Nursing Practice and Evidence-based Indwelling Catheter Care

Hospital-associated infections from an indwelling urinary catheter (IUC) are a major cause of patient mortality and morbidity, and no longer reimbursable events for hospitals.  Evidence-based (EB) research notes these infections are one of the preventable patient safety issues in the acute care setting.  Nurses play a central role in catheter use since they are the primary health care professional who inserts and cares for them.  Objectives of this study were to identify registered nurses (RNs) knowledge of EB IUC care in the acute care setting.  The method was a prospective descriptive pilot study using an online anonymous survey to determine RN knowledge of IUC care.  The study was conducted in a large academic medical center in Eastern United States.  A total of 301 nurses (58% response rate) completed the survey, only 7.0% answered all EB questions correctly.  Differences in knowledge depended on the number of years the RN had practiced.   More inexperienced RNs would not independently make decisions about IUC removal (p=0.000) without a physician’s order. A higher percentage of experienced RN’s (p=0.040) did not know bladder volume necessitating IUC reinsertion.  This study demonstrated a significant gap in RN knowledge of EB recommendations of IUC indications and use.   At least 1 out of 5 nurses were unable to identify indications for an IUC.  Almost half (42.86%, N=129) of the RNs preferred an IUC in a patient with urinary incontinence, although this is not an EB indication.  It also highlighted the need for more intensive and on-going supportive education for RNs, particularly new RNs, as they appear to have difficulty in making independent clinical decisions about IUCs.  Also, the fact that RNs did not know or understand key components of EB IUC care, may have had an impact on the continual use of these devices.