Evidence-Based Recommendations for Urinary Catheter Irrigation
General Principles for Catheter Management
- Routine catheter irrigation with normal saline should not be used to reduce catheter-associated bacteriuria, catheter-associated urinary tract infection, or obstruction in patients with long-term indwelling catheterization 1, 3
- Catheter irrigation with antimicrobials should not be used routinely to reduce or eradicate catheter-associated bacteriuria or catheter-associated urinary tract infection in patients with indwelling catheters 2, 4
Specific Irrigation Recommendations
- Routine addition of antimicrobials or antiseptics to the drainage bag of catheterized patients should not be used to reduce catheter-associated bacteriuria or catheter-associated urinary tract infection 1, 5
- Randomized trials of hydrogen peroxide, chlorhexidine, povidone-iodine, or silver ions added to drainage bags have shown no benefit in reducing catheter-associated bacteriuria rates 3, 5
Limited Situations When Irrigation May Be Considered
- Catheter irrigation with antimicrobials may be considered only in selected patients who undergo surgical procedures and short-term catheterization to reduce catheter-associated bacteriuria (weak recommendation) 2, 4
- For patients with fungal cystitis due to fluconazole-resistant species, amphotericin B deoxycholate bladder irrigation with 50 mg/L sterile water daily for 5 days may be considered (weak recommendation) 6
- For patients with fungal pyelonephritis who have nephrostomy tubes, irrigation through these tubes with amphotericin B deoxycholate is recommended 6
Catheter Management Best Practices
- Elimination of predisposing factors, such as indwelling bladder catheters, is recommended whenever feasible 6
- Daily meatal cleansing with povidone-iodine solution, silver sulfadiazine, polyantibiotic ointment or cream, or green soap and water is not recommended for routine use in patients with indwelling urethral catheters 2, 4
- There is insufficient evidence to recommend routine catheter changes in patients with functional long-term indwelling catheters 3, 7
- Prophylactic antimicrobials should not be administered routinely to patients at the time of catheter placement, removal, or replacement 3, 8