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Urinary Catheter Nursing Care Plan
Assessment Data
Patient demographics: age, sex, relevant medical history (e.g., urinary retention, urinary incontinence, recent surgery, neurogenic bladder, BPH, pelvic trauma).
Indication for catheterization: short-term/long-term, indwelling (Foley), intermittent (straight), suprapubic.
Catheter type, size (French), material (latex, silicone), insertion date/time.
Urine characteristics: color, clarity, odor, presence of sediment, blood, or unusual drainage.
Urine output: hourly and total per shift; note oliguria (<0.5 mL/kg/hr) or anuria.
Signs/symptoms of infection: fever, chills, suprapubic or flank pain, dysuria (if applicable), altered mental status in older adults.
Catheter site: dressing condition, leakage, tubing patency, kinks, securement device presence.
Skin integrity around urethra or suprapubic site.
Patient knowledge and comfort with catheter care.
Laboratory and diagnostic data: urinalysis, urine culture, CBC, creatinine, bladder scans.
Nursing Diagnoses (examples)
Risk for Infection related to indwelling urinary catheter and impaired local tissue integrity.
Impaired Urinary Elimination related to indwelling catheter and urinary tract manipulation.
Risk for Deficient Fluid Volume or Excess Fluid Volume related to altered urine output and underlying comorbidities.
Acute Pain related to catheter insertion or bladder spasms.
Anxiety related to loss of bladder control and unfamiliarity with catheter care.
Risk for Impaired Skin Integrity related to moisture and catheter tubing tension.
Goals/Outcomes (examples)
Patient will remain free from signs and symptoms of catheter-associated urinary tract infection (CAUTI) during hospitalization.
Patient will maintain adequate urine output (age- and weight-appropriate) with clear, light-yellow urine.
Patient will report decreased pain to a tolerable level within 2 hours of intervention.
Patient (or caregiver) will demonstrate correct catheter care and drainage bag handling prior to discharge.
Skin around catheter site will remain intact and free from irritation.
Nursing Interventions and Rationale
Aseptic technique for insertion and maintenance
Ensure catheter insertion and any manipulation follow sterile technique (for insertion) and use clean gloves for routine care.
Rationale: Reduces introduction of pathogens and lowers CAUTI risk.
Appropriate catheter selection and timely removal
Use the smallest effective catheter size and consider intermittent catheterization or external alternatives when appropriate. Review daily need and remove as soon as clinically indicated.
Rationale: Longer duration and larger catheters increase infection risk; early removal reduces CAUTI incidence.
Maintain closed drainage system
Keep the catheter and tubing as a closed system; avoid unnecessary disconnections. If disconnection is needed, use sterile technique when reconnecting.
Rationale: Prevents ascending contamination of the urinary tract.
Secure catheter and ensure unobstructed flow
Use a securement device to prevent traction; position tubing below bladder level and off the floor; avoid kinks and dependent loops.
Rationale: Prevents urethral trauma, accidental removal, reflux, and ensures accurate output measurement.
Proper drainage bag management
Use appropriate drainage bag (leg bag for ambulatory patients; larger bedside bag for those confined to bed). Empty bag at least every 8 hours or when 1/2–2/3 full using a clean container; clean the drainage spigot with alcohol before and after emptying.
Rationale: Prevents overfilling, reduces backflow, and maintains hygiene.
Perineal hygiene
Cleanse perineal area and catheter insertion site at least once per shift and after bowel movements using soap and water; avoid antiseptic wipes unless ordered.
Rationale: Reduces bacterial colonization and skin breakdown.
Monitor urine characteristics and output
Measure and record hourly or per protocol; note changes in color, sediment, blood, and odor. Send urinalysis/urine culture if infection suspected (obtain specimen from sampling port using aseptic technique).
Rationale: Early detection of infection, obstruction, bleeding, or renal issues.
Manage pain and bladder spasms
Assess pain level and provide prescribed analgesics or antispasmodics; consider bladder irrigation if ordered for clots/obstruction.
Rationale: Controls discomfort and reduces complications from spasms.
