Catheter Related Urinary ComplaintsAPPROACH

RENAL AND URINARY · 19 SECTIONS

⚲

640 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Oliguria And Anuria Catheter Related Urinary Complaints Dialysis Patient Presentations Flank Pain And Renal Colic Concern Urinary Retention Hematuria Scrotal Pain

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Environmental and Exposure4▾

01History/hx82

Presenting complaint and context

›Symptom characterization

›Primary concern

›Catheter not draining

›Leakage around catheter

›Suprapubic discomfort

›Dysuria despite catheter

›Hematuria

›Fever or chills

›Flank pain

›New confusion

›Catheter details

›Catheter type

›Urethral Foley

›Suprapubic catheter

›Intermittent catheterization

›Indication for catheter

›Acute urinary retention

›Chronic retention

›Neurogenic bladder

›Postoperative

›Comfort care

›Date and setting of insertion

›Catheter size French

›Balloon volume used

›Three way catheter presence

›Recent catheter change

›Bag position and tubing kinks

›Prior difficult catheterizations

›Timeline and trajectory

›Sudden vs gradual onset

›Intermittent vs persistent symptoms

›Prior similar episodes

›Baseline urine output pattern

OPQRST for pain or discomfort

›OPQRST framework

›Onset

›Time of onset relative to catheter placement or change

›Onset relative to traction or accidental pull

›Provocation and palliation

›Worse with bladder filling

›Worse with movement or traction

›Relief after drainage

›Relief after irrigation

›Quality

›Pressure

›Cramping

›Burning

›Sharp pain

›Region and radiation

›Suprapubic

›Urethral meatus

›Perineal

›Flank

›Severity

›Mild

›Moderate

›Severe

›Timing

›Constant

›Colicky

›Occurs with catheter manipulation

Associated symptoms

›Symptom cluster

›Urinary

›Cloudy urine

›Foul odor

›Sediment

›Reduced output

›Bypassing leakage

›Bladder spasms

›Infectious and systemic

›Fever

›Rigors

›Malaise

›New delirium

›Upper tract involvement

›Flank pain

›Nausea

›Vomiting

›Bleeding and trauma

›Gross hematuria

›Clots

›Bleeding at meatus

›Perineal bruising

02Alarm Features/alarm36

Immediate escalation triggers

›Time critical features

›Suspected sepsis

›Hypotension

›Tachypnea

›Altered mental status

›Lactate elevation

›Suspected urinary obstruction with complications

›Anuria

›Rising creatinine

›Severe suprapubic distension

›Hydronephrosis on ultrasound

›Significant bleeding

›Clot retention with pain and distension

›Ongoing gross hematuria with hemodynamic instability

›Traumatic catheter complication

›Suspected urethral injury

›Unable to pass catheter after multiple attempts

›Severe penile or perineal pain with bleeding

High risk populations

›Vulnerable groups

›Immunocompromised

›Neutropenia

›Transplant

›High dose steroids

›Older adults

›Delirium presentation

›Atypical infection signs

›Anticoagulated patients

›Warfarin

›DOAC

›Antiplatelets

›Spinal cord injury

›Autonomic dysreflexia risk

›Blunted pain perception

›Pregnancy

›Sepsis risk escalation

›Imaging considerations

03Medications/meds31

Current and recent medications

›Medication reconciliation

›Antibiotic exposure

›Recent antibiotics within 90 days

›Prior resistant organisms history

›Drugs affecting urinary function

›Anticholinergics

›Opioids

›Alpha agonists

›Sympathomimetics

›Anticoagulants and antiplatelets

›Warfarin

›Apixaban

›Rivaroxaban

›Dabigatran

›Clopidogrel

›Aspirin

›Nephrotoxins

›NSAIDs

›ACE inhibitors

›ARBs

›Diuretics

Medication considerations for likely therapies

›Therapy constraints

›Antibiotic selection constraints

›Allergy history

›QT prolongation risk

›Drug interactions

