There was an error in the article "Seven Critical Success Factors for the On-Call Home Care Nurse" by Ellen W. Leff and Dale Ellen Walsh in the July 2005 issue of HHN (Figure 2, p. 439).

The figure instructed the nurse to "call MD for irrigation order" if there was absent/decreased urine and a previous presence of sediment/mucus. Best practice guidelines advise not to irrigate long-term indwelling urinary catheters due to sluggish flow or blockage from encrustation because irrigation can increase the incidence of urinary tract infection. The reason the catheter blocks or the flow diminishes is the development of biofilm along the lumen of the catheter. Irrigation with normal saline serves to introduce pathogens into the bladder and can also cause trauma to the bladder lining, thus creating a portal of entry for the bacteria. The following two sources clarify the current recommendations.

Mercer Smith, J. (2003). Indwelling catheter management: From habit-based to evidenced-based practice. Ostomy Wound Management, 49 (12), 34-35.

National Guideline Clearing House. (2005). Care of patients with long-term urinary catheters. Accessed July 27, 2005 at http://www.guideline.gov/summary/summary.aspx?view_id=1&doc_id=5069

HHN apologizes for the error.