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Placement and management of urinary bladder catheters in adults

Anthony J Schaeffer, MD
Section Editor
Jerome P Richie, MD, FACS
Deputy Editor
Wenliang Chen, MD, PhD


Bladder catheters are used for urinary drainage, or as a means to collect urine for measurement. Many clinical situations are appropriate for the placement of catheters, but too frequently they are used without proper indication or continued longer than needed. Daily evaluation of the ongoing need for the catheter is essential to reduce complications. Alternatives to indwelling urethral catheterization should be considered and include external sheath (ie, condom) catheters, suprapubic catheters, intermittent catheterization, and in some cases, supportive management with protective garments. Our recommendations for urinary bladder catheter placement and care are generally consistent with major guidelines that focus on prevention of catheter-associated urinary tract infection [1-4].

This topic will discuss the use and management of urinary bladder catheters. Management of bacteriuria and catheter-associated urinary tract infection is discussed elsewhere. (See "Catheter-associated urinary tract infection in adults" and "Complications of urinary bladder catheters and preventive strategies".)


The single most important factor for preventing urinary catheter-related complications is limiting their use to appropriate indications (table 1) [5-7]. Urinary catheters are indicated in the following clinical situations:

Management of urinary retention with or without bladder outlet obstruction. (See "Clinical manifestations and diagnosis of urinary tract obstruction and hydronephrosis" and "Acute urinary retention", section on 'Options for bladder decompression'.)

Hourly urine output measurement in critically ill patients.


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Literature review current through: Sep 2016. | This topic last updated: May 2, 2016.
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  1. Lo E, Nicolle LE, Coffin SE, et al. Strategies to prevent catheter-associated urinary tract infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014; 35:464.
  2. http://www.cdc.gov/hicpac/cauti (Accessed on September 09, 2014).
  3. Hooton TM, Bradley SF, Cardenas DD, et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis 2010; 50:625.
  4. Pratt RJ, Pellowe CM, Wilson JA, et al. epic2: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect 2007; 65 Suppl 1:S1.
  5. Nicolle LE. Catheter-related urinary tract infection. Drugs Aging 2005; 22:627.
  6. Meddings J, Saint S, Fowler KE, et al. The Ann Arbor Criteria for Appropriate Urinary Catheter Use in Hospitalized Medical Patients: Results Obtained by Using the RAND/UCLA Appropriateness Method. Ann Intern Med 2015; 162:S1.
  7. Gould CV, Umscheid CA, Agarwal RK, et al. Guideline for prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol 2010; 31:319.
  8. Abrams P, Andersson KE, Birder L, et al. Fourth International Consultation on Incontinence Recommendations of the International Scientific Committee: Evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence. Neurourol Urodyn 2010; 29:213.
  9. Cravens DD, Zweig S. Urinary catheter management. Am Fam Physician 2000; 61:369.
  10. Fakih MG, Watson SR, Greene MT, et al. Reducing inappropriate urinary catheter use: a statewide effort. Arch Intern Med 2012; 172:255.
  11. Knoll BM, Wright D, Ellingson L, et al. Reduction of inappropriate urinary catheter use at a Veterans Affairs hospital through a multifaceted quality improvement project. Clin Infect Dis 2011; 52:1283.
  12. Jain P, Parada JP, David A, Smith LG. Overuse of the indwelling urinary tract catheter in hospitalized medical patients. Arch Intern Med 1995; 155:1425.
  13. Gardam MA, Amihod B, Orenstein P, et al. Overutilization of indwelling urinary catheters and the development of nosocomial urinary tract infections. Clin Perform Qual Health Care 1998; 6:99.
  14. Holroyd-Leduc, JM, Sands, LP, Counsell, SR, et al. Risk factors for indwelling urinary catheterization among older hospitalized patients without a specific medical indication for catheterization. J Patient Saf 2005; 1:201.
  15. Givens CD, Wenzel RP. Catheter-associated urinary tract infections in surgical patients: a controlled study on the excess morbidity and costs. J Urol 1980; 124:646.
  16. Tambyah PA, Knasinski V, Maki DG. The direct costs of nosocomial catheter-associated urinary tract infection in the era of managed care. Infect Control Hosp Epidemiol 2002; 23:27.
  17. Huang WC, Wann SR, Lin SL, et al. Catheter-associated urinary tract infections in intensive care units can be reduced by prompting physicians to remove unnecessary catheters. Infect Control Hosp Epidemiol 2004; 25:974.