›Renal dose adjustment requirement

›Analgesia and spasm control constraints

›Delirium risk with anticholinergics

›Urinary retention risk with opioids

›Fall risk with sedating agents

04Diet/diet14

Hydration and intake

›Intake pattern

›Reduced oral intake

›Poor thirst

›Vomiting

›Dehydration contributors

›Diuretics

›Heat exposure

›Diarrhea

›Urine concentration context

›Dark urine

›Low volume baseline

›Catheter maintenance routine

›Usual daily fluid intake

›Routine bag emptying frequency

05Review of Systems/ros29

Focused ROS

›System review

›Constitutional

›Fever

›Chills

›Weight loss

›Fatigue

›Cardiopulmonary

›Chest pain

›Dyspnea

›Palpitations

›Gastrointestinal

›Abdominal pain

›Nausea

›Vomiting

›Constipation

›Genitourinary

›Flank pain

›Suprapubic pain

›New incontinence

›Penile pain

›Vaginal symptoms

›Neurologic

›Confusion

›Weakness

›Headache

›Skin and wound

›Suprapubic site redness

›Drainage at suprapubic site

›Perineal skin breakdown

06Collateral History and Family History/chafh17

Collateral and functional baseline

›Collateral inputs

›Source reliability

›Caregiver report

›Long term care documentation

›Baseline function

›Baseline cognition

›Baseline mobility

›Care environment

›Catheter care performed by

›Recent catheter supply changes

Family history and inherited risk

›Familial risk

›Urologic malignancy history

›Bladder cancer

›Prostate cancer

›Bleeding disorders

›Hemophilia

›Von Willebrand disease

07Risk Factors/rf34

Device and procedure related risks

›Catheter risk profile

›Duration of catheterization

›Less than 7 days

›7 to 30 days

›More than 30 days

›Recent instrumentation

›Catheter insertion within 48 hours

›Traumatic insertion history

›Catheter care issues

›Bag above bladder level

›Dependent loop in tubing

›Poor securement and traction

›Encrustation risk

›Long term catheter

›Prior blockage episodes

Host risk factors

›Patient risk profile

›Diabetes mellitus (E11.9)

›Hyperglycemia

›Recurrent infections

›Chronic kidney disease (N18.9)

›Reduced reserve for obstruction

›Medication dosing impact

›Neurogenic bladder (N31.9)

›Incomplete emptying

›Autonomic dysreflexia risk

›Benign prostatic hyperplasia (N40.1)

›Difficult catheter passage

›Retention recurrence

›Urolithiasis history (N20.0)

›Obstruction risk

›Hematuria risk

›Immunosuppression

›Chemotherapy

›Transplant medications

08Differential Diagnosis/ddx54

Life threatening

›Cannot miss diagnoses

›Urosepsis (A41.9)

›Fever with hypotension

›Altered mental status

›Obstructive uropathy with AKI (N13.9)

›Anuria

›Hydronephrosis

›Pyelonephritis (N10)

›Fever

›Flank pain

›Urethral injury (S37.3)

›Blood at meatus

›Inability to pass catheter

›Fournier gangrene (N49.3)

›Perineal pain out of proportion

›Crepitus

›Systemic toxicity

Common

›Frequent etiologies

›Catheter obstruction

›Kinked tubing

›Dependent loop

›Sediment or encrustation

›Clot obstruction

›Bladder spasms with bypassing

›Leakage around catheter

›Cramping suprapubic pain

›Catheter associated urinary tract infection (T83.511)

›New fever

›Suprapubic tenderness

›Asymptomatic bacteriuria with catheter

›Positive culture without symptoms

›Over treatment risk

›Traction related urethral irritation

›Meatal pain

›Small bleeding

Less common and mimics

›Alternative explanations

›Prostatitis (N41.0)

›Perineal pain

›Systemic symptoms

›Epididymo orchitis (N45.1)

›Scrotal pain

›Swelling

›Bladder tumor bleeding (C67.9)

›Painless gross hematuria

›Recurrent clots

›Anticoagulant associated hematuria

›Recent anticoagulant initiation

›Supratherapeutic INR

›Interstitial cystitis bladder pain syndrome (N30.10)