Hydration and bladder irrigation (as indicated)
Encourage adequate oral fluids unless contraindicated to promote urine flow. Instill sterile normal saline irrigation only
Urinary Catheter Nursing Care Plan
Assessment Data
Patient demographics: age, sex, relevant medical history (e.g., urinary retention, urinary incontinence, recent surgery, neurogenic bladder, BPH, pelvic trauma).
Indication for catheterization: short-term/long-term, indwelling (Foley), intermittent (straight), suprapubic.
Catheter type, size (French), material (latex, silicone), insertion date/time.
Urine characteristics: color, clarity, odor, presence of sediment, blood, or unusual drainage.
Urine output: hourly and total per shift; note oliguria (<0.5 mL/kg/hr) or anuria.
Signs/symptoms of infection: fever, chills, suprapubic or flank pain, dysuria (if applicable), altered mental status in older adults.
Catheter site: dressing condition, leakage, tubing patency, kinks, securement device presence.
Skin integrity around urethra or suprapubic site.
Patient knowledge and comfort with catheter care.
Laboratory and diagnostic data: urinalysis, urine culture, CBC, creatinine, bladder scans.
Nursing Diagnoses (examples)
Risk for Infection related to indwelling urinary catheter and impaired local tissue integrity.
Impaired Urinary Elimination related to indwelling catheter and urinary tract manipulation.
Risk for Deficient Fluid Volume or Excess Fluid Volume related to altered urine output and underlying comorbidities.
Acute Pain related to catheter insertion or bladder spasms.
Anxiety related to loss of bladder control and unfamiliarity with catheter care.
Risk for Impaired Skin Integrity related to moisture and catheter tubing tension.
Goals/Outcomes (examples)
Patient will remain free from signs and symptoms of catheter-associated urinary tract infection (CAUTI) during hospitalization.
Patient will maintain adequate urine output (age- and weight-appropriate) with clear, light-yellow urine.
Patient will report decreased pain to a tolerable level within 2 hours of intervention.
Patient (or caregiver) will demonstrate correct catheter care and drainage bag handling prior to discharge.
Skin around catheter site will remain intact and free from irritation.
Nursing Interventions and Rationale
Aseptic technique for insertion and maintenance
Ensure catheter insertion and any manipulation follow sterile technique (for insertion) and use clean gloves for routine care.
Rationale: Reduces introduction of pathogens and lowers CAUTI risk.
Appropriate catheter selection and timely removal
Use the smallest effective catheter size and consider intermittent catheterization or external alternatives when appropriate. Review daily need and remove as soon as clinically indicated.
Rationale: Longer duration and larger catheters increase infection risk; early removal reduces CAUTI incidence.
Maintain closed drainage system
Keep the catheter and tubing as a closed system; avoid unnecessary disconnections. If disconnection is needed, use sterile technique when reconnecting.
Rationale: Prevents ascending contamination of the urinary tract.
Secure catheter and ensure unobstructed flow
Use a securement device to prevent traction; position tubing below bladder level and off the floor; avoid kinks and dependent loops.
Rationale: Prevents urethral trauma, accidental removal, reflux, and ensures accurate output measurement.
Proper drainage bag management
Use appropriate drainage bag (leg bag for ambulatory patients; larger bedside bag for those confined to bed). Empty bag at least every 8 hours or when 1/2–2/3 full using a clean container; clean the drainage spigot with alcohol before and after emptying.
Rationale: Prevents overfilling, reduces backflow, and maintains hygiene.
Perineal hygiene
Cleanse perineal area and catheter insertion site at least once per shift and after bowel movements using soap and water; avoid antiseptic wipes unless ordered.
Rationale: Reduces bacterial colonization and skin breakdown.
Monitor urine characteristics and output
Measure and record hourly or per protocol; note changes in color, sediment, blood, and odor. Send urinalysis/urine culture if infection suspected (obtain specimen from sampling port using aseptic technique).
Rationale: Early detection of infection, obstruction, bleeding, or renal issues.
Manage pain and bladder spasms
Assess pain level and provide prescribed analgesics or antispasmodics; consider bladder irrigation if ordered for clots/obstruction.
Rationale: Controls discomfort and reduces complications from spasms.
Hydration and bladder irrigation (as indicated)
Encourage adequate oral fluids unless contraindicated to promote urine flow. Instill sterile normal saline irrigation only
