Evaluating the Practice of Catheterising Patients - Essay Example

Evaluating the Practice of Catheterising Patients during the Terminal Stage of Illnesses Introduction Cancer is one of the most leading causes of death among the elderly individuals in UK. (National Statistics, 2009) Although there are some cancer patients who are able to live longer than five years, it remains a fact that there are roughly more than 150,000 cancer deaths that occur in UK each year (Cancer Research, 2009). In UK, most of the terminally ill patients with 78% prefer to receive their care from a palliative care rather than at the comfort of their own home (News Medical, 2007). As part of improving the quality of life of the terminally ill patients, approximately 4 million individuals receive an indwelling urinary catheter (IUC) each year (Hazelett et al., 2006). Urinary tract infection related to the use of urinary catheter is often associated with the increase rate of morbidity, mortality, and length of hospital stay. (Tal et al., 2005) Therefore, it is necessary for health care professionals to continuously improve the hospice and palliative care. To enable the readers to fully understand the subject matter, a list of related definition of words will be provided followed by discussing the main purpose of urinary catheterization and evaluating the impact of using urinary catheter on terminally ill patients who are admitted in a hospice environment. As part of evaluating the practice of using urinary catheter on terminally ill patients, a literature review will be gathered to examine the health benefits of using urinary catheter in terms of promoting dignity and comfort on terminally ill patients. Contrary to the health benefits of using the practice of catheterization, the associated risks of infection and ways to prevent infection among the patients will be thoroughly discussed prior to conclusion. Definition of Words Hospice Care – special care given to terminally ill patients which aims to improve the quality of life by relieving their pain and other symptoms during the last few days in a person’s life. (Avert, 2009a) Nocturia – frequent urination during night time. (Marinkovic, Gillen, & Stanton, 2004) Overactive bladder (OAB) – “a form of urinary incontinence in which sudden, involuntary contractions of the muscle surrounding the bladder produce an urgent need to urinate – often so sudden that the person with the condition is unable to make it to the bathroom in time (a condition known as urge incontinence)” (UCLA, 2009). Palliative Care – a solely being that provides care to terminally ill patients with the purpose of alleviating pain and other related symptoms. (Avert, 2009b) Polyuria – the production of abnormally large amount of urine by the kidney. (Kozier et al., 2004, p. 1260) Urinary Catheterization – the act of inserting a catheter tube via urethra and into the bladder. (NHS, 2009b) Urinary Incontinence – the loss of bladder control. (National Kidney and Urologic Diseases Information Clearinghouse, 2009) Urinary Retention – problem related to the inability to empty the bladder. (National Kidney and Urologic Diseases Information Clearinghouse, 2009) Urinary Tract Infection – the presence of bacterial infection in the urinary tract. Purpose of Urinary Catheterization There are a lot of urinary problems which normally occurs when a person reaches the old age. In some cases, illnesses and physical injuries may also contribute to urinary problems. In general, “the human organs, tubes, muscles, and nerves function together in order to create, store, and carry urine substances to the urinary system which includes the two kidneys, two ureters, the bladder, two sphincter muscles, and the urethra” (National Kidney and Urologic Diseases Information Clearinghouse, 2009). As a person reaches an old age, the kidney structure together with the muscles in the ureters, bladder, sphincters, pelvis, and the urethra weakens. Often times, it is the inability of the urinary system to function well leads to urinary problems among the patients. In reality, there are instances wherein a patient may experience overactive bladder (OAB). Between men and women, the EPIC study that was conducted by Irwin et al. (2006) revealed that 13% of women and 11% of men experience OAB as they reach the old age. In general, individuals who have OAB are facing problems with the need to urinate as much as eight or more times each day (UCLA, 2009). Among the other types of urinary problems, individuals who are diagnosed with nocturia have to go through the consequences of disturbed sleep due to frequent urination at night time (Marinkovic, Gillen, & Stanton, 2004). Basically, the main purpose of urinary catheterization is to help the patient release urine substances from the bladder given that the urethra is blocked, the patient is experiencing bladder retention, unable to control the flow of urine, or when the patient is too weak or unconscious to go to the comfort room to urinate (NHS, 2009b). Aside from the possibility