›Chronic pain pattern

›Negative infection workup

›Vaginitis or urethritis

›External burning

›Discharge

09Past Medical History/pmh25

Relevant medical and surgical history

›Urologic history

›Prior urinary retention episodes

›Prior catheter placements

›Prior failed void trials

›Prior urologic surgery

›TURP

›Prostatectomy

›Urethral stricture procedures

›Known strictures or false passages

›History of difficult catheter insertion

›Prior urology involvement

›Stone disease history

›Prior obstruction

›Prior lithotripsy

Devices and baseline function

›Baseline status

›Baseline voiding method

›Spontaneous voiding

›Intermittent catheterization

›Chronic indwelling catheter

›Implanted or chronic devices

›Suprapubic catheter tract maturity

›Ureteral stent

›Prior infections

›Prior resistant organisms

›Prior bacteremia

10Physical Exam/exam50

General and vital signs

›Global assessment

›Appearance

›Toxic

›Comfortable

›Vitals pattern

›Fever

›Tachycardia

›Hypotension

›Tachypnea

›Perfusion

›Delayed capillary refill

›Cool extremities

Abdominal and genitourinary exam

›Targeted exam

›Abdomen

›Suprapubic distension

›Suprapubic tenderness

›Peritoneal signs

›Flanks

›CVA tenderness

›Flank mass

›Catheter system inspection

›Tubing kinks

›Dependent loop

›Bag below bladder level

›Securement and traction

›External genitalia

›Blood at meatus

›Meatal ulceration

›Penile edema

›Paraphimosis

›Scrotum and perineum

›Tenderness

›Swelling

›Skin necrosis

›Crepitus

›Suprapubic catheter site

›Erythema

›Purulent drainage

›Skin breakdown

Neurologic and special population considerations

›High risk findings

›Mental status

›Delirium

›Lethargy

›Spinal cord injury autonomic dysreflexia

›Severe headache

›Hypertension

›Bradycardia

›Volume status

›Dry mucous membranes

›Orthostasis

11Lab Studies/labs33

Core labs and indications

›Laboratory evaluation

›Urinalysis

›Pyuria interpretation limits in catheterized patients

›Hematuria quantification

›Urine culture

›Obtain from sampling port after disinfection

›Prefer after catheter change when feasible for CAUTI evaluation

›CBC

›Leukocytosis

›Neutropenia

›Electrolytes and creatinine

›AKI pattern

›Hyperkalemia from obstruction

›Lactate

›Sepsis risk stratification

›Trend with resuscitation

›Blood cultures

›If systemic toxicity

›If hypotension

›Coagulation studies

›If gross hematuria

›If anticoagulated

›If procedure anticipated

Interpretation pitfalls

›Common traps

›Asymptomatic bacteriuria in chronic catheterization

›Positive UA without symptoms

›Avoid antibiotics unless symptomatic or specific indications

›Pyuria in catheterized patients

›Not specific for infection

›Correlate with systemic or localized symptoms

›Early sepsis physiology

›Normal temperature does not exclude infection

›Delirium may be primary presentation

12Imaging/img34

Scoring Systems

›Risk frameworks

›Sepsis screening tools

›qSOFA criteria context

›Limitations for ED decision making

›Hematuria evaluation frameworks

›Gross hematuria considered high risk

›Outpatient malignancy workup usually required if stable

MRI

›MRI considerations

›Rare indications in catheter complaints

›Suspected spinal cord pathology with new neuro deficits

›Pelvic soft tissue infection extent when CT contraindicated

›Constraints

›Limited availability in unstable patients

›Implanted device compatibility considerations

›CT pathways

›CT abdomen pelvis with contrast

›Suspected complicated infection

›Suspected Fournier gangrene extent

›CT without contrast

›Suspected obstructing stone

›Suspected emphysematous infection when contrast limited

›CT urogram local protocol dependent

›Persistent gross hematuria with concern for upper tract source

›Requires stable renal function and contrast suitability

Ultrasound

›Ultrasound use cases

›Bladder ultrasound

›Retention despite catheter

›Clot burden suggestion

›Renal ultrasound

›Hydronephrosis from obstruction

›Obstructive uropathy triage

›POCUS pitfalls

›Catheter balloon in urethra may mimic small bladder volume

›Early obstruction may have absent hydronephrosis

13Special Tests/spec24

Bedside catheter troubleshooting

›Catheter function checks

›Mechanical causes

›Tubing kink correction

›Bag below bladder level

›Remove dependent loop

›Patency assessment

›Gentle irrigation with sterile normal saline

›Return flow assessment

›Replacement strategy

›Replace with same size if suspected blockage

›Upsize if recurrent obstruction from debris local protocol dependent

›Difficult catheter passage precautions

›Stop attempts if resistance and bleeding

›Early urology consultation if suspected stricture or false passage

Gross hematuria and clot retention bedside pathway

›Clot management

›Three way catheter

›Indication gross hematuria with clots

›Larger bore catheter consideration

›Manual irrigation

›Remove clots until clear return

›Avoid excessive force if suspected injury

›Continuous bladder irrigation local protocol dependent

›Maintain light pink effluent target

›Monitor for recurrent obstruction

14ECG/ecg20

Indications in catheter related complaints

›ECG triggers

›Sepsis physiology

›Persistent tachycardia

›Hypotension

›Electrolyte disturbance concern

›Hyperkalemia risk in obstruction

›AKI with peaked T wave concern

›Medication related risks

›QT prolonging antibiotics consideration

›Antiemetics with QT risk

High risk patterns to recognize

›Actionable findings

›Hyperkalemia patterns

›Peaked T waves

›Widened QRS

›Ischemia in older or septic patients

›ST elevation

›New ST depression

›Arrhythmias in sepsis

›Atrial fibrillation with RVR

›SVT

15Assessment/ax28

Problem representation

›Working problem list

