A Quality Improvement Project to Reduce the Complications Associated With Indwelling Urinary Catheters

John M. Gotelli, MSN, NP; Priscilla Merryman, RN, MSN, MBA; Carlye Carr, MSN, NP; Linda McElveen, BSN, RN; Carla Epperson, RN, MBA; Debra Bynum, MD


Urol Nurs. 2008;28(6):465-467. 

In This Article

Abstract and Introduction


The indwelling urinary (Foley®) catheter is a widely utilized device in the modern hospital environment in the United States. Under certain established medical conditions, these devices serve as a valuable tool in patient care. However, many indwelling urinary catheters are either placed inappropriately or are left in place longer than their intended use. This article describes a quality improvement project undertaken at the University of North Carolina Healthcare, Memorial Hospital, 8 Bed Tower Nursing Unit that developed and implemented a nurse-driven protocol to manage some of the risks associated with the use of these devices. The hospital team involved in this project was able to decrease the overall prevalence of indwelling urinary catheters from 24% to 17%.


It has been estimated that between 16% and 25% of hospitalized patients in the United States receive an indwelling urinary (Foley®) catheter at some time during their hospital stay (Weinstein et al., 1999). One study found that 21% of those patients with an indwelling urinary catheter did not meet established criteria for its initial insertion and that almost 50% had the device left in place longer than necessary (Jain, Parada, David, & Smith, 1995).

There are many complications of indwelling urinary catheters. Bacteriuria can occur in about one half of the patients who have an indwelling urinary catheter for five days or more (Tambyah, Halvorson, & Maki, 1999). Although most cases of bacteriuria are asymptomatic and resolve spontaneously once the catheter is removed, Warren (1997) noted that as many as 30% of patients with catheter-associated bacteriuria will develop symptom-related urinary tract infections requiring treatment. Additionally, the most clinically important adverse outcome associated with bacteriuria is urinary tract-related bacteremia. Bacteremia, or sepsis, is a highly morbid and costly complication associated with hospitalization and can increase hospital length of stay (Saint & Lipsky, 1999). Use of the indwelling urinary catheter has been considered a "one point restraint;" akin to wrist restraints, the urinary catheter may act as a tether to the bed and is associated with impaired mobility, pain, and loss of dignity (Saint, Lipsky, & Goold, 2002).

Although various technologies have been employed to reduce the risks and associated complications of indwelling urinary catheters (such as bladder irrigation and antibiotic-coated catheters), experts agree that placement of these devices only in patients meeting established criteria as well as their early removal will prevent both bacteriuria and other unfavorable conditions associated with their use (Saint & Lipsky, 1999; Topal et al., 2005).


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