that a disabled individual may not feel any perineal sensation due to some neurological disorders, urinary catheterization is often used to enable the health care professionals monitor and record the patient’s urinary output (Hunt, Pippa, & Whitaker, 2006). Evaluating the Impact of using Urinary Catheter on Terminally Ill Patients who are Admitted in a Hospice Environment Health and Social Benefits of using Urinary Catheter in terms of Promoting Dignity and Comfort on Terminally Ill Patients Urinary catheterization is commonly used among patients with palliative care needs, intractable incontinence despite the use of other highly recommended methods, and those individuals with neurological conditions like multiple sclerosis. (NHS, 2008, p. 5) Basically, the inability of the terminally ill patients to control their urge to urinate can cause them to develop a low self-esteem which could make them isolate themselves from other people. The use of urinary catheter can improve the quality of life of patients who are experiencing urinary problems. With the use of catheterization, a terminally ill patient can continuously live their remaining days to the fullest. Considering that urine is considered as waste body product, each individual has to urinate in order to avoid intoxicating their body with harmful substances like the urea (Kozier et al., 2004, p. 1466). The use of urinary catheter is effective in removing urine straight from the bladder of individuals who are experiencing difficulty to urinate. Often times, difficulty to urinate is caused by the presence of obstruction in the urethra. Associated Risks of Health Complications Although the use of indwelling urinary catheter enables the terminally ill patients to easily urinate without the need to get out of the bed, catheter-related nosocomial urine tract infection (UTI) is the most common health complication of using urinary catheter (Hazelett et al., 2006; Marklew, 2005). As an economic consequences of acquiring catheter-related UTI, patients who receive catheterization often has to go through the financial burden of having to pay additional health care and medical expenses until they manage to recover from the health complications of the bacterial infection (Madeo, Barr, & Owen, 2009). One of the reasons for the high prevalence of urinary infection is due to the poor hand washing practice of the nurses and other health care professionals who are in-charge of monitoring the alignment of the catheter. Even though the use of a silver-alloy catheters seem to have antimicrobial benefits (Brosnahan, Jull, & Tracy, 2006), the research study of McNulty et al. (2006) revealed that approximately 10% of the 1,438 research respondents reported not washing their hands before handling the urinary catheter and/or delaying the emptying of the urine bag until it is three-quarters full. Upon analyzing the entire situation, it is the contamination of the urinary catheter devices that contributes to the high cases of catheter-related infection throughout the United Kingdom. Basically, bacteria enters the bladder given that the tip of the catheter has been contaminated by microorganisms prior to the insertion of the tube into the urethra (Barford & Coates, 2009). In some cases, contaminating the outside and/or inside of the catheter bag may also result to catheter-related infection. Aiming to minimize the risk of bacterial colonization, the NHS guidelines on catheter management clearly stated that the health care professionals like nurses should regularly empty and change the urine bag every after five to seven days. (NHS, 2008, p. 6) However, 60% of 1,438 research respondents do not encourage the patients or patients’ family members to empty their own catheter bags (McNulty et al., 2006). Aside from the possibility that a terminally ill patient would develop urinary tract infection, there is also a high clinical risk that the patient with urinary catheter to develop bleeding, urethral tears and false passages which could lead to the patients’ untimely death (Pomfret & Tew, 2004). Likewise, health care professionals should also be aware that over and/or under inflating the catheter balloons with sterile water can cause serious damage and irritation to the patient’s bladder neck and the bladder itself (NHS, 2008, p. 6). Ways to Prevent Bacterial Infection among the Patients using Urinary Catheter Importance of Proper Handwashing Microorganisms are generally present everywhere we go. These can be found in water, soil, on body surfaces like the skin, intestinal tract, and other open areas like nose, ears, upper respiratory tracts, and lower urinary tract that is exposed to the external environment. Among the common infection causing microorganisms includes: the bacteria, viruses, fungi, and parasites. Since the hands of the nurses and other health care providers are considered as the common vehicle for the spread of these infectious microorganisms, nurses and health practitioners must be very conscious about the proper hand washing. Hand