  18. Gould, C, Umscheid, C, Agarwal, R, et al. Guideline for the Prevention of Catheter-Associated Urinary Tract Infections 2008, HaH Services (Ed), Department of Health and Human Sevices Centers for Disease Control and Prevention, Atlanta 2008. pp.1-47.
  19. Fuse H, Yokoyama T, Muraishi Y, Katayama T. Measurement of residual urine volume using a portable ultrasound instrument. Int Urol Nephrol 1996; 28:633.
  20. Warren JW, Steinberg L, Hebel JR, Tenney JH. The prevalence of urethral catheterization in Maryland nursing homes. Arch Intern Med 1989; 149:1535.
  21. Saint S, Kaufman SR, Rogers MA, et al. Condom versus indwelling urinary catheters: a randomized trial. J Am Geriatr Soc 2006; 54:1055.
  22. Saint S, Lipsky BA, Baker PD, et al. Urinary catheters: what type do men and their nurses prefer? J Am Geriatr Soc 1999; 47:1453.
  23. Newman DK, Willson MM. Review of intermittent catheterization and current best practices. Urol Nurs 2011; 31:12.
  24. Moore KN, Burt J, Voaklander DC. Intermittent catheterization in the rehabilitation setting: a comparison of clean and sterile technique. Clin Rehabil 2006; 20:461.
  25. Di Benedetto P. Clean intermittent self-catheterization in neuro-urology. Eur J Phys Rehabil Med 2011; 47:651.
  26. Assis GM, e Faro AC. [Clean intermittent self catheterization in spinal cord injury]. Rev Esc Enferm USP 2011; 45:289.
  27. Lapides J, Diokno AC, Silber SJ, Lowe BS. Clean, intermittent self-catheterization in the treatment of urinary tract disease. J Urol 1972; 107:458.
  28. Consortium for Spinal Cord Medicine. Bladder management for adults with spinal cord injury: a clinical practice guideline for health-care providers. J Spinal Cord Med 2006; 29:527.
  29. Wyndaele JJ. Complications of intermittent catheterization: their prevention and treatment. Spinal Cord 2002; 40:536.
  30. Duffy LM, Cleary J, Ahern S, et al. Clean intermittent catheterization: safe, cost-effective bladder management for male residents of VA nursing homes. J Am Geriatr Soc 1995; 43:865.
  31. Kidd EA, Stewart F, Kassis NC, et al. Urethral (indwelling or intermittent) or suprapubic routes for short-term catheterisation in hospitalised adults. Cochrane Database Syst Rev 2015; :CD004203.
  32. Carapeti EA, Andrews SM, Bentley PG. Randomised study of sterile versus non-sterile urethral catheterisation. Ann R Coll Surg Engl 1996; 78:59.
  33. Anderson RU. Non-sterile intermittent catheterization with antibiotic prophylaxis in the acute spinal cord injured male patient. J Urol 1980; 124:392.
  34. Shekelle PG, Morton SC, Clark KA, et al. Systematic review of risk factors for urinary tract infection in adults with spinal cord dysfunction. J Spinal Cord Med 1999; 22:258.
  35. Saint S. Clinical and economic consequences of nosocomial catheter-related bacteriuria. Am J Infect Control 2000; 28:68.
  36. Girotti ME, MacCornick S, Perissé H, et al. Determining the variables associated to clean intermittent self-catheterization adherence rate: one-year follow-up study. Int Braz J Urol 2011; 37:766.
  37. Hooton, T, Bradley, S, Cardenas, D, et al. International Clinical Practice Guidelines for the Diagnosis, Prevention, and Treatment of Catheter-Associated Urinary Tract Infection in Adults 2009. pp.1-81.
  38. Belfield PW. Urinary catheters. Br Med J (Clin Res Ed) 1988; 296:836.
  39. Lam TB, Omar MI, Fisher E, et al. Types of indwelling urethral catheters for short-term catheterisation in hospitalised adults. Cochrane Database Syst Rev 2014; :CD004013.
  40. Jahn P, Beutner K, Langer G. Types of indwelling urinary catheters for long-term bladder drainage in adults. Cochrane Database Syst Rev 2012; 10:CD004997.
  41. Srinivasan A, Karchmer T, Richards A, et al. A prospective trial of a novel, silicone-based, silver-coated foley catheter for the prevention of nosocomial urinary tract infections. Infect Control Hosp Epidemiol 2006; 27:38.
