Skills of Male and Female Indwelling Urinary Catheterisation Including Reducing the Infection Risk - Essay Example

Rationale Im working on the neurological surgical ward where we receiving patients from operations (spinal itd).Very often the patients have difficulty passing any urine after surgery and they need to be catheterized. I choose this topic because if I will develop my skills with catheterization then I can be more helpful on the ward and that can be part of my job. Also, I think this is very interesting and important part of giving care to patients thus studying it will help me develop certain important nursing skills, with the developed skills then I will be able to give care to the patient (Living with a urinary catheter). People in need of indwelling catheterization have their risks minimized by the completion of all the required procedures that are necessary for ensuring safe insertion and safe maintenance of the catheter. Also, the removal of the catheter one it is not needed anymore, that is after the completion of the treatment (Wolgin, 2005). My focus is, however, not only understanding the concept of indwelling catheterization in male and female but also understanding the whole concept of catheterization (Crow, 1986) Aims and objectives My main aims and objectives while undertaking the study was to: 1. Outline why individuals may require indwelling catheterization. 2. To describe the correct procedure for inserting a male and female catheter including risk assessment and possible complications 3. Discuss the actions to reduce the risk infection 4. Explain how the information is provided and procedure explained to patients Description of the work undertaken At this step my main focus was to answer the problem statements in the aims and objectives section. As a nurse, whose focus is delivering the best possible care to my patients then the increases knowledge and the development of indwelling catheterization would come in hand. I hence choose this topic, as with the skills and the knowledge I will be more helpful in the ward; also this can be part of my job (catheterization). Patients in this ward are in need of care relating to the process of catheterization and as mentioned above many of the patients prefer indwelling catheterization. To answer some of these questions I booked myself for UCLH theoretical and practical training for Adult Male and Female. In this training I learned broadly about catheterization. This included; Why individuals require indwelling catheterization Indwelling catheters are used for draining the bladder; hence, many of the patients in need of catheterization have problems urinating. In many cases catheters are recommended for patients suffering from urinary incontence, those that have undergone surgery for the genitals, urinary retention and some medical conditions such as dementia Through the training I learned the types of catheters, In this I learned what type of catheters are there, this is the intermittent and the indwelling. From y study, the intermittent catheters only remain in patients body for a few hours but the indwelling remain in the patients urinary tracts for days and sometimes weeks. The indications and the uses of indwelling catheterizations learned were, to relieve the urinary retention, to assist the healing of a perennial wound, to monitor urinary output and to assist in achieving the patient immobilization. These were the major uses of indwelling catheterization (Urinary catheterisation - Better Health Channel). The uses of catheterizations fall on both short and long term basis, the short-term basis falls in place when the patient faces trouble when urinating in normal way, in preparation for surgery and to monitor the urine release of unconscious patients or patients recovering from surgery. For the long-term catheters (indwelling catheters) the patients cannot remove the urine from their bladders at all, this may mainly result from nerve damage. The long-term catheters also fall in those patients suffering from incontinence. In these cases of indwelling catheters, patient training is important; in that they receive training in how to use catheters while at home, a process called self-catheterization (Mcconnel) In the training I have to learn what catheterization are, I learned: Catheterization means the insertion of a catheter into the body cavity with the aim of removing or injecting fluids. Urinary catheterization focuses on the injection of the catheter into the urinary tracts mainly with the purpose of helping the patient urinate. Urinary catheterization helps in reducing risks of infection of diseases associated with the urinary system mainly the kidneys by ensuring that the urinary bladder empties adequately at regular intervals. This type of catheterization helps patients with bladder problems, such as bladder obstruction, urinary retention, urinary incontence, which is leaking urine and those that have undergone surgery on the genitals or the prostrate. An indwelling catheter is a tube made of soft rubber or plastic, in some instances the patients carry out the process themselves. In this case, the process is termed as intermittent clean self-catheterization. This process gives the patient control over their own bladders and helps keep them dry. The intermittent clean self-catheterization also reduces the infection of the urinary system.it is important to note that catheterization does not interfere with the normal sexual relationship unless the process results in infection. In this case, the handler should have sufficient knowledge of sterilization, insertion and the handling of the catheter to reduce infection risks. All the caregivers should have the knowledge of the catheter in order to help patients and reduce risks associated with these infections. Urinary catheters are in most cases inserted by doctors and nurses in hospitals or in the community. Catheters can be inserted directly into a mans or a womans urinary system, that is the bladder (urethral catheter) or through the suprapubic catheterization, in this case, a small opening is made in the lower part of the stomach. They, however, have the same purpose of helping the patients urinate. In urinary catheterization the catheter remains in the bladder; this allows the patients urine to flow into a drainage bag outside the body. The catheter may be removed after hours or days depending on the purpose of the catheter. There are two types of urinary catheters, the intermittent, and the indwelling catheters. The intermittent catheters are those catheters that do not stay long in the patient body; that is they are temporary in that once the patients empty the bladder the catheter is removed. The indwelling catheters are those that remain in the patients body even