RESEARCH EVIDENCE ON INDWELLING URETHERAL CATHETER CARE

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RESEARCH EVIDENCE ON INDWELLING URETHERAL
CATHETER CARE

• Francine M Cheater
• Professor in Public Health Nursing

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Urinary Catheters

• Indwelling urinary catheters (short or long-term
  use)
• Intermittent (self) catheterisation
• External collecting devices
• Supra-pubic catheterisation

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• Medical Necessity
• IDC
• Patient preference

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THE EVIDENCE?
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IDC PREVALENCE

• Hospital- short term use 10-12
• Long term care facilities 16-18
• Home- long term use 4
• Acute median 4 days
• Long term median 4 years

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RESEARCH

• Complications
• Specific Procedures
• Principles of management in hospital/home
• Evaluation of interventions
• Miscellaneous e.g. patient education, economic
  evaluations

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COMPLICATIONS

• 70-90 patients with LT catheters experience 1 or
  more
• recurrent problems-many are secondary to UTI
• Urinary tract infection
• Pain and discomfort
• Leakage of urine
• Blockage

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UTI

• UTI- 105 colony forming units of single species
  of bacteria/ml urine
• In hospital 44 patients with IDC developed
  bacteriuria within 3 days of catheterisation
  (UTIs account for 30 of all hospital acquired
  infections)
• Within 2.5 weeks-90 will have bacteriuria
• (Risks greater for patients with severe
  underlying illness,
• catheter induced UTI contributes directly to
  morbidity and
• mortality).

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UTI

• The duration of catheterisation -most important
  risk factor
• Disrupting the closed drainage system (e.g.poor
  practices when emptying bag/changing bag)
  presents risk of contamination, cross infection
• Use of gloves and/or alcohol rinse and single use
  of disposable containers to empty bags risk of
  
• cross infection. Hand washing alone
  ineffective.
• Optimum time to change bags ?

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UTI

• Bacteria colonise surface of catheter and
  drainage bag-produce biofilm. Some catheter
  materials may be less prone to colonisation (e.g.
  hydrogel coated or silicon Vs. silicon/teflon/late
  x coated)
• Antibiotic therapy for uncomplicated asymptomatic
  UTI in catheterised patients not effective and
  could lead to antibiotic resistance
• Perineal cleansing vs. usual care

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LARGE CATHETERS (Over 16 Ch)

• -Leakage/bypassing (upto 89 patients
  with LT catheter)
• -Trauma - bladder neck
• -Pain

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Selection of Catheter

• Consensus optimal size 12-16 males and 12-14
  females
• Leakage associated with use of balloon size over
  10mls
• Catheter Material (hydrogel coated and full
  silicone less likely to encrust)
• New materials developed all the time, catheter
  must fit needs of patient

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• DRAINAGE BAG/CATHETER VALVES
• CATHETER CLAMPING

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Blocking

• Common (40-87) with long term catheter use, more
  common in females, those with poor levels of
  mobility high Ph urine values and ammonia
  concentrates
• Caused by bladder spasm, twisted catheter tube
  or faecal impaction BUT main reason is
  encrustation

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Blocking

• Bladder washouts (dissolve or flush out mineral
  deposits blocking catheter)
• Evidence of effectiveness of using washouts mixed
• Weak acidic solution/mandelic acid effective in
  encrustation in laboratory tests
• Saline irrigations not effective
• More research needed but bladder washouts may be
  useful in selected patients
• Alternative is to remove catheter and replace

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• Bladder installations/irrigation
• Fluid intake
• Antibiotics/antiseptics
• Principles of catheter care

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• Patient perceptions
• Patient/carer education

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CONCLUSIONS

• Considerable research ( controlled trials) to
  inform practice
• Challenge now to implement what we know into
  practice