Securing the Indwelling Catheter

Department of Urology, University of Virginia, Charlottesville, VA, USA.
The American journal of nursing (Impact Factor: 1.3). 01/2009; 108(12):44-50; quiz 50. DOI: 10.1097/01.NAJ.0000342069.15536.b5
Source: PubMed


Each year, millions of Americans are catheterized to ensure adequate bladder drainage. But despite the high rate of catheterization in acute care facilities, clinicians often pay little attention to the decision to insert an indwelling catheter, its optimal management, or especially its timely removal. A physician or NP typically orders the insertion of a urinary catheter, but a nurse often performs the catheterization and is responsible for its management. Reimbursement policy changes recently mandated by the Centers for Medicare and Medicaid Services-including one stipulating that Medicare will no longer cover the cost of treating catheter-associated urinary tract infections-have resulted in increased scrutiny of indwelling catheter management. This article explores one aspect of catheter management, the use of securement devices, and analyzes the standard practices, expert opinion, and clinical evidence concerning this intervention.

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    • "Other complications of indwelling catheters include bleeding, urethral or bladder injuries, bladder sediment/stones, catheter malfunction (including obstructions), bladder perforation, rectovesical fistula, and bladder cancer [29, 34–36]. For male patients, many experts recommend using the smallest diameter urinary catheter feasible and to tape it to the lower abdominal wall under low tension to minimize the risk of urethral erosions [37]. "
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    ABSTRACT: Congenital anomalies such as meningomyelocele and diseases/damage of the central, peripheral, or autonomic nervous systems may produce neurogenic bladder dysfunction, which untreated can result in progressive renal damage, adverse physical effects including decubiti and urinary tract infections, and psychological and social sequelae related to urinary incontinence. A comprehensive bladder-retraining program that incorporates appropriate education, training, medication, and surgical interventions can mitigate the adverse consequences of neurogenic bladder dysfunction and improve both quantity and quality of life. The goals of bladder retraining for neurogenic bladder dysfunction are prevention of urinary incontinence, urinary tract infections, detrusor overdistension, and progressive upper urinary tract damage due to chronic, excessive detrusor pressures. Understanding the physiology and pathophysiology of micturition is essential to select appropriate pharmacologic and surgical interventions to achieve these goals. Future perspectives on potential pharmacological, surgical, and regenerative medicine options for treating neurogenic bladder dysfunction are also presented.
    Advances in Urology 02/2012; 2012:816274. DOI:10.1155/2012/816274
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    • "The proper management of an indwelling urinary catheter is one of the most common problems faced by patients and health professionals, both in hospital and primary health care settings, and a number of studies have reported on the problems relating to the management of an indwelling catheter (Tenke et al., 2008; Tsuchida et al., 2008; Gallegos, 2009; Parker et al., 2009a, 2009b). The role of the nurse has been suggested as being key to the assessment of appropriateness of continuing indwelling urinary catheter use and to the timely implementation of practices aimed at the identification and prevention of complications associated with this method of urinary drainage (Marklew, 2004; Gray, 2008). While perhaps a truism, it is nonetheless essential that to ensure a standard of care that is high and consistent nurses must have appropriate levels of knowledge and skills as nursing interventions to help prevent complications are required during each phase of nursing care. "
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    ABSTRACT: The aim of this study was to determine whether a structured workshop for nurses promoting best practice technique for management of indwelling urinary catheters results in an improvement in knowledge on the subject. A one-group pre-post test quasi-experimental design using a convenience sample was used. Nurses attended a workshop utilizing interactive lecture approaches, and based on best practice technique for the management of indwelling urinary catheters. Participants (n = 30, 55% of those invited) completed a multiple choice question (MCQ) test, derived from topics to be covered in the workshop, prior to the intervention. The MCQ test was repeated after the workshop to assess retention and application of knowledge. There was a significant improvement in mean test scores after the workshop when compared with pre-workshop scores (mean = 16·9, SD = 1·1 vs. mean = 8·5, SD = 1·7, p < 0·001). It is concluded that interactive lecture workshops based on best practice techniques for the management of urinary catheterization help improve nurses' knowledge. Such educational initiatives also help to overcome deficiencies in initial nurse training where preparation for quality catheter care can be lacking. Within the limitations of a small-scale single-group study of a convenience sample, the information gained in this study will be valuable in helping to establish a baseline for further research. It may also help guide improvements in the implementation of policies for improved management of the care provided to people with an indwelling urinary catheter with the ultimate goal of enhancing safe and quality patient care.
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    ABSTRACT: The US Centers for Medicare & Medicaid Services has enacted 2 policies that have focused considerable attention on the optimal use of indwelling catheters in the acute and long-term care settings and the prevention of complications including catheter-associated urinary tract infection (CAUTI). This is the second of a 2-part Evidence-Based Report Card reviewing current evidence pertaining to nursing actions for prevention of CAUTI in patients with short- and long-term indwelling catheters. Part 2 reviews multiple interventions for CAUTI prevention including staff education, monitoring of catheter use and CAUTI incidence, insertion technique, urethral meatal care, securement, use of a closed drainage system, bladder irrigation, frequency of catheter change, and antiseptic solutions in the drainage bag. Nursing actions for prevention of CAUTI were identified based on search of electronic databases and Web-based search engines for national or international clinical practice guidelines focusing on this topic. Evidence related to the above nursing interventions was identified by searching electronic databases MEDLINE, CINAHL, the Cochrane Library, the ancestry of articles identified in these searches and Google scholar. Limited evidence suggests that the following interventions reduce the incidence of CAUTI in patients managed by short-term indwelling catheterization: (1) staff education about catheter management, combined with regular monitoring of CAUTI incidence, (2) a facility-wide program to ensure catheterization only when indicated and prompt removal of indwelling catheters, (3) daily cleansing of the urethral meatus using soap and water or perineal cleanser, and (4) maintenance of a closed urinary drainage system. Mixed evidence suggests that use of a preconnected system reduces inadvertent interruption of a closed urinary drainage system and may prevent CAUTI. Limited evidence suggests that routine catheter changes every 4 to 6 weeks reduce CAUTI incidence in patients managed by long-term catheterization. Existed evidence suggests that the following interventions are not effective for reducing CAUTI incidence: (1) use of sterile technique for catheter insertion, (2) use of antiseptic solutions or ointments during routine meatal care, (3) use of a 2-chambered urinary drainage bag, (4) use of antiseptic filters incorporated into a urinary drainage bag, (5) bladder or catheter irrigation, (6) frequent changes of the urinary drainage bag, and (7) placement of an antiseptic solution in the urinary drainage bag. Evidence from parts 1 and 2 of this Evidence-Based Report Card provides a sound basis for designing an evidence-based program to prevent CAUTI. Essential elements of a CAUTI prevention program include staff education, ongoing monitoring of CAUTI incidence, monitoring catheter insertion and ensuring prompt removal, and careful attention to techniques for catheterization and catheter care.
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