This patient's indwelling urinary catheter should be removed now. The prevention of catheter-associated urinary tract infection (CAUTI) relies on using urinary catheters only if they are essential to the patient's care and only for as brief a period of time as possible. The risk for a CAUTI increases by 3% to 7% each day a urinary catheter is in place. This translates to a risk for CAUTI of up to 70% when a urinary catheter has been in place for 10 days. Although urinary catheters are useful in select patients when fluid balance must be managed carefully, they should not be used routinely in hospitalized patients, in patients not requiring detailed information about urine output, or for convenience of the patient or staff. Appropriate indications for a urinary catheter include perioperative use for selected surgeries (should be removed before the end of the second postoperative day), need for accurate measurement of urine output in critically ill patients in the ICU, management of acute urinary retention or bladder outlet obstruction, assistance in open sacral or perineal wound healing for patients who are incontinent, and, as an exception, end-of-life patient comfort if needed. Urinary catheters should be inserted by trained personnel following aseptic technique and maintained in a manner that minimizes the chance of contamination or introduction of organisms into the bladder (that is, using a closed drainage system, gravity drainage, and keeping the drainage bag off the floor).

Changing a urinary catheter, whether at the time of hospital admission from the emergency department or routinely (such as every 3 or 5 days), does not decrease the risk for a CAUTI and should not be done for that purpose.

In this patient with chronic kidney disease and decompensated heart failure, monitoring diuretic effect with standard urine collection procedures should be adequate to guide therapeutic decision making. Kidney function remaining above baseline is not an indication for continuing the indwelling urinary catheter. Therefore, continued use of an indwelling catheter has no clear indication.