  42. Vaidyanathan S, Soni BM, Dundas S, Krishnan KR. Urethral cytology in spinal cord injury patients performing intermittent catheterisation. Paraplegia 1994; 32:493.
  43. Diokno AC, Mitchell BA, Nash AJ, Kimbrough JA. Patient satisfaction and the LoFric catheter for clean intermittent catheterization. J Urol 1995; 153:349.
  44. Sarica S, Akkoc Y, Karapolat H, Aktug H. Comparison of the use of conventional, hydrophilic and gel-lubricated catheters with regard to urethral micro trauma, urinary system infection, and patient satisfaction in patients with spinal cord injury: a randomized controlled study. Eur J Phys Rehabil Med 2010; 46:473.
  45. Newton T, Still JM, Law E. A comparison of the effect of early insertion of standard latex and silver-impregnated latex foley catheters on urinary tract infections in burn patients. Infect Control Hosp Epidemiol 2002; 23:217.
  46. Riley DK, Classen DC, Stevens LE, Burke JP. A large randomized clinical trial of a silver-impregnated urinary catheter: lack of efficacy and staphylococcal superinfection. Am J Med 1995; 98:349.
  47. Saint S, Elmore JG, Sullivan SD, et al. The efficacy of silver alloy-coated urinary catheters in preventing urinary tract infection: a meta-analysis. Am J Med 1998; 105:236.
  48. Johnson JR, Kuskowski MA, Wilt TJ. Systematic review: antimicrobial urinary catheters to prevent catheter-associated urinary tract infection in hospitalized patients. Ann Intern Med 2006; 144:116.
  49. Stensballe J, Tvede M, Looms D, et al. Infection risk with nitrofurazone-impregnated urinary catheters in trauma patients: a randomized trial. Ann Intern Med 2007; 147:285.
  50. Karchmer TB, Giannetta ET, Muto CA, et al. A randomized crossover study of silver-coated urinary catheters in hospitalized patients. Arch Intern Med 2000; 160:3294.
  51. 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; 160:2670.
  52. Rupp ME, Fitzgerald T, Marion N, et al. Effect of silver-coated urinary catheters: efficacy, cost-effectiveness, and antimicrobial resistance. Am J Infect Control 2004; 32:445.
  53. Plowman R, Graves N, Esquivel J, Roberts JA. An economic model to assess the cost and benefits of the routine use of silver alloy coated urinary catheters to reduce the risk of urinary tract infections in catheterized patients. J Hosp Infect 2001; 48:33.
  54. Pickard R, Lam T, MacLennan G, et al. Antimicrobial catheters for reduction of symptomatic urinary tract infection in adults requiring short-term catheterisation in hospital: a multicentre randomised controlled trial. Lancet 2012; 380:1927.
  55. Lanara V, Plati C, Paniara O, et al. The prevalence of urinary tract infection in patients related to type of drainage bag. Scand J Caring Sci 1988; 2:163.
  56. Willson M, Wilde M, Webb ML, et al. Nursing interventions to reduce the risk of catheter-associated urinary tract infection: part 2: staff education, monitoring, and care techniques. J Wound Ostomy Continence Nurs 2009; 36:137.
  57. Kunin CM, McCormack RC. Prevention of catheter-induced urinary-tract infections by sterile closed drainage. N Engl J Med 1966; 274:1155.
  58. Schaberg DR, Alford RH, Anderson R, et al. An outbreak of nosocomial infection due to multiply resistant Serratia marcescens: evidence of interhospital spread. J Infect Dis 1976; 134:181.
  59. Jarlier V, Fosse T, Philippon A. Antibiotic susceptibility in aerobic gram-negative bacilli isolated in intensive care units in 39 French teaching hospitals (ICU study). Intensive Care Med 1996; 22:1057.
  60. Krieger JN, Kaiser DL, Wenzel RP. Nosocomial urinary tract infections cause wound infections postoperatively in surgical patients. Surg Gynecol Obstet 1983; 156:313.
  61. Wagenlehner FM, Krcmery S, Held C, et al. Epidemiological analysis of the spread of pathogens from a urological ward using genotypic, phenotypic and clinical parameters. Int J Antimicrob Agents 2002; 19:583.
  62. Swami SK, Liesinger JT, Shah N, et al. Incidence of antibiotic-resistant Escherichia coli bacteriuria according to age and location of onset: a population-based study from Olmsted County, Minnesota. Mayo Clin Proc 2012; 87:753.
