Use of Catheters in Nursing Homes

A urinary (foley) catheter is a thin, soft tube inserted in the bladder, and the tube is attached to a bag that collects urine. Catheters are used to assist residents to void if they cannot do so on their own, or if a medical condition warrants use. Catheters should be used only when medically necessary. Federal nursing home regulations mandate that catheters cannot be used for convenience and do not take the place of toileting residents.

What are some indications where a nursing home might want to place a Foley catheter?

• If the resident cannot pass urine due to an acute condition, such as recent surgery, or due to a neurological disease, such as a stroke.
• To heal deep pressure sores if bladder control is lacking and urine is likely to get into the wound bed and slow healing.
• Monitoring of fluid balance for patients who are acutely ill such as those with renal failure or congestive heart failure.
• For care of terminally ill or severely ill residents for whom bed and clothing changes are uncomfortable or disruptive.

What special monitoring should the nursing home do when a Foley catheter is placed?

• Monitor the condition of urine in the tubing. If it is dark and tea-colored, the resident is probably not receiving enough fluids. Cloudy urine may be a sign of dehydration or infection.
• Catheter care should be completed and documented every 8 hours. This includes cleaning between the legs around the site of catheter insertion. Good catheter care can help reduce dangerous complications of catheter use.
• Catheter bags should be changed monthly and dated (look for the date of the bag change).
• The Foley catheter tube should be changed as needed. Recent research shows that catheters do not need to be changed monthly as once thought to protect against infection, but if catheters are left in for months at a time, the increased chance of severe infection and damage to the urinary tract is high. Most nursing homes choose to change the catheter monthly to prevent the increased risk of infection.

What are the main complications of catheter use?

• Urinary tract infections
• Injuries from the insertion of the catheter into the bladder
• Physical injury (ex. trying to walk, getting the tubing caught, and falling)
• Bladder stones
• Blood in the urine

Questions you can ask the nursing home related to foley catheters:

• Under what conditions does the nursing home recommend insertion of a catheter?
• What does the facility do to prevent complications from using a catheter such as urinary tract infections?
• How does the facility restrict the use of catheters?
• How does the facility maintain and monitor the use of catheters?

Resources

National Quality Measures Clearinghouse