washing considered to be one of the most effective infection control measures. When managing the urinary catheter of a terminally ill patient, nurses should ensure that they wash their hands before and after using giving care to the patient. Likewise, nurses and other health care professionals should keep their finger nails short and avoid wearing jewelleries in order to avoid harbouring harmful microorganisms. Religiously Change the Catheter, Tubing, and the Urine Bag Every After Five to Seven Days Because of professional negligence of the health care workers, it is possible that failure to replace the catheter line and urine bag on time. This may result to the unwanted breeding of bacteria. To avoid the risk of not changing the urine bag every after five to seven days, the NHS strongly advised the proper labelling of the urine back aside from proper documentation in the patients’ health record (NHS, 2008, p. 6). Routinely changing the urinary catheter and tubing line is not necessary unless there is an obvious sign that the catheter is collecting sediments or has an impaired urine drainage. (Kozier et al., 2004, p. 1279) Upon seeing these signs, health care professionals should consider changing the line by removing the urinar catheter and changing it with a sterile set of catheter. Although the research study of Nicolle (2005) revealed that catheter flushing or performing a daily perineal care on patient with urinary catheter does not prevent the risk for infection, the health care professionals must always perform a perineal care before and after inserting or changing a set of sterile urinary catheter on a terminally ill patient in order to remove normal perineal secretions and odor (Kozier et al., 2004, p. 713). Select the Correct Type and Size of Urinary Catheter for the Patient There are two main types of urinary catheter known as the indwelling catheter and the intermittent catheter. In general, the indwelling catheter is left inside the patient’s urethra due to long-term care whereas the intermittent catheter is inserted and removed immediately after the patient was able to empty his/her bladder (NHS, 2009b). Urinary catherers are usually made of silicone and/or latex which is eventually coated by either silicone or hygrogel. The problem with using either siliicone or latex is the fact that these types of materials are not capable of protecting the patients from bacterial infection. (Jones et al., 2006) Given that a urinary catheter is designed with holes at the tip, microorganisms can easily be trapped causing infection in the patient’s urinary tract (Stickler et al., 2003). Based on the research study that was conducted by Madeo, Barr, & Owen (2009), the use of a preconnected catheter can significantly reduce the rates of catheter-associated urinary tract infection (CAUTI) by 41% as compared to the use of a traditional bag and catheter system. Other than the use of silver-coated catheters, the antimicrobial impragnated or hydrogel catheters can also be used to minimize the incidence of catheter-related bacterial infections (Kozier et al., 2004, p. 1274). Particularly for the male patients, the use of a condom-type catheter device is more effective in terms of damaging the urethral tissue associated with the insertion of urinary catheter inside the urethra (Kozier et al., 2004, p. 1270). The size of urinary catheters should also be considered when selecting the most appropriate type of urinary catheters for the patient. Basically, sizes between No. 8 and No. 10 can be used for children whereas sizes No. 14 to No. 16 are designed for the adult patients (Kozier et al., 2004, p. 1274). With regards to the differences between men and women, it is advisable to use No. 18 for men with length of 40 cm. as compared to 22 cm in women (p. 1274). Choosing the right size of urinary catheter is necessary in order to prevent unnecessary skin breakdown or urethral injury which could increase the patient’s risk of becoming infected with harmful microorganisms. (Gilbert, 2008) Ensure that the Patient is not Allergic to Latex or Anaesthetic Gels Urinary catherers are normally manufactured using silicone and/or latex which is eventually coated by either silicone or hygrogel. (Jones et al., 2006) Although there is not much research study done in the possible allergic reation of using latex made urinary catheter on terminally ill patients, it remains inevitable for some patients to have allergy on latex materials (Turjanmaa, 2009; Reddy, 1998). To protect the terminally ill patients from developing a risk for allergic reaction, the health care professionals should carefully check the patient’s history record aside from asking them whether or not they have experienced allergy from the use of these instruments / materials. Over exposing the patients with allergic reaction to latex-made medical devices may increase their risk to a life-threatening situation. (Reddy, 1998) In order to minimize the risk of latex allergy, the patient who is to receive a latex-made urinary catheter should