after the patient empties his or her bladder (Urinary catheterisation - Better Health Channel). The catheter can stay for days and even weeks in the patients urinary systems. Water filled balloons help hold the catheter in position; this report focuses on this kind of catheter. Many people prefer the indwelling catheters as its more convenient, and its use helps avoid the repeated insertions as in the intermittent catheters. In indwelling catheterization, however, the patient is at more risk of infection than in intermittent catheterization. In these cases, the doctors and nurses who carry out the catheterization should have enough knowledge of the risks associated with indwelling catheterization and the methods to adapt in order to prevent infections The correct procedure for inserting a male and female catheter including risk assessment and possible complications. a) Methods and procedure of insertion This is the whole process of catheterization and the nurse carrying out the process should be well informed of the process of insertion. Before insertion the care provider must consider the possible medical issues that may result from poor catheterization, this should stick in the nurse mind all through the catheterization process. The nurse must first observe cleanliness before the whole process; he or she must understand that even scrupulously clean equipments can result in bacteria introduction in the urinary system. In most cases, the urinary system has bacterias; however, infection does not take place. Hence, it is important to have thorough training about catheterization and hygiene related to the process. For indwelling catheterization patients, prescription of antibiotics is the best method of treatment. However, a trained nurse should understand that catheterization infection should never reach the treatment level. The procedure for the insertion of a catheter is; gathering the required equipment, after the nurse has all the requires equipment, he or she explains the whole catheterization process to the patient. The nurse or the doctor then assist the patient get into a suspine position, then the nurse opens the catheterization kit, prepared the sterile field, and also decontaminated hands, he or she checks the balloon for potency. After the step the nurse lubricates the catheter and applies the sterile drape.In female catheterization the nurse should wash the pre urethral micosa before insertion with the necessary solution, in male on the other hand the nurse holds the penis in position and then applies upward traction. The nurse then identifies the urinary meatus and inserts the catheter up to 2 inches beyond noting urine. The drainage system is connected on the other end of the catheter and tied on the abdomen or thigh. A skilled nurse after the process should evaluate the catheters function, the color amount, and the odor of the urine coming into the balloon. After the procedure is completed, gloves removed and discharged properly, and then the nurse should document the size of the catheter inserted patients respond to the catheter, amount of water in the balloon and the assessment of the urine. b) Possible complications and risk assessment Indwelling catheterization may result in trauma and the bruising of the urethral mucosa, once damaged the mucosa acts as the entry point for microorganisms into the lymphatic system and the blood (Urinary catheters: MedlinePlus Medical Encyclopedia). Through the training, I learned that it is appropriate to use anesthetic gel or a sterile lubricant, the nurse should apply the gel, or the lubricant to the catheter and the urethral meatus surfaces prior to the insertion of the indwelling catheter. This minimizes the probability of infection or urethral trauma, once the insertion happens, then the urine drains into the balloon. In indwelling catheterization, the care provider should connect the catheter to a sterile drainage bag usually placed below the bladder level, this in turn facilitates drainage. In the process of insertion, the care provider should document the relevant information related to catheterization. This information should indicate the catheter insertion, the time and the date for insertion, the size and the type of catheter, and the amount of the water used for balloon inflation. Other relevant information for indwelling catheterization includes, complications encountered, the review date and the name of the care provider who inserted the catheter (Procedure for insertion of an indwelling urinary catheter, plus Catheter care and closed-system of urinary drainage, 1993). Actions to reduce the risk infection This infections need to be taken care of, a method to do this is through Meatal cleaning and disinfection .Since the infection can occur via the external surface of the catheter, the urethral meatus must be cleaned before insertion. The process of Meatal cleaning involves the removal of smegma and exudate mechanically. The care provider should wash the meatal area either by use of sterile saline or antiseptic solutions (Wolgin, 2005). Where possible the care providers should retract the foreskin, and then clean the gans of the penis, for men. The foreskin is then returned to the normal position after the insertion of the catheter. In women, the care provider should first separate the labia minora, after the separation the nurse clean the urethra using a front to back motion. In this case the nurse should use sterile saline solution or use sterile water, he or she should do this using sterile swabs or by using sterile gauze balls. Another effective method is through hand decontamination, in this is one also one of the most important aspects the nurse should note in the process of catheterization for the prevention of patients infection and even own self. The nurse may observe the world health organizations techniques of hand hygiene; this tells when to decontaminate the hands. To WHO a care provider should decontaminate his or her hands before contact with a patient, before aseptic procedure, after any exposure to body fluids, after touching a patient and finally after touching any of the patients surrounding. The care provider may also use gloves in all the procedures Even after I booked myself for UCLH theoretical and practical training for Adult Male and Female, I still proceeded to carry out some research on the internet and did some literature review. Basically the internet and the literature review talked about the same things from the training Infection In the process of catheterization infecting mainly occurs from the carelessness of the care providers or from the lack of knowledge and skills in regard to catheterization (Urinary catheterization). The nurses should follow all the prevention procedures; this will help prevent