›Catheter malfunction with retention

›Bladder distension

›Low or no output

›Suspected catheter associated infection

›Local symptoms

›Systemic symptoms

›Gross hematuria

›Clots

›Anticoagulant exposure

›Traumatic catheter complication

›Bleeding at meatus

›Severe pain with attempts

›Suspected obstructive uropathy

›Rising creatinine

›Hydronephrosis

Severity and risk stratification

›Risk tiering

›Low risk

›Normal vitals

›Symptoms resolve after troubleshooting

›Moderate risk

›Persistent symptoms after catheter change

›UTI symptoms without sepsis

›High risk

›Sepsis physiology

›AKI

›Inability to catheterize

›Ongoing gross hematuria with clots

16Plan/plan66

First 5 minutes critical patient workflow

›Immediate stabilization

›Monitoring

›Continuous pulse oximetry

›Cardiac monitor if unstable

›Frequent blood pressure cycling

›Access and labs

›IV access

›Lactate and blood cultures if sepsis concern

›Fluids and pressors

›Crystalloid bolus if hypotension

›Vasopressor if persistent shock local protocol dependent

›Antibiotics timing

›If septic shock start within 1 hour

›If sepsis start after cultures when feasible without delay

Stepwise catheter problem management

›Practical sequence

›Simple mechanical fixes first

›Straighten tubing

›Ensure dependent drainage

›Bladder ultrasound to confirm retention

›Large bladder volume suggests obstruction or malposition

›Small bladder volume suggests low production or diversion

›Catheter irrigation

›Sterile technique

›Stop if severe pain or resistance

›Catheter replacement

›Replace if blocked

›Consider coude catheter in BPH

›Suspected urethral injury pathway

›Stop repeated attempts

›Urology consultation for guidewire assisted placement local protocol dependent

›Suprapubic catheter issues

›Assess tract maturity

›Avoid blind reinsertion if immature tract

›Urgent urology if dislodged with urinary retention

Antibiotics and symptom control

›Treatment options

›Suspected CAUTI without sepsis

›Replace catheter if long term catheter in place

›Antibiotics guided by local antibiogram

›Example adult regimens local protocol dependent

›Ceftriaxone IV 1 g daily

›Piperacillin tazobactam IV 3.375 g every 6 hours

›Ciprofloxacin PO 500 mg every 12 hours

›Avoidance reminders

›Avoid nitrofurantoin for suspected pyelonephritis

›Avoid fluoroquinolones when safer alternatives exist in high risk tendinopathy populations

›Pain and spasm control

›Acetaminophen PO 1000 mg every 6 hours maximum 4000 mg per day

›Ibuprofen PO 400 mg every 6 hours if renal function adequate and bleeding risk acceptable

›Oxybutynin PO 5 mg up to three times daily for bladder spasms if no contraindication

›Hematuria management

›Hold anticoagulants only with clear indication and prescriber alignment local protocol dependent

›Three way catheter and irrigation for clots

›Transfusion threshold based on symptoms and hemodynamics local protocol dependent

Reassessment loop

›Iterative monitoring

›Recheck after interventions

›Pain score

›Urine output

›Vital signs

›Repeat focused exam

›Suprapubic distension

›Flank tenderness

›Escalation triggers

›Persistent anuria

›Worsening vitals

›Rising creatinine

›Recurrent clot retention

17Disposition/dispo36

Level of care criteria

›ICU considerations

›Shock requiring vasopressors

›Persistent hypotension after fluids

›Lactate elevation with instability

›Severe metabolic derangements

›Hyperkalemia with ECG changes

›Severe acidosis local protocol dependent

›Rapidly progressive soft tissue infection

›Fournier gangrene concern

›Need for emergent surgery

›Inpatient admission considerations

›Complicated UTI

›Persistent fever

›Unable to tolerate oral intake

›AKI from obstruction

›Rising creatinine

›Hydronephrosis

›Gross hematuria

›Recurrent clot retention

›Ongoing irrigation needs

›Failed catheter management

›Unable to place catheter

›Need for urologic intervention

›Discharge considerations

›Stable vitals

›No hypotension

›No persistent tachycardia

›Catheter functioning

›Adequate drainage observed

›No significant suprapubic distension

›Symptom control

›Pain controlled

›Nausea controlled

›Follow up reliability

›Access to catheter supplies

›Urology follow up arranged

18Discharge Instructions/di21

Copy discharge instructions

›Patient facing instructions

›Summary

›You were seen for problems related to your urinary catheter

›Your catheter was checked and is now draining

›Catheter care

›Keep the bag below bladder level

›Avoid pulling on the catheter tubing

›Empty the bag regularly

›Medications

›Take antibiotics exactly as prescribed if given

›Do not take extra NSAIDs if kidney disease or bleeding risk

›Follow up

›Contact your catheter clinic or urology within 24 to 72 hours

›If you have a suprapubic catheter issue contact urology urgently

›Return to emergency department now for

›Fever or shaking chills

›New confusion

›Severe abdominal or flank pain

›No urine draining for 2 to 3 hours with bladder fullness

›Large amount of blood or clots in the urine

›Dizziness or fainting

19References/r6

Guidelines and key sources

›Evidence base

›Infectious Diseases Society of America guideline for diagnosis prevention and treatment of catheter associated urinary tract infection in adults 2009

›Centers for Disease Control and Prevention guideline for prevention of catheter associated urinary tract infections updated guidance local protocol dependent

›American Urological Association guidance on evaluation of hematuria 2020 and updates

›Surviving Sepsis Campaign international guidelines for management of sepsis and septic shock 2021 and updates

›Project instructions source

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.

