Well, we've to monitor urine output? Condom catheters or External urine management systems could be alternative. Thanks- Rabiul.

In Pediatric ICU, we balance the risk : benefit ratio daily, so unless accurate urine output is needed, it can be avoided in patients except if urine retention ensues (example with paralysis or heavy sedation).

You have use sonography for assessment of volume urine in bladder and put in urine catheter when bladder is full.

once your patient in on mechanical ventilation and sedated, you need to monitor the urine out put. The accurate method to monitor urine out put is by inserting an foley's catheter. If your patient is awake and on NIV or HFNC then you need not to catheterize you patient.

By my opinion, yes. If you have mechanically ventilated and if you have prolonged ventilation time, you have to be able to measure balance between entries and lost of fluids during the day. In many cases, ventilated and sedated patients you have to feed (enteraly and/or parenteraly), and measure the balance. The best way is across daily urine output. Keep in mind that some patients' fluid loosing you will have by perspiration and evaporation .

Thank you all!!

I have been trying to change my current icu teams attitude towards foley cathter and CAUTI related to them and wanted to see what are we doing in digferent parts of the world. CDC doenot have an indication for a foley cathter in ventilated and sedated patient.

Again - thank you all

Sandeep

Yes we need in Critical situation because the patient can't move and loss of consciousness

After all these years of service in healthcare, I found out the two most uncomfortable devices to patients are; Foley catheter and Naso-gastric tube, I think its about time to look for alternative devices.

they are not just uncomfortable, there complications also some times are catastrophic.

Absolutely not, the decision to do this should be made on a case by case basis while using additional information.

Foley catheter placement in the OR or the ICU increases the risk of catheter related infections resulting in longer hospital stay, increased morbidity and now-decreased hospital reimbursement.

It is important to use a catheter in cases when you need to monitor de urine output. In hypovolemic patients you must, so you can control the hydric balance strictly. In case where the presures insede the thorax are too high it is also important, so you can have insights of lower kidney perfusion.

sometimes, when sedating with fentanyl, patients retain urine in the bladder. However, I do not mean the need to use a Foley catheter.

CDC-

A. Examples of Appropriate Indications for Indwelling Urethral Catheter Use 1-4 • Patient has acute urinary retention or bladder outlet obstruction. • Need for accurate measurements of urinary output in critically ill patients. • Perioperative use for selected surgical procedures: o Patients undergoing urologic surgery or other surgery on contiguous structures of the genitourinary tract. o Anticipated prolonged duration of surgery (catheters inserted for this reason should be removed in PACU). o Patients anticipated to receive large-volume infusions or diuretics during surgery. o Need for intraoperative monitoring of urinary output. • To assist in healing of open sacral or perineal wounds in incontinent patients. • Patient requires prolonged immobilization (e.g., potentially unstable thoracic or lumbar spine, multiple traumatic injuries such as pelvic fractures). • To improve comfort for end of life care if needed. B. Examples of Inappropriate Uses of Indwelling Catheters • As a substitute for nursing care of the patient or resident with incontinence. • As a means of obtaining urine for culture or other diagnostic tests when the patient can voluntarily void. • For prolonged postoperative duration without appropriate indications (e.g., structural repair of urethra or contiguous structures, prolonged effect of epidural anaesthesia, etc.).

There are clearly risks and benefits as many have already said,but my opinion is that most sedated/ventilated patients in ICU will need a urinary catheter,for ease of urine o/p monitoring in critically ill patients,and for sampling.

The downsides are equally obvious,and I'm sure we've all seen cases of catheter related sepsis,so the indications and complications need weighing up in each case.

Sí el gasto urinario es determinante para guiar la terapéutica en un paciente crítico; no hay duda para su uso.

I keep reminding my PICU team to consider removing such cathers on daily basis, aiming to reduce CAUTI risk

We do not need foley catheter insertion in a patient solely because of being ventilated/sedated. We can and have been successful in removing IUCs in such patients unless specific conditions are met. These conditions are based on the CDC criteria:

A. Examples of Appropriate Indications for Indwelling Urethral Catheter Use

Patient has acute urinary retention or bladder outlet obstruction.

• Need for accurate measurements of urinary output in critically ill patients.

• Perioperative use for selected surgical procedures:

o Patients undergoing urologic surgery or other surgery on contiguous structures of the genitourinary tract.

o Anticipated prolonged duration of surgery (catheters inserted for this reason should be removed in PACU).

o Patients anticipated to receive large-volume infusions or diuretics during surgery. o Need for intraoperative monitoring of urinary output.

• To assist in healing of open sacral or perineal wounds in incontinent patients.

• Patient requires prolonged immobilization (e.g., potentially unstable thoracic or lumbar spine, multiple traumatic injuries such as pelvic fractures).

• To improve comfort for end of life care if needed.

Hope this is helpful and, would agree, that changing culture regarding IUC utilization can be a long journey.

Agree with @Richard Arbour, especially in vulnerable ICU patients

Although just being on a ventilator is not an indicator for having a foley, it a patients is sedated with Propofol, does that increase risk of retention? Or could a condom cath be tried?

The best option for any ICU patient (including those on a ventilator of sedated) requiring bladder management for fluid output or retention is to use the T-SPeC suprapubic catheter kit. This approach will eliminate UTI and CAUTI as the bacteria causing such infections are gastrointestinal bacteria which migrate across the perineum onto the foley and into the urethra/bladder. The suprapubic approach is easy to manage, provides patient comfort w/o urethral trauma and allows for easy voiding trials without recathing the patient.