the patient and the care provider from any infection (Infection prevention and control). In most cases, infections occur during the insertion of the catheter where the nurse does not observe the required standard procedures. From the training learned the important steps to help prevent infection of the patient and also what the nurse should do to protect him/herself (Stamm, 2003). The main disadvantage of the catheter is that it may allow bacteria to enter into the body system, which in turn causes infection in the bladder, urethra, and at times the kidneys. Infections commonly known as urinary tract infections, the UTIs are the most common type of catheter infections for the patients staying in hospitals. Because of this, then the usage of the indwelling catheters should only apply where there are no other alternative methods of emptying the patients bladder (Newman, 658) Risk of poor insertion When the insertion of the catheter is wrongly done, then there are high chances of infections. Apart from damaging the urethral mucosa, poor insertion may later lead to infections such as bacteriuria, urinary tract infection, and epididymis (UTI). The urine of patients with indwelling catheters show bacteria in it, these bacteria enters the body system in case the mucosa was damaged causing diseases. In this case, the training will help me learn the procedure in which I can insert that catheter without damaging any part of the body (Procedure for insertion of an indwelling urinary catheter, plus Catheter care and closed-system of urinary drainage, 1993). The care providers must have sufficient knowledge and should also possess the skills on how to insert that indwelling catheter without damaging the patients body (Cochran) How the information is provided and procedure explained to patients The methods to inform the patients of the procedures to take in cases where the catheterized patients remain at their homes. In this cases where the patients take care of their catheters at the comfort of their homes, and then the best mode of infection prevention is training. At this stage, I learned how to have an open communication with the patients. The developed relationship would allow my patient to call me at any time in case they notice problems with the catheters or infections resulting from the catheters (Reduction of Indwelling Urinary Catheter-associated Urinary Tract Infections (CAUTI) through System-wide Interventions). I learned how to train the patient in different steps; the first step was on teaching the patients on how to efficiently clean their skin and how to clean their catheters. By using some nursing models, for example, the self-care nursing model, then the patients can learn how to take care of their catheters efficiently through training (Stamm, 2003). Training the patient also enables him or her know the right time to call the doctor and when there is emergency needed, for example, the patient should call the doctor in case he or she has some pain in the lower back or when the urine smells bad. I learned all this from the theoretical assessments of topics related to catheters, and through observation and the important notes I took when I helped a nurse carry out the process of catheterization to a male patient. This was the beginning of experience in the practice of catheterization which ended up being more interesting that I expected at the beginning of the study (Stamm, 2003). Once the process of catheterization is explained to the patients,the patient should be given a chance to give the consent, that is whether he or she agrees with the process. Results I acquired immeasurable skills from the training; first I managed to complete my aims and the objectives. Through completion of the aims and the objectives then I had acquired the relevant skill needed for catheterization. The remaining part is the experience, under experience I intend to apply the theory ‘from novice to expert. (Newman, 658) The study also improved the skills not only toward the practice of catheterization but on how to handle the patients in need of the process and how to maintain a close relationship with them. This will help me ensure that my services satisfy the patients fully and at the same time ensure that there is the maintenance of close relationship with my patients. The main outcome of the training was that at the end of it, I understood all the concepts revolving around indwelling catheterization; this is the processes of catheterization (insertion, maintenance, and removal. Professional development Catheterization requires cooperation from the patient, with enough skills than the patient tends to cooperate at all levels of catheterization. In terms of skills acquired, I would say that they are also immeasurable; my devotion to the study has helped me developed in many ways. In the beginning, I only helped in a neurosurgical ward but I could see that many of the patients needed catheters to help them in urinating. Now I can undertake the process of indwelling catheterization as I continue to learn and get enough experience (Stamm, 2003). I have also gained skills related to interactions is should have with my patients, this skill ensures that the patient gets the best care and can confide in me in case there is no satisfaction. Personal development I have also developed personally in terms of generic skills to people skills, the generic skills learned from the module include communication, organization and time management. From the catheterization process, I learned that communication between the patients is one of the most important aspects of delivering the best care, organization and time management follows this, care providers should possess that characteristic of being well organized and at the same time be able to manage time. I also developed my people skills which basically revolves around communication teamwork and at the same time learning from the experienced. These basic skills make a good nurse (Stamm, 2003) Implications for practice The concept of catheterization has helped meet the patients need as once implemented the patients no longer have problems associated with urinary problems or urinary tract related infections. Conclusions Catheterization is one of the most important concepts in nursing; each and every nurse has the responsibility to learn the process of catheterization. Catheterization lies on the basis of taking care of patients suffering from urinary related problems; nursing is built on the pillar of taking care of the patient (Nursing Center - CE Article). Nurses should also understand the procedures of catheterization, which includes insertion, management and finally the removal of catheters, this helps in infection prevention. 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