While caring for a patient with an indwelling catheter, which intervention are important for the nurse to include in the plan of care? (Select all that apply)

Effective indwelling catheter care focuses on preventing infection and ensuring mechanical patency of the drainage system. Nurses must adhere to aseptic principles and provide meticulous perineal hygiene to minimize the risk of catheter-associated urinary tract infections, which significantly increase patient morbidity and healthcare costs. A. To safely remove an indwelling catheter, the nurse must ensure the anchoring balloon is completely deflated by withdrawing all sterile water via the inflation port. Failing to deflate the balloon before withdrawal would cause significant urethral trauma, mucosal tearing, and potentially permanent damage to the urinary sphincter. B. Monitoring the drainage system is essential to ensure there are no kinks or obstructions that could lead to bladder overdistention. Noting the urine level and characteristics (color, clarity, odor) allows the nurse to assess renal function and identify early signs of infection or hematuria requiring medical intervention. C. Regular hygiene of the urethral meatus and the external portion of the catheter is a standard intervention to reduce the microbial load at the insertion site. Using mild soap and water during daily care helps prevent the migration of bacteria up the catheter lumen, thereby reducing the risk of infection. D. Ambulation is highly encouraged for patients with indwelling catheters unless contraindicated by other medical conditions. Mobility helps prevent complications such as deep vein thrombosis and pneumonia. The nurse simply needs to ensure the drainage bag is secured to the leg or a mobile stand during movement. E. This statement is incorrect and dangerous. The drainage bag must always be kept below the level of the bladder to prevent the backflow (reflux) of contaminated urine from the bag into the bladder. Placing the bag even with the bed increases the risk of gravity-induced reflux and subsequent infection.