Proper Catheterization Requirements for Nursing Homes

Nursing home residents are subject to emotional abuse when nursing home staff does not properly implement catheterization procedures.  During the time that a resident is forced to remain in a soiled bed, his or her dignity is compromised. In addition, when a resident is not turned frequently, they are susceptible to pressure ulcers and infection.  Thus, proper catheterization procedures are crucial to maintaining resident’s physical health and emotional well-being.

Urinary incontinence requires that the resident’s clinical condition demonstrates that catheterization is necessary.  The facility is responsible for the assessment of the resident at risk for urinary catheterization and/or the ongoing assessment for the resident who currently has a catheter.  Additionally, staff must follow up by implementing appropriate individualized interventions and monitoring for the effectiveness of these interventions.  See 42 C.F.R. 483.25(d)(1).
Federal regulations mandate that a facility with residents who require and subsequently use catheters perform comprehensive assessments of each resident.
First, regardless of the admission status of a resident, nursing home staff should conduct a comprehensive assessment to address those factors that predispose the resident to the development of urinary incontinence and the use of an indwelling urinary catheter.
An admission evaluation of the resident’s medical history and a physical examination helps identify the resident at risk for requiring the use of an indwelling catheter.  This evaluation must include detection of reversible causes of incontinence and identification of individuals with incontinence caused by conditions that may be reversible, such as bladder tumors and spinal cord diseases.
Second, for the resident with an indwelling catheter, the facility’s documented assessment and staff knowledge of the resident should include information to support the use of an indwelling catheter.  Because indwelling catheters pose a risk of substantial complications, residents should be frequently assessed for blockage of the catheter, expulsion of the catheter, any pain, discomfort, or bleeding, pressure sores, and irregular discharge.
Catheter-related urinary tract infections and Urosepsis must be treated immediately.  Symptoms of a UTI or Urosepsis include:

  • Fever or chills
  • New flank pain or tenderness in the suprapubic area
  • Change in character of urine (bloody urine, foul smell, change in amount of sediment)
  • Worsening of mental or functional status.

In response to these symptoms, facilities must demonstrate that they:

  • Employ standard infection control practices in managing catheters and associated drainage system
  • Strive to keep the resident and catheter clean of feces to minimize bacterial migration to the site of the catheter
  • Implement a fluid management program based on the individualized needs of the resident

See Nursing Home Federal Requirements, 42 C.F.R. 483.25(d)(1), Catheterization: Follow-Up of UTI
If your loved one resides in a nursing home and requires an indwelling catheter, nurses and physicians must be implementing these proper catheterization procedures, as mandated by federal law.