Pt ID? Room #?
Reason for catheter
- Known or suspected urinary tract obstruction
- Neurogenic bladder dysfunction/Urinary retention
- Urologic surgery, bladder injury, pelvic surgery
- other surgical patients postop day 0-1
- urinary incontinence w/ stage III or stage IV pressure ulcer
- Need for accurate measurement of urinary output in ICU patient
- Gross hematuria w/potential clots
- Epidural catheter still in place
- Palliativw care for terminally ill
- Immmobility (complete bedrest)
- Bard Standard
- Bard Urine Meter
- Condom Cath
- Temp Sensing
Red Tamper-evident Seal Present and intact?
Foley Catheter Secured to patient?
If yes, Type of securement?
NO drainage tubing Looped or Kinked/ dependent loops observed?
Green Sheeting clip is being used- to sheet/gown?
Drain tube and bag below bladder?
Bag/Meter is not touching floor?
System labeled with insertion information?
Device Insertion Location
# Foley days?