Catheter Related Urinary ComplaintsAPPROACH

RENAL AND URINARY · 19 SECTIONS

⚲

640 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Oliguria And Anuria Catheter Related Urinary Complaints Dialysis Patient Presentations Flank Pain And Renal Colic Concern Urinary Retention Hematuria Scrotal Pain

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Environmental and Exposure4▾

01History/hx82

Presenting complaint and context

›Symptom characterization

›Primary concern

›Catheter not draining

›Leakage around catheter

›Suprapubic discomfort

›Dysuria despite catheter

›Hematuria

›Fever or chills

›Flank pain

›New confusion

›Catheter details

›Catheter type

›Urethral Foley

›Suprapubic catheter

›Intermittent catheterization

›Indication for catheter

›Acute urinary retention

›Chronic retention

›Neurogenic bladder

›Postoperative

›Comfort care

›Date and setting of insertion

›Catheter size French

›Balloon volume used

›Three way catheter presence

›Recent catheter change

›Bag position and tubing kinks

›Prior difficult catheterizations

›Timeline and trajectory

›Sudden vs gradual onset

›Intermittent vs persistent symptoms

›Prior similar episodes

›Baseline urine output pattern

OPQRST for pain or discomfort

›OPQRST framework

›Onset

›Time of onset relative to catheter placement or change

›Onset relative to traction or accidental pull

›Provocation and palliation

›Worse with bladder filling

›Worse with movement or traction

›Relief after drainage

›Relief after irrigation

›Quality

›Pressure

›Cramping

›Burning

›Sharp pain

›Region and radiation

›Suprapubic

›Urethral meatus

›Perineal

›Flank

›Severity

›Mild

›Moderate

›Severe

›Timing

›Constant

›Colicky

›Occurs with catheter manipulation

Associated symptoms

›Symptom cluster

›Urinary

›Cloudy urine

›Foul odor

›Sediment

›Reduced output

›Bypassing leakage

›Bladder spasms

›Infectious and systemic

›Fever

›Rigors

›Malaise

›New delirium

›Upper tract involvement

›Flank pain

›Nausea

›Vomiting

›Bleeding and trauma

›Gross hematuria

›Clots

›Bleeding at meatus

›Perineal bruising

02Alarm Features/alarm36

Immediate escalation triggers

›Time critical features

›Suspected sepsis

›Hypotension

›Tachypnea

›Altered mental status

›Lactate elevation

›Suspected urinary obstruction with complications

›Anuria

›Rising creatinine

›Severe suprapubic distension

›Hydronephrosis on ultrasound

›Significant bleeding

›Clot retention with pain and distension

›Ongoing gross hematuria with hemodynamic instability

›Traumatic catheter complication

›Suspected urethral injury

›Unable to pass catheter after multiple attempts

›Severe penile or perineal pain with bleeding

High risk populations

›Vulnerable groups

›Immunocompromised

›Neutropenia

›Transplant

›High dose steroids

›Older adults

›Delirium presentation

›Atypical infection signs

›Anticoagulated patients

›Warfarin

›DOAC

›Antiplatelets

›Spinal cord injury

›Autonomic dysreflexia risk

›Blunted pain perception

›Pregnancy

›Sepsis risk escalation

›Imaging considerations

03Medications/meds31

Current and recent medications

›Medication reconciliation

›Antibiotic exposure

›Recent antibiotics within 90 days

›Prior resistant organisms history

›Drugs affecting urinary function

›Anticholinergics

›Opioids

›Alpha agonists

›Sympathomimetics

›Anticoagulants and antiplatelets

›Warfarin

›Apixaban

›Rivaroxaban

›Dabigatran

›Clopidogrel

›Aspirin

›Nephrotoxins

›NSAIDs

›ACE inhibitors

›ARBs

›Diuretics

Medication considerations for likely therapies

›Therapy constraints

›Antibiotic selection constraints

›Allergy history

›QT prolongation risk

›Drug interactions

