Yes or no? Pretesting indwelling urinary catheter balloons

Abstract

Insertion of an indwelling (retention) urinary catheter is a frequently performed procedure in the acute care setting, with approximately 25% of patients having a urinary catheter placed at some point during hospitalization (see Reasons to place an indwelling urinary catheter). Indwelling catheters are associated with increased incidence of urinary tract infections and can impact patient comfort and safety (see Potential risks of indwelling urinary catheter placement). Historically, indwelling catheter balloons were pretested by nurses before insertion to prevent the use of a defective catheter. However, some manufacturers pretest their indwelling catheter balloons before sterilization and packaging as a quality control measure and specifically instruct healthcare professionals not to do so. How does this translate into practice? Evidence says... Evidence-based practice (EBP) recommendations don't support pretesting indwelling catheter balloons by putting the prefilled sterile water syringe into the balloon port before insertion. The rationale underscoring this clinical decision is that pretesting the balloon may stretch and actually distort the catheter, resulting in damage that can lead to increased trauma on insertion. Previously, pretesting of indwelling catheter balloons was done as a way to prevent insertion of a catheter with a defective balloon. However, pretesting doesn't guarantee that the balloon won't be defective once the catheter is in the bladder. In addition, pretesting silicone catheter balloons isn't recommended; the silicone can develop a cuff or crease at the balloon area that may result in trauma to the urethra during catheter insertion and removal. The sterile kit will generally have clear instructions indicating the status of balloon pretesting; the recent consensus is to nix pretesting entirely. Recommendations for catheter selection and insertion should be followed so that the catheter doesn't cause harm to your patient. Furthermore, review your facility's guidelines and apply its policy regarding pretesting of indwelling catheter balloons. Nurses entering the workforce are usually not taught to pretest indwelling catheter balloons because several nursing text manuals recommend against it. CDC guidelines advise that hospital personnel and individuals who participate in catheter care should be given regular in-service training that emphasizes use of the correct technique, as well as the possible complications of urinary catheterization, such as catheter-associated urinary tract infections and urosepsis. Keeping current and safe As nurses, we're responsible for keeping up with EBP recommendations and knowing the risks and benefits of any procedure we're performing. Review your facility's current policies and advocate for changes when necessary. It's vital that we translate evidence into practice to improve patient safety and optimize outcomes. Further research will be beneficial to fully elucidate the implications for nurse-driven protocols and develop consistency in standardized practices. Reasons to place an indwelling urinary catheter Acute urinary retention or bladder outlet obstruction Accurate intake and output measurements in critically ill patients Selected surgical procedures (genitourinary surgery/colorectal surgery) Intraoperative monitoring of urinary output during surgery or diuretic therapy Continuous or intermittent bladder irrigations Healing of open sacral/perineal wounds in incontinent patients Prolonged immobilization (such as in multiple traumatic injuries) Comfort for end-of-life care Potential risks of indwelling urinary catheter placement Urethral trauma Urethral or perineal irritation Catheter encrustation Compromised mobility