Securing the indwelling catheter
ABSTRACT 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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- "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. "
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.International Journal of Urological Nursing 10/2010; 4(3):125 - 132. DOI:10.1111/j.1749-771X.2010.01107.x · 0.19 Impact Factor
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ABSTRACT: Adverse outcomes of long-term urethral catheterization include urethral erosion, ventral penile erosion, meatal erosion, and device-related necrosis of adjacent tissues. We describe the case of a 63-year-old male resident of a local skilled nursing facility who was transported to our hospital for evaluation of spiking fevers and possible infection surrounding his percutaneous endoscopic gastrostomy tube insertion. Physical examination revealed an unsecured urinary catheter inserted into an unnatural opening in his groin, just medial to the shaft of his penis. Further inspection revealed that the catheter had eroded completely through the urethra and the lateroventral skin of penis to the penoscrotal junction. We then inspected every patient in our 100-bed hospital and documented the number of patients with Foley catheters (34%) and of those who were secured (18%). Existing research suggests that negative outcomes associated with urethral and meatal erosions can be prevented by properly securing the indwelling catheter. Though this is one of the easiest and most effective practices, we found a low level of compliance with this preventive measure.Journal of wound, ostomy, and continence nursing: official publication of The Wound, Ostomy and Continence Nurses Society / WOCN 38(5):581-3. DOI:10.1097/WON.0b013e31822b3280 · 1.00 Impact Factor
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ABSTRACT: Changes in reimbursement policies have focused attention on the use of indwelling catheters in the critical care unit as well as their role in hospital-acquired urinary tract infections. Implementation of an evidence-based prevention program can significantly reduce both the prevalence of indwelling catheterization and the incidence of hospital-acquired catheter-associated urinary tract infection. This article describes the epidemiology and pathophysiology of catheter-associated urinary tract infection, and outlines essential elements of an evidence-based prevention program for the critical care unit.AACN Advanced Critical Care 01/2010; 21(3):247-57. DOI:10.1097/NCI.0b013e3181db53cb