›Renal dose adjustment requirement

›Analgesia and spasm control constraints

›Delirium risk with anticholinergics

›Urinary retention risk with opioids

›Fall risk with sedating agents

04Diet/diet14

Hydration and intake

›Intake pattern

›Reduced oral intake

›Poor thirst

›Vomiting

›Dehydration contributors

›Diuretics

›Heat exposure

›Diarrhea

›Urine concentration context

›Dark urine

›Low volume baseline

›Catheter maintenance routine

›Usual daily fluid intake

›Routine bag emptying frequency

05Review of Systems/ros29

Focused ROS

›System review

›Constitutional

›Fever

›Chills

›Weight loss

›Fatigue

›Cardiopulmonary

›Chest pain

›Dyspnea

›Palpitations

›Gastrointestinal

›Abdominal pain

›Nausea

›Vomiting

›Constipation

›Genitourinary

›Flank pain

›Suprapubic pain

›New incontinence

›Penile pain

›Vaginal symptoms

›Neurologic

›Confusion

›Weakness

›Headache

›Skin and wound

›Suprapubic site redness

›Drainage at suprapubic site

›Perineal skin breakdown

06Collateral History and Family History/chafh17

Collateral and functional baseline

›Collateral inputs

›Source reliability

›Caregiver report

›Long term care documentation

›Baseline function

›Baseline cognition

›Baseline mobility

›Care environment

›Catheter care performed by

›Recent catheter supply changes

Family history and inherited risk

›Familial risk

›Urologic malignancy history

›Bladder cancer

›Prostate cancer

›Bleeding disorders

›Hemophilia

›Von Willebrand disease

07Risk Factors/rf34

Device and procedure related risks

›Catheter risk profile

›Duration of catheterization

›Less than 7 days

›7 to 30 days

›More than 30 days

›Recent instrumentation

›Catheter insertion within 48 hours

›Traumatic insertion history

›Catheter care issues

›Bag above bladder level

›Dependent loop in tubing

›Poor securement and traction

›Encrustation risk

›Long term catheter

›Prior blockage episodes

Host risk factors

›Patient risk profile

›Diabetes mellitus (E11.9)

›Hyperglycemia

›Recurrent infections

›Chronic kidney disease (N18.9)

›Reduced reserve for obstruction

›Medication dosing impact

›Neurogenic bladder (N31.9)

›Incomplete emptying

›Autonomic dysreflexia risk

›Benign prostatic hyperplasia (N40.1)

›Difficult catheter passage

›Retention recurrence

›Urolithiasis history (N20.0)

›Obstruction risk

›Hematuria risk

›Immunosuppression

›Chemotherapy

›Transplant medications

08Differential Diagnosis/ddx54

Life threatening

›Cannot miss diagnoses

›Urosepsis (A41.9)

›Fever with hypotension

›Altered mental status

›Obstructive uropathy with AKI (N13.9)

›Anuria

›Hydronephrosis

›Pyelonephritis (N10)

›Fever

›Flank pain

›Urethral injury (S37.3)

›Blood at meatus

›Inability to pass catheter

›Fournier gangrene (N49.3)

›Perineal pain out of proportion

›Crepitus

›Systemic toxicity

Common

›Frequent etiologies

›Catheter obstruction

›Kinked tubing

›Dependent loop

›Sediment or encrustation

›Clot obstruction

›Bladder spasms with bypassing

›Leakage around catheter

›Cramping suprapubic pain

›Catheter associated urinary tract infection (T83.511)

›New fever

›Suprapubic tenderness

›Asymptomatic bacteriuria with catheter

›Positive culture without symptoms

›Over treatment risk

›Traction related urethral irritation

›Meatal pain

›Small bleeding

Less common and mimics

›Alternative explanations

›Prostatitis (N41.0)

›Perineal pain

›Systemic symptoms

›Epididymo orchitis (N45.1)

›Scrotal pain

›Swelling

›Bladder tumor bleeding (C67.9)

›Painless gross hematuria

›Recurrent clots

›Anticoagulant associated hematuria

›Recent anticoagulant initiation

›Supratherapeutic INR

›Interstitial cystitis bladder pain syndrome (N30.10)

