Supporting safe and high-quality management of indwelling urinary catheters

High-quality and safe urinary catheter care is vital to protect the health and wellbeing of older people. It helps prevent serious health complications such as urine blockages and infections.

The Commission receives many complaints about catheter care. Under the Aged Care Quality Standards (Quality Standards), providers must have a strong clinical governance system that supports the health of the people they care for.

This includes having guidelines, processes, education and clinical monitoring for managing indwelling catheters (IDCs).

When we use IDCs

An IDC is a flexible, hollow tube that is inserted into the bladder through the urethra to empty urine from the bladder.

We use IDCs in specific situations, including when someone has:

urinary retention or obstruction (blockage)
an injury, or has had surgery, that affects their urinary function
urinary incontinence with wound care or end-of-life care.

IDCs increase the risk of urinary tract infection

An IDC can cause infection because of:

the way it’s inserted
how long it’s used
the quality of catheter care
the person’s susceptibility to infection.

Most catheter-associated urinary tract infections (CAUTIs) enter the body by the urinary tract, through:

non-sterile techniques when managing or inserting the catheter
reflux or backflow of bacteria from a contaminated urine drainage bag.

CAUTIs can lead to hospitalisation, sepsis, delirium and death.

Case study

An older person living with dementia went to hospital after having repeated falls at home. They were in a state of general decline.

While in hospital, they developed urinary retention and couldn’t empty their bladder. An IDC was inserted before the older person was moved to transition care in a residential care home.

After a week in transition care, the older person started to look unwell. They had rigors and a high temperature, and the residential care home transferred them back to hospital.

The hospital doctors found that the older person’s IDC was kinked and blocked with pus. Urine was leaking around the catheter. They diagnosed the older person with sepsis caused by a CAUTI. Unfortunately, the older person died soon after.

This case study presents a situation in which better clinical supervision at the home could have prevented the older person’s death.

Providing the best IDC care

Guidelines and practice

Guidelines for managing IDCs in older people should focus on:

preventing infection
managing the drainage system
keeping the person comfortable
regularly reviewing the person to reduce the risk of complications.

Key practices include:

making sure the person is well hydrated (getting enough fluids through their food and drinks)
keeping the drainage system closed
keeping the drainage bag below bladder level
doing regular genital hygiene checks
making sure IDC care is aseptic (sterile)
securing the IDC to prevent trauma where it enters the body
regularly monitoring for signs of blockage, infection or other complications
regularly reviewing if the person still needs the IDC
scheduling regular IDC changes.

Quality Standards and clinical care

In line with the Quality Standards, we expect providers (including those in the Transition Care Program) to:

ensure adequate numbers of suitably qualified and competent aged care workers
educate all clinical and personal care staff on managing IDCs safely and effectively
use the latest, evidence-based clinical guidelines to develop IDC policies and procedures.

Supporting all staff to safely manage and monitor IDCs

Registered nurses (RNs) are responsible for managing IDCs. However, they often ask enrolled nurses or personal care workers to monitor urinary catheter function and safety.

Providers need clinical governance systems and processes that support RNs to supervise enrolled nurses or personal care workers.

Arranging an external health practitioner

Sometimes providers need to arrange for an external health practitioner to insert or replace an IDC.

For example, in residential care homes, RNs commonly remove, insert and replace urinary catheters for female residents. However, they don’t always do this for male residents as the procedure can be more complicated.

To remove, replace or insert an IDC for a male resident, residential care homes may need to take the person to hospital or get help from a:

GP
‘hospital in the home’ service
trained paramedic.

Providers need to set up systems and processes so they can quickly get help from an external health practitioner if they need to.

Continuous quality improvement

If an incident happens with an IDC because a provider doesn’t meet their duty of care, we expect them to make sure they don’t make the same mistake again.

You should review what happened and why and take action to stop it from happening again. For example, you could:

review everyone who has an IDC
tell staff to do regular observations and clearly document the person’s urinary output
provide extra training for staff on documenting care in personal care charts
provide refresher training in IDC care, including monitoring and escalating concerns or complications
review hospital findings and incident details with the Transition Care Program coordinator ensuring that there were adequate processes for handover of care from the hospital to transition care
review people’s transition care assessments and develop thorough care plans and directives for each person moving into transition care.

This is an opportunity to look at the latest evidence-based management of IDCs and improve your care.