Indwelling Catheter Management: From Habit-based to Evidence-based Practice

JoAnn Mercer Smith, BSN, RN, CWOCN

A disadvantage of silicone catheters is the permeability of the balloons, resulting in loss of fluid over time18; silicone balloons should be checked regularly, adding fluid as needed. Another disadvantage of silicone catheters is the tendency of the balloons to form creases or cuffs when deflated, which can lead to painful and difficult removal.10,13 Finally, patients may complain that silicone catheters are firmer and cause more discomfort than softer latex catheters.

     Silicone-elastomer. Silicone-elastomer coated catheters are sometimes confused with 100% silicone catheters; these catheters are actually latex catheters coated inside and out with silicone. The difference between silicone-coated and 100% silicone catheters is worth noting for two reasons: 1) patients who are latex-sensitive should be managed with all-silicone catheters, not silicone-coated catheters, and 2) patients who are not latex-sensitive may prefer silicone-coated catheters to all-silicone catheters because these catheters combine the strength and flexibility of latex with the durability and reduced encrustation typical of all-silicone catheters.

     Hydrogel coating. Hydrogel-coated catheters (eg, Lubricath®, C.R.Bard, Inc. Covington., Ga.) are soft and highly biocompatible. Because they are hydrophilic, they absorb fluid to form a soft cushion around the catheter; thus, reducing friction and urethral irritations.

     Antimicrobial coatings. The newest technology involves the use of antimicrobial coatings designed to reduce bacterial attachment, colonization, and migration with the goal of preventing catheter-associated urinary tract infection (CAUTI) and nosocomial urinary tract infections (NUTI). One type of coating combines a thin layer of silver alloy with hydrogel (Bardex® IC, C.R. Bard, Inc. Covington, Ga.). Multiple studies have shown this coating to be effective in reducing CAUTI without causing bacterial resistance.3,19 A randomized double blind study of 850 catheterized patients demonstrated that use of these catheters for up to 20 days provided a 30% reduction in CAUTI.3 Numerous randomized studies support the effectiveness of these catheters against NUTI3,19; as yet, these catheters have not been studied in patients with long-term indwelling catheters to determine efficacy and cost effectiveness. Silver-hydrogel coated catheters are available in latex and silicone.

     A catheter coated with nitrofurazone is also available. Studies have shown that this catheter (Release-NF, Rochester Medical, Stewartville, MN) can reduce UTI rates for up to 7 days; however, they failed to provide a significant reduction in infections caused by organisms resistant to nitrofurazone, and clinicians are concerned that this coating could lead to selective antimicrobial resistance.3

Catheter Size

     The prevailing guideline for catheter size is to use the smallest diameter that will provide good drainage, typically a 14 to 18 French unless the patient has blood clots or sediment that occlude the lumen. Larger catheters are uncomfortable for the patient, can lead to urethral erosion, and impair paraurethral gland function. The paraurethral glands produce mucous that protects against ascending bacteria; compression of these glands can result in urethritis or ascending infection.20 Nurses commonly ask about management of a patient who already has a large catheter (>18 French) in place. In this case, the catheter should be downsized with each catheter change until the catheter is in an acceptable size range.

Straight-tipped versus Coude-tipped Catheters

     For routine catheterization, a straight-tipped catheter should be used. Coude-tipped catheters have a firm, curved tip designed to negotiate the male prostatic curve and may be helpful for difficult insertions.


