Evidence-Based Practice in the Care of the Indwelling Catheter Patient in the Home Care Setting

Clinical Problem: Our Home Care Agency wanted to implement Evidence-Based Practice for Indwelling Foley Catheter Care. After an in-depth search of literature, we found we needed to make some significant changes in our practice. 

Description of Past Management: While our Agency procedure reflected much of the evidence base for caring for patients with indwelling Foleys, we found considerable variation in the practice among our clinicians. All sizes of indwelling catheters and balloons were used. Foleys were irrigated when occluded. Foleys were changed automatically on a monthly basis without assessment of the need to change. Drainage bags were disconnected to apply a leg bag during the day and reconnected at night. Urine samples were taken by disconnecting the catheter to allow urine to drain into a sterile cup. 

Current Clinical Approach: We implemented Evidence-Based Practice for all indwelling catheter patients. This includes identifying patients who are appropriate for indwelling catheters. Every patient needing a catheter based on this criteria will have it inserted with the overnight drainage bag already attached. The system will remain closed until the next catheter change. If the patient wants to use a leg bag, then leg bag will remain in place for the duration of the catheter and the overnight drainage bag will be attached to the leg bag to drain at night. This ensures a closed system. All urine samples will be taken from the catheter port, using a sterile syringe and transferred to a sterile urine cup.  

All staff went through Clinical Competency Class. Our product formulary was updated to reflect the changes made to our practice. Staff can only order products that allow for Best Practice Indwelling Catheter Care. 

Conclusion: We as an agency have moved towards Evidence-Based Indwelling Catheter Care. This ensures our patients the highest standard of care. They will be at less risk from complications related to indwelling catheters, given this approach.