Various Issues in Relation to Indwelling Urinary Catheters - Term Paper Example

Student Name: Tutor: Title: Analytical Report on Indwelling Urinary Catheters Course: Table of contents 1. Executive summary 2 2. Introduction 3 3. Purpose 4 4. Literature review 4 5. Discussion 7 6. Implications for Practice 9 7. Conclusion 10 Reference list 11 1. Executive summary Nurses have for a long time offered care of patients who are catheterized. A lot of this care has actually been individual organization policy, anecdotal data that is care based, or care offered on the ground of time frames that are insurance-allowable. To offer the optimal care for patients, scientific-based research should be considered for delivery of care. Indwelling urinary catheters (IDC) are among the common invasive clinical devices used within acute care environments. Urinary catheters are considered as the common causes of infections that are hospital related. Catheter associated urinary tract infection (CAUTI) brings about unwanted distress to patients in addition to delayed recovery process. To avoid these issues, proper care need to be taken. Compliance with optimal practice of care can decrease the possibility of infection. This paper has provided a brief description of IDC, a literature review on IDC in terms of CAUTI prevention and it has further provided a number of strategies that can be used to prevent CAUTI. 2. Introduction Indwelling urinary catheters (IDC) are extensively used in patients who are hospitalized and may be a suitable way of therapeutic care under certain circumstances. On the other hand, a lot of IDCs are used with no clear indications, hence placing patients at a preventable risk for various complications in the course of their hospitalization. Complications that are catheter-associated include psychological and physical discomfort to patients, renal inflammation, bladder calculi, and most commonly, catheter-associated urinary tract infections (CAUTI) (Gokula et al, 2007). CAUTI development in aged adults can lead to delirium, immobility, and falls (Lautenbach, et al, 2010). This is why it is important to consider that in order to offer the optimal management for every patient; the management ought to be based on research that is scientific-based. This report will provide a description of IDC; thereafter provide a literature review on this clinical practice. 3. Purpose IDC’s insertion is a procedure that is invasive that should solitary be performed by a trained experienced health care provider using aseptic technique or use of proper hand washing (Perry et al, 2013). Aseptic technique is a method of minimizing or preventing the possibility of introducing micro-organisms that are harmful into the body’s sterile areas when carrying out procedures that interfere with the natural defenses of the body (Lautenbach, et al, 2010). The rationale is to prevent susceptible body sites’ contamination which could result in infection. Urinary tract catheterization should simply be performed once there is a particular and satisfactory clinical indication, since it carries a great potential of infection (Bennett et al, 2007). The rationale is to make sure that the insertion as well as care of the catheter is performed in a way that minimizes infection risks and trauma (Parker et al, 2009). I chose this clinical process in order to provide a summary of the best offered evidence connected to CAUTI prevention during hospitalization particularly in short-term catheterization. 4. Literature review Clean vs. sterile are debated with respect to catheterization technique. A sterile technique of insertion is not guaranteed given the extra expenses (Walsh & Crumbie, 2007). In a study, the non-sterile method, carried out within the operating room setting, involved water and soap hand washing, genitalia cleansing using tap water as indicated, lubricant, non-sterile gloves, tap water for balloon inflation (Moola & Konno, 2010). With regards to water cleansing, a study did not find considerable distinction in outcome involving cleansing with chlorhexidine gluconate or water. With reference to meatal care, three studies that investigated care of the meatus found no benefit or little benefit in the use of anything aside from regular personal hygiene and debris removal in management of patients with IDC for bacteriuria prevention (Moola & Konno, 2010). On the other hand, there were a number of benefits specified for some female patients who are at high-risk. Six studies concentrated on the composition of the catheter. No considerable distinction the rates of infections related to catheter was found between latex or silicone catheters, although a statistically important distinction was established by the sixth day favoring silver catheters and not the Teflon-coated latex Foley catheter (Crouzet et al, 2007). Another considerable result favored catheters that are silver coated unlike those that are silicone coated. Using 100 percent catheters that are silicon compared with silver salts-coated and hydrogel catheters showed there no statistically considerable distinction in the result (Moola & Konno, 2010). A randomized controlled trial that is double blind assessed the catheter that is nitrofurazone-impregnated compared to the regular catheter that is silicon coated in patients with trauma and