  63. Burton DC, Edwards JR, Srinivasan A, et al. Trends in catheter-associated urinary tract infections in adult intensive care units-United States, 1990-2007. Infect Control Hosp Epidemiol 2011; 32:748.
  64. Singhai M, Malik A, Shahid M, et al. A study on device-related infections with special reference to biofilm production and antibiotic resistance. J Glob Infect Dis 2012; 4:193.
  65. DeGroot-Kosolcharoen J, Guse R, Jones JM. Evaluation of a urinary catheter with a preconnected closed drainage bag. Infect Control Hosp Epidemiol 1988; 9:72.
  66. Huth TS, Burke JP, Larsen RA, et al. Clinical trial of junction seals for the prevention of urinary catheter-associated bacteriuria. Arch Intern Med 1992; 152:807.
  67. Danachaivijitr. S. Should the open urinary drainage system be continued. J Med Assoc Thai 1988; 71:S14.
  68. Leone M, Garnier F, Dubuc M, et al. Prevention of nosocomial urinary tract infection in ICU patients: comparison of effectiveness of two urinary drainage systems. Chest 2001; 120:220.
  69. Leone M, Garnier F, Antonini F, et al. Comparison of effectiveness of two urinary drainage systems in intensive care unit: a prospective, randomized clinical trial. Intensive Care Med 2003; 29:410.
  70. Wenzler-Röttele S, Dettenkofer M, Schmidt-Eisenlohr E, et al. Comparison in a laboratory model between the performance of a urinary closed system bag with double non-return valve and that of a single valve system. Infection 2006; 34:214.
  71. Nasiriani K, Kalani Z, Farnia F, et al. Comparison of the effect of water vs. povidone-iodine solution for periurethral cleaning in women requiring an indwelling catheter prior to gynecologic surgery. Urol Nurs 2009; 29:118.
  72. Al-Farsi S, Oliva M, Davidson R, et al. Periurethral cleaning prior to urinary catheterization in children: sterile water versus 10% povidone-iodine. Clin Pediatr (Phila) 2009; 48:656.
  73. Webster J, Hood RH, Burridge CA, et al. Water or antiseptic for periurethral cleaning before urinary catheterization: a randomized controlled trial. Am J Infect Control 2001; 29:389.
  74. http://www.uroweb.org/fileadmin/EAUN/guidelines/EAUN_Paris_Guideline_2012_LR_online_file.pdf (Accessed on December 10, 2013).
  75. Daneshmand S, Youssefzadeh D, Skinner EC. Review of techniques to remove a Foley catheter when the balloon does not deflate. Urology 2002; 59:127.
  76. Erickson RP, Merritt JL, Opitz JL, Ilstrup DM. Bacteriuria during follow-up in patients with spinal cord injury: I. Rates of bacteriuria in various bladder-emptying methods. Arch Phys Med Rehabil 1982; 63:409.
  77. Prieto J, Murphy CL, Moore KN, Fader M. Intermittent catheterisation for long-term bladder management. Cochrane Database Syst Rev 2014; :CD006008.
  78. Chartier-Kastler E, Amarenco G, Lindbo L, et al. A prospective, randomized, crossover, multicenter study comparing quality of life using compact versus standard catheters for intermittent self-catheterization. J Urol 2013; 190:942.
  79. Amarenco G, Guinet A, Jousse M, et al. Pencil and paper test: a new tool to predict the ability of neurological patients to practice clean intermittent self-catheterization. J Urol 2011; 185:578.
  80. Wyndaele JJ. Intermittent catheterization: which is the optimal technique? Spinal Cord 2002; 40:432.
  81. Jacob P, Rai BP, Todd AW. Suprapubic catheter insertion using an ultrasound-guided technique and literature review. BJU Int 2012; 110:779.
  82. Mody L, Saint S, Galecki A, et al. Knowledge of evidence-based urinary catheter care practice recommendations among healthcare workers in nursing homes. J Am Geriatr Soc 2010; 58:1532.
  83. Wong, ES, Hooton, TM. Guidelines for prevention of catheter-associated urinary tract infections. Infect Control 1981; 2:126.
  84. Zimakoff JD, Pontoppidan B, Larsen SO, et al. The management of urinary catheters: compliance of practice in Danish hospitals, nursing homes and home care to national guidelines. Scand J Urol Nephrol 1995; 29:299.
  85. Burke JP, Garibaldi RA, Britt MR, et al. Prevention of catheter-associated urinary tract infections. Efficacy of daily meatal care regimens. Am J Med 1981; 70:655.