›Chronic pain pattern

›Negative infection workup

›Vaginitis or urethritis

›External burning

›Discharge

09Past Medical History/pmh25

Relevant medical and surgical history

›Urologic history

›Prior urinary retention episodes

›Prior catheter placements

›Prior failed void trials

›Prior urologic surgery

›TURP

›Prostatectomy

›Urethral stricture procedures

›Known strictures or false passages

›History of difficult catheter insertion

›Prior urology involvement

›Stone disease history

›Prior obstruction

›Prior lithotripsy

Devices and baseline function

›Baseline status

›Baseline voiding method

›Spontaneous voiding

›Intermittent catheterization

›Chronic indwelling catheter

›Implanted or chronic devices

›Suprapubic catheter tract maturity

›Ureteral stent

›Prior infections

›Prior resistant organisms

›Prior bacteremia

10Physical Exam/exam50

General and vital signs

›Global assessment

›Appearance

›Toxic

›Comfortable

›Vitals pattern

›Fever

›Tachycardia

›Hypotension

›Tachypnea

›Perfusion

›Delayed capillary refill

›Cool extremities

Abdominal and genitourinary exam

›Targeted exam

›Abdomen

›Suprapubic distension

›Suprapubic tenderness

›Peritoneal signs

›Flanks

›CVA tenderness

›Flank mass

›Catheter system inspection

›Tubing kinks

›Dependent loop

›Bag below bladder level

›Securement and traction

›External genitalia

›Blood at meatus

›Meatal ulceration

›Penile edema

›Paraphimosis

›Scrotum and perineum

›Tenderness

›Swelling

›Skin necrosis

›Crepitus

›Suprapubic catheter site

›Erythema

›Purulent drainage

›Skin breakdown

Neurologic and special population considerations

›High risk findings

›Mental status

›Delirium

›Lethargy

›Spinal cord injury autonomic dysreflexia

›Severe headache

›Hypertension

›Bradycardia

›Volume status

›Dry mucous membranes

›Orthostasis

11Lab Studies/labs33

Core labs and indications

›Laboratory evaluation

›Urinalysis

›Pyuria interpretation limits in catheterized patients

›Hematuria quantification

›Urine culture

›Obtain from sampling port after disinfection

›Prefer after catheter change when feasible for CAUTI evaluation

›CBC

›Leukocytosis

›Neutropenia

›Electrolytes and creatinine

›AKI pattern

›Hyperkalemia from obstruction

›Lactate

›Sepsis risk stratification

›Trend with resuscitation

›Blood cultures

›If systemic toxicity

›If hypotension

›Coagulation studies

›If gross hematuria

›If anticoagulated

›If procedure anticipated

Interpretation pitfalls

›Common traps

›Asymptomatic bacteriuria in chronic catheterization

›Positive UA without symptoms

›Avoid antibiotics unless symptomatic or specific indications

›Pyuria in catheterized patients

›Not specific for infection

›Correlate with systemic or localized symptoms

›Early sepsis physiology

›Normal temperature does not exclude infection

›Delirium may be primary presentation

12Imaging/img34

Scoring Systems

›Risk frameworks

›Sepsis screening tools

›qSOFA criteria context

›Limitations for ED decision making

›Hematuria evaluation frameworks

›Gross hematuria considered high risk

›Outpatient malignancy workup usually required if stable

MRI

›MRI considerations

›Rare indications in catheter complaints

›Suspected spinal cord pathology with new neuro deficits

›Pelvic soft tissue infection extent when CT contraindicated

›Constraints

›Limited availability in unstable patients

›Implanted device compatibility considerations

›CT pathways

›CT abdomen pelvis with contrast

›Suspected complicated infection

›Suspected Fournier gangrene extent

›CT without contrast

›Suspected obstructing stone

›Suspected emphysematous infection when contrast limited

›CT urogram local protocol dependent

›Persistent gross hematuria with concern for upper tract source

›Requires stable renal function and contrast suitability

Ultrasound

›Ultrasound use cases

›Bladder ultrasound

›Retention despite catheter

›Clot burden suggestion

›Renal ultrasound

›Hydronephrosis from obstruction

›Obstructive uropathy triage

›POCUS pitfalls

›Catheter balloon in urethra may mimic small bladder volume

›Early obstruction may have absent hydronephrosis

13Special Tests/spec24

Bedside catheter troubleshooting

›Catheter function checks

›Mechanical causes

›Tubing kink correction

›Bag below bladder level

›Remove dependent loop

›Patency assessment

›Gentle irrigation with sterile normal saline

›Return flow assessment

›Replacement strategy

›Replace with same size if suspected blockage

›Upsize if recurrent obstruction from debris local protocol dependent

›Difficult catheter passage precautions

›Stop attempts if resistance and bleeding

›Early urology consultation if suspected stricture or false passage

Gross hematuria and clot retention bedside pathway

›Clot management

›Three way catheter

›Indication gross hematuria with clots

›Larger bore catheter consideration

›Manual irrigation

›Remove clots until clear return

›Avoid excessive force if suspected injury

›Continuous bladder irrigation local protocol dependent

›Maintain light pink effluent target

›Monitor for recurrent obstruction

14ECG/ecg20

Indications in catheter related complaints

›ECG triggers

›Sepsis physiology

›Persistent tachycardia

›Hypotension

›Electrolyte disturbance concern

›Hyperkalemia risk in obstruction

›AKI with peaked T wave concern

›Medication related risks

›QT prolonging antibiotics consideration

›Antiemetics with QT risk

High risk patterns to recognize

›Actionable findings

›Hyperkalemia patterns

›Peaked T waves

›Widened QRS

›Ischemia in older or septic patients

›ST elevation

›New ST depression

›Arrhythmias in sepsis

›Atrial fibrillation with RVR

›SVT

15Assessment/ax28

Problem representation

›Working problem list