established that the infection incidence was lower among trauma patients within the nitrofurazone cluster (Crouzet et al, 2007). Seven studies investigated devices of the drainage system. One study found no considerable distinction in the risk or rates of bacteriuria involving a two compartment arrangement in comparison to a compound closed arrangement even though there was delay in onset with the application of the two compartment system (Vonberg et al, 2006). Pre-connected sealed connections had favorable outcomes over drainage bags and unconnected catheters (Vonberg et al, 2006). A small investigation that compared a silicone catheter that is hydrophilic coated with a drainage system that is sealed with a regular catheter with transferable bags established no distinction with regards to urethral pain, incontinence, meatal discharge or redness (Vonberg et al, 2006). The effect of a povidine-iodine discharging cartridge on urinary tract infection unlike the regular closed drainage scheme favored treatment (Vonberg et al, 2006). No advantage was established from chlorhexidine addition to urinary bags of drainage. A study with several interventions established that an antimicrobial catheter that had trichloroisocyanuric acid and adaptor was effective in the reduction of catheter-related bacteriuria (Moola & Konno, 2010). Hydrogen peroxide’s use was not found to make remarkable distinction in the catheter-associated bacteriuria incidence. In terms of care delivery, bag change frequency did not show a statistically considerable difference. Additionally, the study indicated not changing bags of drainage for short-term catheterized patients might be connected to a costs’ reduction as well as better workers’ time (Fernandez & Griffiths, 2006). An investigation on women who went through hysterectomy established that instant catheter removal following an operation is considered to be cost effective and safe since it reduces stay in hospital. Another study discovered a statistically considerable lower UTI incidence in the group that had an early removal of the catheter. A study by Vonberg et al (2006) on women who had a surgery of vaginal prolapsed found that the count of bacteria rises among patients who had delayed removal of vaginal pack and catheter. Urinary catheters’ stop orders were established to prevent unnecessary prolonged catheterization. In general, there was some evidence that established that catheters that were silver impregnated decreased CAUTI’s incidence (Kaye, 2011). The results from the recently recognized cross-over investigation back up silver impregnated catheter’s effectiveness over those with no silver impregnation. A systematic analysis that involved 23 quasi-randomised and randomized controlled experiments compared kinds of IDCs on the danger of UTI in patients who were short-term catheterized in patients who were hospitalized (Kaye, 2011). The review made a conclusion that no single kind of catheter was established to be superior to the other with regards to reduction of the possibility of bacteriuria in patients that are hospitalized (Ham, 2007). According to Elpern et al, (2009) interventions that are nurse-led make use of nursing staff (staff nurses, clinical nurse, or charge nurse) to assess, following a phase of time, if an IDC is still applicable for the hospitalized patient. This results in a judgment to continue or discontinue the catheter via shared discussion with other staff members or a standing order’s application. 5. Discussion IDCs are frequently used for drainage of the bladder in the course of hospital care. Using an IDC in a short-term use is an effective and safe strategy in the protection of bladder as well as renal health and cautious use adds to improved outcomes (Bernard et al, 2012). On the other hand, an IDC insertion involves some complications’ risk. CAUTIs are the leading infections and the day to day risk of having CAUTI is three to seven percent in the setting of acute care. Short-term catheterization’s indications (not more than 30 days) have actually been demonstrated by various authors (Gokula et al., 2007; Hooton et al., 2010; Nazarko, 2008). These include urinary tract obstruction, urinary retention, close observation of the output of urine in patients who are critically ill, incontinence of urine that puts a patient at risk due to stage 3 ulcers to the sacral region, and comfort management for patients who are terminally ill. Regardless of these guidelines and recommendation, catheters are frequently put for poorly or inappropriate documented reasons (Raffaele et al, 2008). Among patients who are hospitalized, the unnecessary urethral catheterization rate has been shown to be between 21 and 50 percent. The common inappropriately put catheters are actually initiated and inserted at the emergency department (Gokula et al, 2007). IDC are placed without the order of the physician in almost 1/3 of patients, and although there is recording of the order, there is no provision of documented rationale. The absence of documented justification was identified many years back and is still a continuous problem (Gokula et al, 2007). People who are 65 years old or above are at greater risk for unwanted catheterization (Holroyd-Leduc et al, 2007), a concern that they are at greater danger of getting complications, specifically