Indwelling Bladder Catheters

Indwelling bladder catheters (IBC) are medical devices used to drain urine from the bladder. An IBC should only be placed when medically necessary and for the shortest amount of time possible. Specific situations that may require the use of an IBC include:

• Acute urinary retention or bladder outlet obstruction.
• Timed urine collection for a diagnostic study.
• Acute medical conditions requiring accurate measurements of urine output.
• Stage 3 or 4 pressure injuries that will not heal due to urinary incontinence.
• Comfort care at end of life as part of a palliative plan of care.

Long-term use of an IBC can lead to significant complications, including catheter-associated urinary tract infections (CAUTI), trauma to the urethra, urethral fistula and bladder stones. IBCs can also cause pain and discomfort, often related to bladder spasms.

A nursing facility (NF) should have a process in place to evaluate IBC use and discontinue catheters when they are no longer medically necessary. The NF’s infection prevention and control plan should also address monitoring and surveillance for CAUTIs in people with IBCs.

Resource Created by HHSC

• Evidence-Based Best Practices: Indwelling Bladder Catheters (PDF) provides evidence-based recommendations for the appropriate use and care of indwelling bladder catheters.

Resources from Other Organizations

Agency for Healthcare Research and Quality

• Toolkit to Reduce CAUTI and Other HAIs in Long-Term Care Facilities provides resources for reducing CAUTI in nursing facilities.

Centers for Disease Control and Prevention

• Guideline for Prevention of Catheter-Associated Urinary Tract Infections outlines the CDC’s recommendations for preventing CAUTI, including a discussion of when long-term urinary catheterization may be clinically appropriate.
• Indwelling Urinary Catheter Insertion and Maintenance (PDF) provides information on the aseptic insertion of IBCs and strategies for catheter maintenance.
• Appropriate Use and Prompt Removal of Indwelling Urinary Catheters (PDF) discusses appropriate indications for use of an IBC as well as strategies for ensuring removal when the IBC is no longer necessary,
• Consideration for Use of Enhanced Barrier Precautions in Skilled Nursing Facilities (PDF) provides an overview of recommendations for preventing the spread of multi-drug resistant organisms in nursing facilities, including enhanced precautions for people with indwelling medical devices such as IBCs.
• Targeted Assessment for Prevention (TAP) CAUTI Implementation Guide (PDF) is a framework for quality improvement, encouraging the use of data to drive a facility’s efforts to prevent CAUTI.

The Society for Post-Acute and Long-Term Care Medicine (AMDA)

• Choosing Wisely: Fifteen Things Physicians and Patients Should Question in Post-Acute and Long-Term Care can be used to help guide discussions about specific tests and treatments to determine which are necessary and which are not, including placement of an IBC.