An open drainage system means that the catheter has been separated from the drain bag following insertion. This can be avoided by changing the entire catheter system every time there’s a break in the system, as recommended by CDC guidelines.
But this can get complicated when a patient is admitted to the ICU. After an emergency or operating room nurse inserts an IUC with a regular drain bag, an ICU nurse may switch to a urine meter drain bag without replacing the entire catheter. They do this to monitor the patient’s urine output on an hourly basis. But it means “breaking the system,” which can lead to an increase in infection rates.
Eble recommends thinking about the patient’s future needs and choosing a catheter system that’s least likely to be opened. Typically, patients undergoing simple procedures need only short-term IUC placement with a regular drain bag. Patients who go to the operating room for complex surgeries will usually need a urine meter. But patients admitted for a simple procedure who have comorbidities may end up in the ICU for monitoring. So, nurses need to use their critical thinking skills to decide which IUC system to insert.
“The nurse should be thinking about things like that and not automatically put on a drain bag without a urine meter,” Eble says. In fact, it’s a good idea to make urine meters easily available for acute care nurses to use instead of regular drain bags. That’s an advantage as long as clinicians also receive the right training on drain bag use.