II. summary of recommendations
I. Appropriate Urinary Catheter Use
A. Insert catheters only for appropriate indications (see
Table 2 for guidance), and leave in place only as long as
needed. (Category IB) (Key Questions 1B and 2C)
1. Minimize urinary catheter use and duration of use
in all patients, particularly those at higher risk for CAUTI
or mortality from catheterization such as women, the
elderly, and patients with impaired immunity. (Category
IB) (Key Questions 1B and 1C)
2. Avoid use of urinary catheters in patients and nursing
home residents for management of incontinence.
(Category IB) (Key Question 1A)
a. Further research is needed on periodic (eg,
nighttime) use of external catheters (eg, condom catheters)
in incontinent patients or residents and the use
of catheters to prevent skin breakdown. (No recommendation/
unresolved issue) (Key Question 1A)
3. Use urinary catheters in operative patients only as
necessary, rather than routinely. (Category IB) (Key
Question 1A)
4. For operative patients who have an indication for
an indwelling catheter, remove the catheter as soon as
possible postoperatively, preferably within 24 hours, unless
there are appropriate indications for continued use.
(Category IB) (Key Questions 2A and 2C)
B. Consider using alternatives to indwelling urethral
catheterization in selected patients when appropriate.
1. Consider using external catheters as an alternative
to indwelling urethral catheters in cooperative male patients
without urinary retention or bladder outlet obstruction.
(Category II) (Key Question 2A)
2. Consider alternatives to chronic indwelling catheters,
such as intermittent catheterization, in spinal cord
injury patients. (Category II) (Key Question 1A)
3. Intermittent catheterization is preferable to indwelling
urethral or suprapubic catheters in patients
with bladder emptying dysfunction. (Category II) (Key
Question 2A)
4. Consider intermittent catheterization in children
with myelomeningocele and neurogenic bladder to reduce
the risk of urinary tract deterioration. (Category
II) (Key Question 1A)
5. Further research is needed on the benefit of using
a urethral stent as an alternative to an indwelling catheter
in selected patients with bladder outlet obstruction. (No
recommendation/unresolved issue) (Key Question 1A)
6. Further research is needed on the risks and benefits
of suprapubic catheters as an alternative to indwelling
urethral catheters in selected patients requiring shortor
long-term catheterization, particularly with respect to
complications related to catheter insertion or the catheter
site. (No recommendation/unresolved issue) (Key
Question 2A)
II. Proper Techniques for Urinary Catheter Insertion
A. Perform hand hygiene immediately before and after
insertion or any manipulation of the catheter device or
site. (Category IB) (Key Question 2D)
B. Ensure that only properly trained persons (eg, hospital
personnel, family members, or patients themselves)
who know the correct technique of aseptic catheter insertion
and maintenance are given this responsibility. (Category
IB) (Key Question 1B)
C. In the acute care hospital setting, insert urinary catheters
using aseptic technique and sterile equipment. (Category
IB)
1. Use sterile gloves, drape, sponges, an appropriate
antiseptic or sterile solution for periurethral cleaning,
and a single-use packet of lubricant jelly for insertion.
(Category IB)
2. Routine use of antiseptic lubricants is not necessary.
(Category II) (Key Question 2C)
3. Further research is needed on the use of antiseptic
solutions versus sterile water or saline for periurethral
cleaning prior to catheter insertion. (No recommendation/
unresolved issue) (Key Question 2C)
D. In the nonacute care setting, clean (ie, nonsterile)
technique for intermittent catheterization is an acceptable
and more practical alternative to sterile technique for patients
requiring chronic intermittent catheterization. (Category
IA) (Key Question 2A)
1. Further research is needed on optimal cleaning and
storage methods for catheters used for clean intermittent
catheterization. (No recommendation/unresolved issue)
(Key Question 2C)
E. Properly secure indwelling catheters after insertion
to prevent movement and urethral traction. (Category IB)
F. Unless otherwise clinically indicated, consider using
the smallest bore catheter possible, consistent with good
drainage, to minimize bladder neck and urethral trauma.
(Category II)
G. If intermittent catheterization is used, perform it at
regular intervals to prevent bladder overdistension. (Category
IB) (Key Question 2A)
H. Consider using a portable ultrasound device to assess
urine volume in patients undergoing intermittent catheterization
to assess urine volume and reduce unnecessary
catheter insertions. (Category II) (Key Question 2C)
1. If ultrasound bladder scanners are used, ensure that
indications for use are clearly stated, nursing staff are
trained in their use, and equipment is adequately cleaned
and disinfected in between patients. (Category IB)