Urinary Catheterization Indwelling Catheters

Urinary Catheterization

Urinary catheterisation: indwelling catheters

Urinary catheterization: indwelling catheters

In the medical field, the uses of indwelling catheters have become a common patient care intervention (Clinical Review, 2009). In addition, this intervention has proven to have substantial risks; infection is the most common. However, nurses can assist in prevention of catheter-associated urinary tract infections by incorporating aseptic methods when doing insertions, following best practice by quickly changing catheters, and embracing hand hygiene when doing insertion or handling catheters. In addition, catheterization is a painful process; therefore, the patient should consent to the procedure, after they are made aware of the benefits and risks associated with the procedure.

Urinary catheterization is the practice of inserting a hollow tube into a bladder using an aseptic method to enable drainage of urine or instillation of fluids as an intervention in the medical field. Some 3000 years ago, owing to inadequate resources and knowledge, people used reeds to drain the urinary bladder. This clinical practice, urinary catheterization, applies only when it is medically significant and the catheter should remain in position for a short period. In respect to this, leaving the catheter intact risks the development of a catheter-associated problem, such as UTI (Robinson, 2007).

This paper outlines the procedure of catheterization and borrows from research carried out on the topic of catheterization to help in developing this analytical report. The aim of the paper was to evaluate current practice in relation to indwelling catheters and urinary catheterization. In part of this analysis, this paper borrows from a research carried out in a hospital-based prospective study to offer alternatives to the over use of indwelling catheters in acute hospital settings (Bhatia et al., 2010).

Introduction

Urinary Tract Infections have substantial influence and account for a substantial percentage of all health care associated infections (Leaver, 2007). In addition, UTIs are the most general nosocomial infections in the intensive care unit. Urinary catheters are frequently used in the ICUs for regular and exact examination of urinary output. Once inserted, the catheters tend to remain in place after appropriate indications that a patient may need the interventions. In addition, these urinary tract infections in ill patients make the patients stay for a long time in hospitals and increases the morality rates.

Therefore, in a bid to prevent catheter associated urinary tract infections (CAUTIs), the medical practitioners have adopted several strategies such as catheter materials, drainage systems, insertion techniques and anti-infective agents to prevent CAUTIs. However, among all these methods, the medical practitioners have to discourage the continuous use of catheters. This is a significant intervention, but these catheters bring rise to infections and other complications, which may lead to high mortality rates in the critically ill patients. Apart from limiting indwelling catheter use, the health practitioners should also remove the catheters, as soon there is an indication that their use is no longer present (Pomfret).

Background

CAUTIs are healthcare associated infections acquired during the process of receiving medication for other health complications within a healthcare setting (Robinson, 2009). Research acknowledges that CAUTIs qualify as an infection resulting from the catheter interventions, and approximately, 10-12% of the hospital patients and four percent of patients in the community have urinary catheters. In addition, Nosocomial (UTIs) develop in almost five percent of patients who undergo catheterization in the United States, and an estimate of 80% of other patients are because of urinary catheters. Some of the complications that arise from catheterization include fever, pyelonephritis, urinary tract stones and renal inflammation.

UTIs also prolong the stay in hospital and increase the costs involved in managing the disease (Leaver, 2007). One of the essential reasons for wrong catheterization is the lack of the widely accepted guidelines in respect to IUTC placement in patients. For instance, these catheters apply after chemotherapy, increasing comfort in critically ill patients, managing incontinence, measuring urine output in critically ill patients, pre- or post bladder operation, and after radiology tests (Dailly, 2011). Professionals, who perform, teach and offer advice on urinary catheterization should follow evidence-based regulations:

Catheterize only if absolutely necessary

Review need for catheterization regularly

Remove catheter as soon as possible

Document insertion, changes and care in individual catheter care regimen

Use lubricant from single-use container (Mangnall)

Do not change catheters or empty drainage bags routinely but when clinically indicated.

Despite the limited research on this topic, Newman (2007) suggests that health professionals should rely on their practical knowledge to realize that without any form of catheter securment, damage must occur to the urethra and meatus (Bhatia et al., 2010). In addition, constant tension will have to inflict discomfort to the patient (Wilson, 2008). Gray (2008) suggests that it is significant to recommend and implement regular securement in patients with both short- and long-term indwelling urinary catheters (Mangnall, 2011). Newman (2007), in his prior studies, suggest that the best method of stabilizing urinary catheters lacks a definition; however, it is significant to select a device that will suit the patient's needs.