1. Dobson C, Naidu S, Johnson M. Nurses’ perceptions of urinary catheter selection and management. Urology Nursing. 1996;16:140–144.
2. Evans E. Indwelling catheter care: dispelling the misconceptions. Geriatric Nursing. 1999;20(2):85–89.
3. Maki DG, Tambyah PA. Engineering out the risk of infection with urinary catheters. Emerg Infect Dis. 2001;7(2)342–347.
4. Wilde M. Meanings and practical knowledge of people with long-term urinary catheters. Journal of Wound Ostomy Continence Nursing. 2003;30(1):33–39.
5. Saint S, Veenstra DL, Sullivan SD, et al. The potential clinical and economic benefits of silver alloy urinary catheters in preventing urinary tract infection. Arch Intern Med. 2000;160(17):2670–2675.
6. Cravens DD, Zweig S. Urinary catheter management. Am Fam Physician. 2000;61(2):369–376.
7. Fanti JA, Newman DK, Colling J, et al. Clinical Practice Guidelines, No. 2, 1996 Update: Urinary Incontinence in Adults. Acute and Chronic Management. Rockville, Md. US Department of Health and Human Services. Public Services Agency for Health Care Policy and Research; March 1996. AHCPR Publication No.96-0682.
8. Wong ES, Hooten TM. Guideline for prevention of catheter-associated urinary tract infection. Center for Disease Control and Prevention. 1981;Feb. [serial online]. Available at: Accessed September 8, 2003.
9. Addison R, Mould C. Risk assessment in suprapubic catheterization. Nursing Standard. 2002;14(36):43–46.
10. Robinson J. Deflation of a foley catheter balloon. Nursing Standard. 2003;17(27):33–38.
11. Mitsui T, Minami K, Furuno T, et al. Is suprapubic cystostomy an optimal urinary management in high quadriplegics? A comparative study of suprapubic cystostomy and clean intermittent catheterization. Eur Urol. 2000; 38(4):434–438.
12. Nomura S. Ishido T, Teranishi J, Makiyama K. Long-term analysis of supra-pubic cyctostomy drainage in patients with neurogenic bladders. Urologia Internationalis. 2000;65(4):185–189.
13. Parkin J, Scanlan J, Woolley M, et al. Urinary catheter “deflation cuff” formation: clinical audit and quantitative in vitro analysis. British Journal of Urology. 2002;90(7):666–671.
14. Liss GM, Sussman GL. Latex sensitization: occupational versus general prevalence rates. Am J Ind Med. 1999;35(2):196–200.
15. Vila L, Sanchez G, Ano M, et al. Risk factors for latex sensitization among health care workers. J Investig Allergol Clin Immunol. 1999;9(6):356–360.
16. Department of Health and Human Services. FDA. Federal Register: Natural Rubber-Containing Medical Devices; User Labeling, Federal Register 1997;62(189):51021–51030.
17. Tullock AGS. Ferguson AF. Catheter-induced urethritis: a comparison between latex and silicone catheters in a prospective clinical trial. British Journal of Urology. 1985;57(3):325–328.
18. Studder UE, Bishop MC, Zingg EJ. How to fill silicone catheter balloons. Urology. 1983;22(3):300–302.
19. Salgado CD, Karchmer TB, Farr BM. Prevention of catheter-associated urinary tract infections. In: Wenzel RP, ed. Prevention and Control of Nosocomial Infections, 4th ed. Philadelphia, Pa.: Lippincott Williams & Wilkins; 2003;297–311.
20. Robinson J. Urethral catheter selection. Nursing Standard. 2001;15(25):39–42.
21. Newman DK. Managing indwelling urethral catheters. Ostomy/Wound Management. 1998;44(12):26–35.
22. Chinnes L, Dillion A, Fauerbach L. Home Care Handbook of Infection Control 2002. Washington, DC: Association of Professionals in Infection Control and Epidemiology (APIC);2002.
23. Gerard L, Sueppel C. Lubrication technique for male catheterization. Urology Nursing. 1997;17(4):156–158.
24. Cancio LC, Sabanegh ES JR, Thompson IM. Managing the foley catheter. Am Fam Physician. 1993;48(5):829–836.
25. Wilde M. Long-term indwelling urinary catheter care:conceptualizing the research base. J Adv Nurs. 1997;25(6):1252–1261.