infection. No current research is published concerning decision making in relation to the IDC use although historically, the increased application in aged people has been an endeavour to manage emptying of the bladder among those with incontinence, cognitive impairment, and reduced function in performing daily living activities (Melnyk & Fineout-Overholt, 2011). Whatever the motive for insertion, continuous need of assessment for an IDC is frequently ignored, and catheters hence remain in situ with no proper indications. Mark (2007) reported that even though nurse staff poses knowledge regarding improper and proper indications for IDCs and related risk, they still use IDCs for personal preference reasons and that they do not do continual use assessment. Regardless of the optimal IDC nursing care, every day brings about a rising danger for infection that ranges from 3 to 10 percent (Hooton et al, 2010). Strategies ought to be developed in order to guarantee that IDCs are only used when necessary and simply for the required period (Bernard et al, 2012). Special precautions need to be considered for patients’ catheterization. For instance, rapid discharge of large amounts of urine might lead to haemorrhage and/or hypotension. Hence, the nursing intervention is to clamp catheter once there appears to be excessive volume (Bernard et al, 2012). The clamp should be released 20 minutes later in order to facilitate drainage of more urine. Another precaution is that for diuresis that is post obstructive, electrolytes’ IV replacement might be required (Bernard et al, 2012). Documentation together with day to day assessment of continual necessity for catheterization reduces the period that catheters are in situ (Parker et al, 2009). Parker et al (2009), highlight what should be included in documentation as: Catheterization’s indication Date and time of procedure Kind of the catheter Catheter’s size Catheter’s expiry date Quantity of water inside the balloon Any issues with insertion Description of volume, colour and urine Review date Parker et al (2009) suggest other complications associated with urinary catheterization include: Incapacity to catheterize Urethral injury as a result of trauma sustained in the process of insertion or inflation of balloon in the wrong position Urethral strictures after urethral damage. This might be a lasting problem Paraphimosis because of inability to return the foreskin to its normal place after catheter insertion. 6. Implications for Practice The evidence implies tap water is satisfactory for genitalia cleansing. Care of the catheter should entail proper personal hygiene within the meatal region. Silver alloy impregnated catheters might decrease the catheter-related bacteriuria incidence. Sealed (e.g. presealed, taped) systems of drainage must not be considered as the sole prevention mechanism for bacteriuria. Addition of antibacterial solutions to bags of drainage does not have effect in minimizing the prevalence of infections that are catheter-related. Routine changing of the drainage bag does not display any protective effect. Catheter’s early removal is encouraged in UTI’s prevention and early discharge facilitation. The stop order method is recommended to decrease unnecessary prolonged catheterization (Parker et al, 2009). 7. Conclusion In conclusion, this paper has presented various issues in relation to IDCs. Evidently, catheterization of IDC is an invasive procedure that has potentially serious results that may result in issues of mortality and morbidity in patients who are hospitalized. Even though there is a clinical accord on catheterization’s indications in acute management, further evidence is needed to establish the best method of guaranteeing prompt removal of IDCs in every setting. The present studies show that nurse-led intervention is effective in reduction of the duration of catheterizations, and consequently, CAUTI’s incidence. Research into various barriers of knowledge transfer concerning CAUTI into nursing practice might be significant in implementation of this intervention. Reference list Bernard, MS, Hunter, KF & Moore KN, 2012, A Review of Strategies to Decrease the Duration of Indwelling Urethral Catheters and Potentially Reduce the Incidence of Catheter-Associated Urinary Tract Infections, Urologic Nursing, 32(1), 29-37. Bennett, JV, Jarvis, WR & Brachman, PS, 2007, Bennett & Brachman’s Hospital Infections, New York: Lippincott Williams & Wilkins. Crouzet, J, Bertrand X, Venier AG, Badoz M, Husson C, Talon D, 2007, Control of the duration of urinary catheterization: impact on catheter-associated urinary tract infection, J Hosp Infect, 67(3):253–257. Elpern, EH, Killeen, K, Ketchem, A,Wiley, A, Patel, G, & Lateef O, 2009, Reducing use of indwelling urinary catheters and associated urinary tract infections. American Journal of Critical Care, 18(6), 535-541. Fernandez, RS & Griffiths, RD, 2006, Duration of short-term indwelling catheters – A systematic review of the evidence, Journal of Wound Ostomy and Continence Nursing, 33(2), 145-155. Gokula, RM, Smith, MA, & Hickner J, 2007, Emergency room staff education and use of a urinary catheter indication sheet improves appropriate use of Foley catheters. American Journal of Infection Control, 35(9), 589-593. 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