In a bid to improve quality life, this should reflect by providing comfortable and secure devices (Fisher, 2010). Current researchers suggest that there are a number of growing devices, available on prescription, purchase and enable securing urinary catheters. Much of the early studies suggest that adhesive and non-adhesive devices are mostly available (Fisher, 2010). Despite the challenge of inserting catheters in needy patients, a literature review, reveals that there are no tested devices, or available devices to assist nurses in this procedure (Pelter and Stephens, 2008).

Catheterization Procedure

Step one: This involves evaluating and finding a situation, which requires this intervention. The district nurse should do the evaluation in a community setting as part of the single evaluation process (Clarkson and Booth). Community staff nurses can then take over in maintenance evaluation and monitoring the catheter. However, it is important that nurses keep accurate records of the patient's notes clearly showing:

The catheter size

The manufacturer of the catheter

The date of insertion

The catheter batch number

The expiry date

The next date of changing the catheter in respect to the manufacturer's instructions

The amount of water injected into the balloon.

Step two: This step involves the consideration of other options rather than catheterization to deliver the same results. These include referral to an advisor, appropriate toileting regimens and retraining the bladder. In addition, referral to t euro-gynecology is appropriate.

Step three: In case there is no other available option, there is a need to determine the type of catheterization needed; long-term or short-term (Clarkson and Booth).

Step four: At this stage, the nurse should discuss with the patient using the appropriate language; the discussions will involve the benefits and risks, and the patient giving consideration of his or her age, ability and mental status. Catheterization is frightening and painful; additionally, it carries risks of infection, and trauma (Clarkson and Booth). In this step, it is important to engage the patient in making the decisions.

Step five: In this step, the nurse will need to involve another person either a family member, or other nurses in the decision-making process. In addition, if there are family members using catheters, it is important to involve them in the process (Bhatia et al., 2010). Within primary care, health promotion and appropriate training will enhance self-management.

Step six: In this step, the nurse should evaluate whether the patient was able to provide a valid consent. The nurse should consider the legal implications such as the Trust policy. In addition, the nurse should document the patient's consent, whether verbal or written. However, written consent is preferable in a first catheterization (Bhardwaj, Pickard and Rees, 2010).

Step seven: The device needed will relate to the type of catheterization agreed. The nurses should follow the manufacturer's guidelines with all the medical equipment (Clarkson and Booth). The nurse should always use international measures, and carrying out the process will require doing it as an aseptic technique in the patient's home. Trusts provide sterile catheterization kits for the procedure, which will contain:

A solution for cleansing the skin

Sterile paper sheet to position around the urethra

Receiving bowl to hold residual urine

Syringe and water for filling the balloon

A topical anesthetic gel

Sterile catheter to attach to the insertion catheter

Step eight: Undertake the procedure in an able manner; however, if one inadequately trained they should not undertake the procedure. In addition, this step will require supervision and the Trust will provide a competency framework that one should work accordingly (Clarkson and Booth).

Step nine: On completion of the procedure, the catcher bag will hold draining urine. Afterwards, the nurse should complete the documentation and the patient's record including the product name, other products used. In addition, the nurse should record the lot number, batch number, Charriere size, balloon size, expiry date and date of next change (Booth and Clarkson, ).

Catheter Insertion

Catheterization is an aseptic process and healthcare practitioners should have appropriate training and competency when carrying out the procedure (Robinson, 2008). Before insertion, the physicians should clean the urethra meatus with sterile saline. In addition, an appropriate lubricant from a single-use container is significant to reduce trauma and infection (Narzako). There is no advantage of using antiseptic preparations over normal saline for cleaning; therefore, physicians should follow the recommendations. In addition, the use of lubrication is to ease discomfort and reduce friction during the procedure (Mangnall).

Research suggests that catheterization in women is a challenge compared to men, because in women, the urethra's location is in the vulvas vestibule (Pelter and Stephens, 2008). There are two methods of catheter insertion. One is by using sterile gloves and the second one is without gloves. The latter is commonly used because risk of contamination is low; however, there is no literature to support this. If the patient lacks a palpable bladder, then it is significant to fill the bladder with at least 300ml prior to insertion of a catheter. However, for patients with a history of lower abdominal surgery, then it is appropriate to perform an open surgery to insert the catheter.

Risks of Catheterization

Infection: Although insertion is an aseptic procedure, microorganisms can find their way in on insertion or via the catheter leading to CAUTIs. For this reason, some products have clorhexidine; however, some bacteria responsible for catheter encrustation, Proyeus mirabilis, are resistant to chlorhexidine. Therefore, patient remains vulnerable to catheter related tissue damage, such as trauma, skin opening at the tract, and necrosis (Wilson, 2013). Indwelling urinary catheterizations carry risks and the risk of these complications relates to the duration of catheterization. The risks include; Tissue damage, bladder damage, infection and catheter encrustation and blockage (Nazarko, 2007).