26. Hanchett M. Techniques for stabilizing urinary catheters. Am J Nurs. 2002;102(3):44–48.
27. Getliffe K. Managing recurrent urinary catheter blockage: problems, promises and practicalities. Wound Ostomy Continence. 2003;30(3):146–151.
28. Dille C, Kirchhoff K. Increasing the wearing time of vinyl urinary drainage bags with bleach. Rehabilitation Nursing. 1993;18(5):292–295.
29. Rutala WA, Barbee SL, Aquiar NC, et al. Antimicrobial activity of home disinfectants and natural products against potential human pathogens. Infect Control Hosp Epidemiol. 2000;21(1):33–38.
30. Daifuku R. Stann WE. Association of rectal urethral colonization with urinary tract infection in patients with indwelling catheters. JAMA. 1984;252(15)2028–20230.
31. Warren JW. Catheter-associated urinary tract infections. Int J Antimicrob Agents. 2001;17(4):299–303.
32. Maki DG, Knasinski V, Halvorson K, Tambyah PA. Risk factors for catheter-associated urinary tract infection: a prospective study showing the minimal effect of catheter care violations on the risk of CAUTI (abstract). Infect Control Hosp Epidemiol. 2000;21:165.
33. Stickler DJ. Bacterial biofilms and encrustations of urethral catheters. Biofouling. 1996;94:293–305.
34. Donlan RM. Biofilms and device-associated infections. Emerg Infect Dis CDC. 2001;(7)2:277–281.
35. Kunin CM, Chin QF, Chambers S. Formation of encrustations on indwelling urinary catheters in the elderly: a comparison of different types of catheter materials in “blocker” and “nonblocker”. J Urol. 1987;138(4):899–902.
36. Tambyah PA, Maki DG. Catheter-associated urinary tract infection is rarely symptomatic; a prospective study of 1,497 catheterized patients. Arch Intern Med. 2000;160(5):678–682.
37. Gammack JK. Use and management of chronic urinary catheters in long-term care: much controversy, little consensus. Journal of the American Medical Directors Association. 2002;3(3):162–168.
38. McGeer A, Campbell B, Emori TG, et al. Definitions of infection for surveillance in long-term care facilities. Am J Infect Control. 1991;19(1):1–7.
39. Switters DM. Assessing leakage from around the urethral catheter. Urological Nursing. 1989;9(3):8–10.
40. Bhatia NN, Bergman A. Cystometry: unstable bladder and urinary tract infection. Brit J Urol. 1986;58(2):134–137.
41. Ziemann LK, Lastauskas NM, Ambrosini G. Incidence of leakage from indwelling urinary catheters in home-bound patient. Home Healthcare Nurse. 1984;2(5):22–26.
42. Stickler DJ. Hewitt P. Activity of antiseptics against biofilms of mixed bacterial species growing on silicone surfaces. Eur J Clin Microbiol Infect Dis. 1991;10:416–421.
43. Morris NS, Stickler DJ. Does drinking cranberry juice produce urine inhibitory to the development of crystalline, catheter-blocking Proteus mirabilis biofilms? BJU Int. 2001;88(3):192–197.

Anonymoussays: January 10.2010 at 23:59 pm

Hi there, thanks for this wonderful article. have gotten quite a bit of insight on evidence-based practice on the care of IDC.

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Anonymoussays: October 2.2009 at 19:47 pm

Excellent article. I work in a facility where they are filling 30 ml balloons with 10 ml and wondering constantly why they are leaking . Foleys are being changed on a continual basis because of lack of knowledge. All we have is 14 & 16 fr 30- ml . Of course orders are always for 14 , 16 10 ml. And the story goes on and on . i printed this article and I am going to leave in the DON's desk. Directions are right on the foleys by the way , " fill 30 ml only with 30 ml " Yet they still fill the balloons with 10 ml , and the foleys fall out. I left a note to order 14 and 16 fr 5 ml . Hopefully this article will do some good

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