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Urinary Catheter Management

This is a corrected version of the article that appeared in print.

Kyle J. Fletke, MD
Dae Hyoun Jeong, MD
Alexander V. Herrera, MD, MS

American Family Physician. 2024;110(3):251-258.

Author disclosure: No relevant financial relationships.

This clinical content conforms to AAFP criteria for CME.

Family physicians often treat patients who require urinary management with the use of external urinary devices, clean intermittent catheterization, or indwelling urinary catheterization. External urinary devices are indicated for urinary incontinence (postvoid residual less than 300 mL), urine volume measurement for hospitalized patients, nonsterile urine diagnostic testing, improved comfort for patients in hospice or palliative care, and fall prevention for high-risk patients. Indwelling urinary catheterization is indicated for severe urinary retention or bladder outlet obstruction; wound healing in the sacrum, buttocks, or perineal area; prolonged immobilization; and as a palliative measure for patients who are terminally ill. Clean intermittent catheterization is an alternative to indwelling urinary catheterization for acute or chronic urinary retention (postvoid residual greater than 300 mL) without bladder outlet obstruction, sterile urine testing, postvoid residual volume assessment, and wound healing. Suprapubic catheter placement is considered when long-term catheterization is needed or urethral catheterization is not feasible. Urinary catheters should not be used solely for staff or caregiver convenience, incontinence-related dermatitis, urine culture procurement from a voiding patient, or initial incontinence management. Common complications of urinary catheter use include obstruction, bladder spasm, urine leakage, and skin breakdown of the sacrum, buttocks, or perineum. The risk of catheter-associated urinary tract infections increases with the duration of catheter use. Urologist referral is indicated for patients requiring urinary management who have recurrent urinary tract infections, acute infectious urinary retention, suspected urethral injury, or substantial urethral discomfort or if long-term catheterization is being considered.

Nearly 1 in 14 patients, mostly men 18 to 70 years of age in the community setting, has an indwelling urethral catheter at any point in time.1 In skilled nursing facilities, up to 36% of patients have indwelling catheters.2 The most common reasons for catheter use are spinal cord injuries and progressive multiple sclerosis.3 Common complications of urinary catheter use include urinary tract infection (UTI; 31% of patients), catheter blockage (24%), and accidental catheter dislodgement (12%).3 Family physicians often aid in initial catheter choice, provide routine care, and address complications for patients requiring urinary catheterization.4

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendation Evidence rating Comments
Urinary catheters should not be used for routine management of incontinence in community or institutional settings.2,19 C Consensus guidelines
The need for indwelling urinary catheters should be evaluated regularly, and they should be removed as soon as indicated.1,6,7,14 C Consensus guidelines
Hydrophilic-coated catheters should be used for intermittent catheterization in appropriate patients because they decrease urethral microtrauma and risk of urinary tract infections compared with nonhydrophilic catheters.28,29 A Systematic literature review with meta-analysis
Catheters that have been in place for more than 2 weeks should be replaced before obtaining a urine sample for suspected catheter-associated urinary tract infection or initiating antimicrobial therapy.5,14,51 B Randomized controlled trial and consensus guidelines

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

KYLE J. FLETKE, MD, is an assistant professor in the Department of Family and Community Medicine at the University of Maryland School of Medicine, Baltimore.

DAE HYOUN JEONG, MD, FAAFP, is an associate professor in the Department of Family and Community Medicine at the University of California, San Francisco.

ALEXANDER V. HERRERA, MD, MS, is a physician at the Oregon Health and Sciences University, Portland. At the time this article was written, he was an assistant professor in the Department of Family and Community Medicine at the University of Maryland School of Medicine.

Address correspondence to Kyle J. Fletke, MD, at kfletke@som.umaryland.edu.

Author disclosure: No relevant financial relationships.

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