Securing the indwelling catheter

Each year, millions of Americans are catheterized to ensure adequate bladder drainage. But despite the high rate of catheterization in acute care facilities, clinicians often pay little attention to the decision to insert an indwelling catheter, its optimal management, or especially its timely removal. A physician or NP typically orders the insertion of a urinary catheter, but a nurse often performs the catheterization and is responsible for its management. Reimbursement policy changes recently mandated by the Centers for Medicare and Medicaid Services-including one stipulating that Medicare will no longer cover the cost of treating catheter-associated urinary tract infections-have resulted in increased scrutiny of indwelling catheter management. This article explores one aspect of catheter management, the use of securement devices, and analyzes the standard practices, expert opinion, and clinical evidence concerning this intervention.