undergo immunologic testing or to simply use latex-free urinary catheter at all times. Basically, the occurrence of allergies can weaken the patients’ resistance against possible infection (Food and Drug Administration, 2009). For this reason, health care professionals should consider possibility that the patient has allergy reaction to materials used in manufacturing the catheter devices. Discussion As compared to the past audit back in 1998, evidences show that the practice of catheter management based on the NICE guidelines had improved a lot (McNulty et al., 2006). Despite the positive signs of improvements, it remains a fact that there are still a lot of health care professionals who fail to comply with the national standards regarding the use of urinary catheter. It is the duty and responsibility of the health care professionals to provide the terminally patients with holistic care. Based on the nursing professional ethics, nurses should render care and treatment to patients without causing further harm to their existing health condition. Considering the adverse health and socio-economic consequences of using urinary catheterization, McNulty (2009) strongly suggest that urinary catheter should be used only as a last resort for managing urinary retention and incontinence. Similar to the research findings of McNulty (2009), the study of Getliffe & Newton (2006) concluded that urinary catheterisation should be considered as the last resort because this type of bladder management option for elderly individuals is the primary source of increase morbidity and economic burden among the patients within the primary and community care settings. It is a common misconception to consider the provision of daily perineal care as an important way of controlling the high incidence of catheter-related infection among the terminally ill patients. Based on the research findings of Nicolle (2005), the provision of perineal care on terminally ill patients with urinary catheter would only increase the patient’s risk of acquiring infection. This is primarily due to the possibility that the health care professionals may accidentally wipe the presence of microorganisms close to the insertion site. Instead of focusing on the provision of perineal care, Nicolle (2005) suggests the importance of giving antibacterials to control bacteuria before performing the insertion of urinary catheter aside from strictly preventing catheter blockage, twisting, and/or trauma. Conclusion Despite the effort of the National Institute of Clinical Excellence (NICE) and the National Health Service (NHS) to control the high incidence of catheter-related infection associated with the use of urinary catheter, evidences show that problems related to catheter-related infection remains a problem not only within the hospital settings but also in the care homes based throughout the United Kingdom. One of the main duty and responsibility of the nurses is to provide a holistic care for their patients. Considering the fact that it is ethical for nurses and other health care professionals to avoid harming the patients either directly or indirectly, nurses should always balance the health and social benefits of using giving urinary catheterization to a terminally ill patient. For this reason, the use of urinary catheter should be considered as the last resort in managing urinary problems. In general, there are many ways to treat patients who are having difficulty in urinating. For instance: The health care professionals may subject a patient to undergo a bladder training with the use of pelvic muscle exercises and increasing the water consumption of the patient who are having difficulty urinating (Kozier et al., 2004, p. 1265 – 1270). In case the use of urinary catheter is the only way to improve the quality of life of the patient, health care professionals should avoid causing skin and tissue injury on the patient during the insertion of the catheter. Likewise, health care professionals should observe a strict aseptic technique to avoid contaminating the catheter line. By constantly looking for signs of catheter-related complications every time the nurses visit the patients, the health care administration team will have a better assurance that the terminally ill patients who are receiving urinary catheterization are safe from the adverse health and financial impact of acquiring catheter-related infection. *** End *** References: Avert. (2009a). Retrieved March 14, 2009, from Definitions of Hospice Care: http://www.avert.org/palliative-care.htm Avert. (2009b). Retrieved March 15, 2009, from Definitions of Palliative Care: http://www.avert.org/palliative-care.htm Barford, J., & Coates, A. (2009). The pathogenesis of catheter-associated urinary tract infection. Journal of Infection Prevention , 10(2):50 - 56. Brosnahan, J., Jull, A., & Tracy, C. (2006). Types of urethral catheters for management of short-term voiding problems in hospitalised adults. In Getliffe K. & Newton, T. 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