Tissue damage: This is because of an inflammatory reaction, owing to the fact that the catheter is new to the body and may cause inflammation. The response may have mild or severe effects to an individual. Mild outcomes include oedema, while severe responses include hemorrhage. In addition, the catheters are made of silicone, latex, and some reactive elements, which call for selection of an appropriate catheter to minimize the risk of reaction.

Bladder damage: The catheter undertakes the task of the bladder; therefore, catheterization, and continuous drainage to take over the bladder's job, reduces the bladder's capacity. In addition, these catheters may cause the bladder to misshapen (Mangnall, 2011).

Alternatives to Placing an Indwelling Catheter

An indwelling catheter is only necessary when there is a need. In addition, its stay should not exceed than necessary. However, it is significant to consider alternatives before recommending an indwelling catheter and should consider as the last resort when all other options fail. Other alternatives include intermittent catheterization, or a male external catheter. In addition, when appropriate, patents may use suprapubic catheter, compared to an indwelling catheter. This is because, intermittent catheterization is appropriate in comparison to indwelling catheter, if it is medically fit and practically applicable for the patient.

Measures to Prevent Infections

Hand washing

Hand initiated transmission is a significant element in increasing infections to patients, which stresses the influence of hand hygiene and the usage of protective equipment such as gloves and aprons. Hand washing is an essential clinical practice before cleaning procedures to prevent HCAI (Bhatia et al., 2010). WHO emphasizes that this practice is important and this organization aims to implement hand hygiene as an appropriate clinical practice when handling catheterization (Wilson, 2008; Wilson 2013). This practice is significant and adoption will help to accomplish reliable care, avoid confusion among nurses and standardize measurement of conformance with hand hygiene policies. Hand hygiene is not a barrier to providing timely care to patients. One particular recommendation for hand hygiene is to apply it in urinary catheters (Kilpatrick et al., 2012).

Material and Methods

The study took place in a referral hospital in New Delhi. It involved 125 patients admitted consecutively in the wards of a tertiary care, it excluded patients who had undergone catheterization using Foley's catheter (Bhatia et al., 2010). Age, sex, diagnosis, functional condition, psychological condition, indication, period and place of catheterization are some of the parameters used for evaluation. Data collection utilized interviewing the treating nurses and data from the patient records. The physicians were to answer questions touching on the place of catheterization, indication of catheterization. Recording of data utilized a performa, which included the following parameters: functional status as well as age, sex, diagnosis and medical ward, duration of catheterization and analysis of urine culture.

Results

Out of the 125 patients, 80 were males and 45 were females. 33 of the patients were catheterized in the wards and the rest in the medical emergency. In addition, 60 of the patients recorded an impaired mental status (Bhatia et al., 2010). The duration of catheterization was 4.8 days, and the mean of catheterization for patients in the emergency was 4.3 days, 6.2 days for those catheterized in the medical wards.

Urinary Tract Infections

28 patients developed a symptomatic UTI during the period. In addition, all the patients developed a BCFC, revealing that all the patients had similar organisms as those separated from their urine (Bhatia et al., 2010). 38 of the patients developed a symptomatic colonization owing to their Foley's catheters (Feneley, Calvin and David, 2011). Majority of the patients developed colonization owing to their catheters. Majority of the patients catheterized in the emergency wards, developed a BCFC.

Inappropriate catheterization

From the study, only 36 patients were wrongly catheterized. The most inappropriate reason that showed evidence of inappropriate catheterization was urinary inconsistence without substantial skin breakdown (Bhatia et al., 2010). For the female sex, the risk associated with inappropriate catheterization was mental status (Nazarko, 2009). In addition, wrong catheterization did not show association with development of BCFC.

Discussion

Inappropriate catheterization is prevalent, in both medical wards and tertiary referral wards, and it leads to development of BCFC, which led to patients diagnosed with CAUTI (Nazarko, 2009). Concerning previous studies, the evaluation of this study shows that, previously, the number of inappropriate catheterization was higher. The large numbers of patients developing a BCFC calls for implementation of aseptic methods when inserting a Foley's catheter and proper infection control (Bhatia et al., 2010). In addition, it is important to note that catheterization in the emergency is likely to result to inappropriate catheterization. This is due to the large number of patients, spontaneous decision on catheterization, and lack of evaluations on the real need for catheterization (Feneley, Calvin and David, 2011).