  86. Huth TS, Burke JP, Larsen RA, et al. Randomized trial of meatal care with silver sulfadiazine cream for the prevention of catheter-associated bacteriuria. J Infect Dis 1992; 165:14.
  87. Classen DC, Larsen RA, Burke JP, et al. Daily meatal care for prevention of catheter-associated bacteriuria: results using frequent applications of polyantibiotic cream. Infect Control Hosp Epidemiol 1991; 12:157.
  88. Koskeroglu N, Durmaz G, Bahar M, et al. The role of meatal disinfection in preventing catheter-related bacteriuria in an intensive care unit: a pilot study in Turkey. J Hosp Infect 2004; 56:236.
  89. Bergqvist D, Brönnestam R, Hedelin H, Ståhl A. The relevance of urinary sampling methods in patients with indwelling Foley catheters. Br J Urol 1980; 52:92.
  90. Beveridge LA, Davey PG, Phillips G, McMurdo ME. Optimal management of urinary tract infections in older people. Clin Interv Aging 2011; 6:173.
  91. Kunin CM, Chin QF, Chambers S. Indwelling urinary catheters in the elderly. Relation of "catheter life" to formation of encrustations in patients with and without blocked catheters. Am J Med 1987; 82:405.
  92. Tenney JH, Warren JW. Bacteriuria in women with long-term catheters: paired comparison of indwelling and replacement catheters. J Infect Dis 1988; 157:199.
  93. Warren JW, Platt R, Thomas RJ, et al. Antibiotic irrigation and catheter-associated urinary-tract infections. N Engl J Med 1978; 299:570.
  94. Schneeberger PM, Vreede RW, Bogdanowicz JF, van Dijk WC. A randomized study on the effect of bladder irrigation with povidone-iodine before removal of an indwelling catheter. J Hosp Infect 1992; 21:223.
  95. Sweet DE, Goodpasture HC, Holl K, et al. Evaluation of H2O2 prophylaxis of bacteriuria in patients with long-term indwelling Foley catheters: a randomized controlled study. Infect Control 1985; 6:263.
  96. Darouiche RO, Thornby JI, Cerra-Stewart C, et al. Bacterial interference for prevention of urinary tract infection: a prospective, randomized, placebo-controlled, double-blind pilot trial. Clin Infect Dis 2005; 41:1531.
  97. Holroyd-Leduc JM, Sen S, Bertenthal D, et al. The relationship of indwelling urinary catheters to death, length of hospital stay, functional decline, and nursing home admission in hospitalized older medical patients. J Am Geriatr Soc 2007; 55:227.
  98. Wald HL, Ma A, Bratzler DW, Kramer AM. Indwelling urinary catheter use in the postoperative period: analysis of the national surgical infection prevention project data. Arch Surg 2008; 143:551.
  99. Phipps S, Lim YN, McClinton S, et al. Short term urinary catheter policies following urogenital surgery in adults. Cochrane Database Syst Rev 2006; :CD004374.
  100. Saint S, Wiese J, Amory JK, et al. Are physicians aware of which of their patients have indwelling urinary catheters? Am J Med 2000; 109:476.
  101. Meddings J, Rogers MA, Macy M, Saint S. Systematic review and meta-analysis: reminder systems to reduce catheter-associated urinary tract infections and urinary catheter use in hospitalized patients. Clin Infect Dis 2010; 51:550.
  102. Gülmez I, Ekmekcioglu O, Karacagil M. A comparison of various methods to burst Foley catheter balloons and the risk of free-fragment formation. Br J Urol 1996; 77:716.
  103. Sandock DS, Gothe BG, Bodner DR. Trimethoprim-sulfamethoxazole prophylaxis against urinary tract infection in the chronic spinal cord injury patient. Paraplegia 1995; 33:156.
  104. Niël-Weise BS, van den Broek PJ. Antibiotic policies for short-term catheter bladder drainage in adults. Cochrane Database Syst Rev 2005; :CD005428.
  105. Marschall J, Carpenter CR, Fowler S, et al. Antibiotic prophylaxis for urinary tract infections after removal of urinary catheter: meta-analysis. BMJ 2013; 346:f3147.
  106. Juthani-Mehta M. Should antibiotic prophylaxis after urinary catheter removal be standard practice? BMJ 2013; 346:f3938.
  107. Lusardi G, Lipp A, Shaw C. Antibiotic prophylaxis for short-term catheter bladder drainage in adults. Cochrane Database Syst Rev 2013; :CD005428.