›Catheter malfunction with retention

›Bladder distension

›Low or no output

›Suspected catheter associated infection

›Local symptoms

›Systemic symptoms

›Gross hematuria

›Clots

›Anticoagulant exposure

›Traumatic catheter complication

›Bleeding at meatus

›Severe pain with attempts

›Suspected obstructive uropathy

›Rising creatinine

›Hydronephrosis

Severity and risk stratification

›Risk tiering

›Low risk

›Normal vitals

›Symptoms resolve after troubleshooting

›Moderate risk

›Persistent symptoms after catheter change

›UTI symptoms without sepsis

›High risk

›Sepsis physiology

›AKI

›Inability to catheterize

›Ongoing gross hematuria with clots

16Plan/plan66

First 5 minutes critical patient workflow

›Immediate stabilization

›Monitoring

›Continuous pulse oximetry

›Cardiac monitor if unstable

›Frequent blood pressure cycling

›Access and labs

›IV access

›Lactate and blood cultures if sepsis concern

›Fluids and pressors

›Crystalloid bolus if hypotension

›Vasopressor if persistent shock local protocol dependent

›Antibiotics timing

›If septic shock start within 1 hour

›If sepsis start after cultures when feasible without delay

Stepwise catheter problem management

›Practical sequence

›Simple mechanical fixes first

›Straighten tubing

›Ensure dependent drainage

›Bladder ultrasound to confirm retention

›Large bladder volume suggests obstruction or malposition

›Small bladder volume suggests low production or diversion

›Catheter irrigation

›Sterile technique

›Stop if severe pain or resistance

›Catheter replacement

›Replace if blocked

›Consider coude catheter in BPH

›Suspected urethral injury pathway

›Stop repeated attempts

›Urology consultation for guidewire assisted placement local protocol dependent

›Suprapubic catheter issues

›Assess tract maturity

›Avoid blind reinsertion if immature tract

›Urgent urology if dislodged with urinary retention

Antibiotics and symptom control

›Treatment options

›Suspected CAUTI without sepsis

›Replace catheter if long term catheter in place

›Antibiotics guided by local antibiogram

›Example adult regimens local protocol dependent

›Ceftriaxone IV 1 g daily

›Piperacillin tazobactam IV 3.375 g every 6 hours

›Ciprofloxacin PO 500 mg every 12 hours

›Avoidance reminders

›Avoid nitrofurantoin for suspected pyelonephritis

›Avoid fluoroquinolones when safer alternatives exist in high risk tendinopathy populations

›Pain and spasm control

›Acetaminophen PO 1000 mg every 6 hours maximum 4000 mg per day

›Ibuprofen PO 400 mg every 6 hours if renal function adequate and bleeding risk acceptable

›Oxybutynin PO 5 mg up to three times daily for bladder spasms if no contraindication

›Hematuria management

›Hold anticoagulants only with clear indication and prescriber alignment local protocol dependent

›Three way catheter and irrigation for clots

›Transfusion threshold based on symptoms and hemodynamics local protocol dependent

Reassessment loop

›Iterative monitoring

›Recheck after interventions

›Pain score

›Urine output

›Vital signs

›Repeat focused exam

›Suprapubic distension

›Flank tenderness

›Escalation triggers

›Persistent anuria

›Worsening vitals

›Rising creatinine

›Recurrent clot retention

17Disposition/dispo36

Level of care criteria

›ICU considerations

›Shock requiring vasopressors

›Persistent hypotension after fluids

›Lactate elevation with instability

›Severe metabolic derangements

›Hyperkalemia with ECG changes

›Severe acidosis local protocol dependent

›Rapidly progressive soft tissue infection

›Fournier gangrene concern

›Need for emergent surgery

›Inpatient admission considerations

›Complicated UTI

›Persistent fever

›Unable to tolerate oral intake

›AKI from obstruction

›Rising creatinine

›Hydronephrosis

›Gross hematuria

›Recurrent clot retention

›Ongoing irrigation needs

›Failed catheter management

›Unable to place catheter

›Need for urologic intervention

›Discharge considerations

›Stable vitals

›No hypotension

›No persistent tachycardia

›Catheter functioning

›Adequate drainage observed

›No significant suprapubic distension

›Symptom control

›Pain controlled

›Nausea controlled

›Follow up reliability

›Access to catheter supplies

›Urology follow up arranged

18Discharge Instructions/di21

Copy discharge instructions

›Patient facing instructions

›Summary

›You were seen for problems related to your urinary catheter

›Your catheter was checked and is now draining

›Catheter care

›Keep the bag below bladder level

›Avoid pulling on the catheter tubing

›Empty the bag regularly

›Medications

›Take antibiotics exactly as prescribed if given

›Do not take extra NSAIDs if kidney disease or bleeding risk

›Follow up

›Contact your catheter clinic or urology within 24 to 72 hours

›If you have a suprapubic catheter issue contact urology urgently

›Return to emergency department now for

›Fever or shaking chills

›New confusion

›Severe abdominal or flank pain

›No urine draining for 2 to 3 hours with bladder fullness

›Large amount of blood or clots in the urine

›Dizziness or fainting

19References/r6

Guidelines and key sources

›Evidence base

›Infectious Diseases Society of America guideline for diagnosis prevention and treatment of catheter associated urinary tract infection in adults 2009

›Centers for Disease Control and Prevention guideline for prevention of catheter associated urinary tract infections updated guidance local protocol dependent

›American Urological Association guidance on evaluation of hematuria 2020 and updates

›Surviving Sepsis Campaign international guidelines for management of sepsis and septic shock 2021 and updates

›Project instructions source

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.