Clinical Practice Approval Form Clinical Practice Title ...

Clinical Practice Approval Form

Clinical Practice Title: Indwelling urinary catheter use during labor

Type of Review: Care Management Council submission date:
August 2011
New Clinical Practice
Revisions of Existing Clinical Practice

Original Approval date:

Clinical Practice Owner / Author: (e.g., CCG and Contact Information

WG Lead(s) named)

Name:
Phone:
email:

Type of Clinical Expected Recommended Optional

Practice:

Brief Description of Clinical Practice / Reason for Proposed Change

Indwelling urinary catheters will be used for patients in labor only when clinically necessary such as

Category III fetal heart rate tracing or arrest of labor, anticipating operative delivery, closer monitoring of hourly

I&O’s, obese patients where bladder assessment is unobtainable. This will reduce the risk for catheter

associated urinary tract infection and positively impact the patients perception of her labor due to less

intervention. In addition, a cost savings of $200,000 may be realized across the system.

Departments/Disciplines Affected

Reviewed History

Reviewed by (name/group): Date:

WIS Discipline August 2, 2011

OB Clinical Consensus August 10, 2011

OB Anesthesia workgroup August 23, 2011

Clinical Practice Toolkit Link:

Upon Care Management Council Approval Clinical Practices enter DESIGN Phase in Care Management.

Care Management Council Approval

Returned to Author for Revision Date:

Comments:

X Approved by Care Management Council Date: Aug 2011

CLINICAL PRACTICE

TITLE: Indwelling urinary catheter use during labor

Number: Date Posted:

Type: Clinical Practice Contact:

Approved Date: Implementation Date: Deactivation Date:

Facilities:

Approved by:

Indwelling urinary catheter use during labor (adult)

PRACTICE APPROACH:
Expected/Recommended/Optional Clinical Practice

PRACTICE STATEMENT:
Indwelling urinary catheters will be used for patients in labor only when clinically necessary, such as
Category III fetal heart rate tracing or arrest of labor, anticipating operative delivery, closer monitoring of hourly
I&O’s, obese patients where bladder assessment is unobtainable.

Rationale:
Indwelling urinary catheters have been used routinely for laboring patients with epidurals for some time
throughout Banner Health. However, there is no evidence that this process improves patient care. In fact,
studies indicate a patients perception and satisfaction of her labor is improved with less intervention (Bryanton
et al, 2008). Likewise, there is no evidence to suggest the use of an indwelling catheter will shorten labor
(Evron et al, 2008). Therefore, the use of an indwelling urinary catheter should not be dependant upon a
patient receiving a labor epidural but rather upon her clinical need. Clinical need may include Category III fetal
heart rate tracing or arrest of labor, anticipating operative delivery, closer monitoring of hourly I&O’s, obese
patients where bladder assessment is unobtainable.

The greatest risk for urinary tract infections is the placement of the indwelling urinary catheters. In alignment
with the CAUTI initiative, this practice will reduce the risk of urinary tract infection.

In addition to the clinical benefits of this practice, Banner Health could realize some cost savings estimated at
$200,000 per year systemwide.

CLINICAL APPROACH: P a g e 2 of 3
• Remove “insert indwelling catheter” from Labor Order Sets in PeriBirth.
• Order indwelling catheter for laboring patient only when clinically appropriate

Banner Health | Clinical Practice NAME

CLINICAL PRACTICE

• Patient should be encouraged to void prior to epidural placement
• Nursing should assess the bladder and perform peri-care every 2 hours for every patient in labor.
• Bedpan should be offered to patients with epidurals every 2 to 4 hours– many are able to void

spontaneously.
• If patient is unable to void, proceed with straight cath and record volume. This may be repeated as

needed, using sterile technique.

REFERENCES:
Bryanton,J., Gagnon, A., Johnston, C. & Hatem, M (2008). Predictors of the childbirth experience.
JOGNN, 37 (1), 24-34.

De Sevo,M & Severaro, P. (2010). Urinary catherization: women should have a choice. Nursing for
Women’s Health, 14(1), 11-13

Evron,S. et al (2009). The effect of intermittent versus continuous bladder catheterization on labor duration and
postpartum urinary retention and infection: a randomized trial. Journal of Clinical Anesthesia, 20, 567-572.

KEYWORDS AND KEYWORD PHRASES: Indwelling catheter, foley catheter, straight cath, labor
patient, epidural.

Banner Health | Clinical Practice NAME P a g e 3 of 3