meter# 841086 Blue Catheter Replacement# 841088 Green Catheter Replacement# 841089 Orange Catheter Replacement# 841090 Violet Catheter Replacement# 841091 ü Male • All inclusive kit with 3 sizes • Available with and without urine meter • Does not use suction Men's Liberty Acute External Catheters: With CathGrip Securement Device# 463599 Without CathGrip Securement Device # 679210 ü Male • Average wear time of up to 24 hours • 8 oz. urine collection pouch • Connects directly to a leg or bed bag for extended or overnight use • Does not use suction PureWick Male: # 1008774 ü Male • Average wear time of up to 24 hours or when soiled • Trim or clip the pubic area before placement to help securely adhere to skin • Use low continuous suction, 40mmHg • Contraindications include diarrhea, agitation, skin breakdown at the perineum, or recent surgery of external male anatomy • See local guidelines for additional contraindications Quick Change Wrap 10 pack # 762579 25 pack # 762580 ü Male • Product to manage incontinence, not considered a device • One-size-fits-all wrap collects urine before skin contact can be made • Can be used on bariatric patients, patients with scrotal edema or retracted anatomy Male Urinal #338907 ü Male • Product to manage urine, not considered a device • Collects up to 1000ml of urine Female Urinal # 1055017 ü Female • Product to manage urine, not considered a device • Collects up to 1000ml of urine PureWick Flex# 1085823 Latex Free# 704713 ü Female • Use low continuous suction, 40mmHg-60mmHg • Change device every 8-12 hrs and when soiled • Must be removed and skin inspected every 2 hours • Remove prior to therapy and transporting patient to procedure, test, or surgery • Contraindications include diarrhea, menses, agitation, skin breakdown at the perineum • See local guidelines for additional contraindications Versette # 1085434 ü Male ü Female • Use low continuous suction, 40mmHg-60mmHg • Optional: use mesh underwear to help keep device in place • Can be used on retracted male anatomy • Change device every 8-12 hrs and when soiled • Must be removed and skin inspected every 2 hours • Remove prior to therapy and transporting patient to procedure, test, or surgery • Contraindications include diarrhea, menses, agitation, skin breakdown at the perineum • See local guidelines for additional contraindications Bedpan Fracture # 232845 Bariatric # 388715 ü Male ü Female • Product to manage urine, not considered a device • Collects up to 1600ml of body fluids • Additional options available on contract • Accurate I/O for critically ill patients requiring hourly urine output measurement for clinical decisions (must document output every 1 hour, ICU only) • Continuous bladder irrigation • Epidural or spinal anesthesia within the first 24-48 hours • Order to maintain chronic long term urinary catheter • Prolonged immobilization (unstable spine & pelvic fractures pre-stabilization, prone patients) • Specific surgical procedures - Surgery on contiguous structures of the genitourinary tract • Stage III or IV pressure injury complicated by incontinence and alternative urinary devices* have failed • Urinary obstruction • End of life — death expected within 48 hours Ensure Accurate Record of Intake and Output • Accuracy is important whenever I/O is ordered • Catheterization is only appropriate when clinical decisions are informed by hourly output • Use alternative urinary devices* if urine output is needed, when appropriate For Patients With Skin Breakdown Decreased Mobility For Patients With Acute Urinary Retention • Voiding trial • Scheduled toileting • Regular ultrasound bladder scans • Scheduled straight catheterization • Consult pharmacy and provider about discontinuing medications that cause retention • Consult provider about medications that can treat retention Assess patient to validate and verify appropriate clinical indication for catheter** Order for/or Indwelling Urinary Catheter present Appropriate Clinical Indication* for IUC Present • Place indwelling urinary catheter per order • Assess for valid catheter indication at least daily • Advocate for use of alternative urinary devices* • Remove catheter as soon as possible (Utilize Nurse Driven Removal Protocol) When There is No Appropriate Clinical indication for Indwelling Urinary Catheter If catheter is present, utilize the Nurse Driven Removal Protocol) to remove catheter. If an exception to the protocol exists, contact provider. For Patients at End of Life • If death is not imminent (within 48 hours) assess end of life goals • Utilize alternative urinary devices* as needed to manage incontinence • Utilize alternative urinary devices* as needed to manage incontinence • Consult Physical Therapy **PSJH CAUTI Prevention policy Appropriate Clinical Indications for Indwelling Urinary Catheter ** If catheter is ordered but not yet placed, question the order. Discuss alternative urinary devices* with provider Refer to the urinary retention pathway for best practices, including: • Utilize alternative urinary devices* as needed to protect injured skin and dressings • Provide skin hygiene and ooad pressure per standard of care • Consult Wound Care nurse YES NO *See alternative urinary devices on page 2-3 Provider Education Training Manual 10 |