Placement and maintenance of indwelling urethral catheters5
For all site cleansing, wear examination gloves and use sterile gauze sponges to cleanse, alternating between an appropriate dilute skin antiseptic (e.g., chlorhexidine scrub diluted with sterile saline to 0.5–2% chlorhexidine, 1:200 povidone iodine/sterile saline) and sterile saline.
- Clip hair on prepuce and surrounding ventral abdomen. Shorten nearby long hair.
- Cleanse the area, using at least three scrubs with each solution.
- Flush the prepuce three to five times with 2–12 mL of dilute skin antiseptic (volume depends on size of dog) using a sterile syringe.
- Assistant wearing clean examination gloves should exteriorize the penis. Cleanse of any gross exudates, then cleanse the entire area, using at least three wipes with each solution. Flush with 2–5 mL dilute skin antiseptic.
- Cleanse vulva and perivulvar area, using at least three scrubs with each solution.
- Flush the vaginal vault three to five times with 0.5–12 mL dilute skin antiseptic (volume depends on size of animal) using a sterile syringe.
- Place a sterile fenestrated drape over the work area.
- Perform hand hygiene and put on sterile gloves.
- Test the bulbs of Foley catheters before placement.
- Coat the distal catheter with sterile lubricating jelly from a single-use packet and place the catheter using sterile technique.
- Immediately connect a sterile closed collection system.
- Anchor the catheter to prevent displacement and place an Elizabethan collar on the animal.
Daily maintenance of indwelling catheters
Perform hand hygiene and put on sterile gloves. Clean at the junction of the patient and the external portion of the catheter every 24 hr with sterile gauze sponges, alternating between dilute skin antiseptic solution and sterile saline (greater than or equal to three scrubs with each solution).
Managing the closed collection system
- Do not administer prophylactic antimicrobials; these increase the risk of hospital-acquired resistant infections and have not been shown to prevent infection. Give antimicrobials only for documented infection.
- Position collection bags lower than the animal to allow urine to flow by gravity. Prevent retrograde flow of urine from the collection bag back into the patient because this may cause iatrogenic urinary tract infection with resistant organisms. The collection system clamp should be closed when the patient is moved or walked and immediately reopened once the collection bag is again lower than the patient. Check patency of the tubing hourly.
- Culturing the urine (via cystocentesis) at the time of catheter removal is only indicated if there is evidence of cystitis. Urine culture results drawn from indwelling catheters (not recommended) should be interpreted with caution. Do not culture the tip of a removed catheter.