The catheter may not be clogged, so always check the volume of urine in the bladder before replacing it. Latex catheters may develop incrustations more easily than silicone, so think about this option. Low urine output may be related to edema or kidney failure, increasing fluid may help the urine flow through the catheter. Irrigation should be considered only after the urine catheter has been replaced. The risk of infection may be the only solution in rare circumstances.

Irrigation supplies should only be used according to the label directions. The catheter-tubing connection may be a source of bacteria, so disinfect it prior to disconnection using aseptic technique to prevent the tubing from getting contaminated. Vinegar has not been found to be beneficial in preventing infection. Never allow the urine in the tubing to flow back into the bladder.

• If obstruction is anticipated, closed continuous irrigation is suggested to prevent obstruction.

• If obstruction occurs and it is likely that the catheter material is contributing to obstruction, change the catheter.

• Silicone may be preferable to other materials to reduce the risk of encrustation in long-term catheterized patients who have frequent obstruction.

• Further research is needed on the benefit of irrigating the catheter with acidifying solutions or use of oral urease inhibitors in long-term catheterized patients who have frequent catheter obstruction.

• Unless obstruction is anticipated (eg, as may occur with bleeding after prostatic or bladder surgery), bladder irrigation is not recommended.

• Further research is needed on the use of methanamine to prevent encrustation in patients requiring chronic indwelling catheters who are at high risk for obstruction.

• Use portable ultrasound in patients with low urine output to reduce unnecessary catheter insertions or irrigations (in catheterized patients).

• Changing indwelling catheters or drainage bags at routine, fixed intervals is not recommended. Rather, catheters and drainage bags should be changed based on clinical indications such as infection, obstruction, or when the closed system is compromised.

• Perform hand hygiene immediately before and after insertion or any manipulation of the catheter site or device.