Urinary Catheterization: Insertion, Maintenance, Catheter Care,

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Urinary CatheterizationInsertion, Maintenance,
Catheter Care, RemovalSeptember 2012
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Why are we revising our process?

• Joint Commission requirements
• National Patient Safety Goal 2013
• Goal 7
• Reduce the risk of health care-associated
  infections.
• Implement evidence-based practices to prevent
  indwelling catheter-associated urinary tract
  infections (CAUTI).
• CDC guidelines
• Catheter Associated Urinary Tract Infections
  (CAUTIs)
• Are the most common healthcare acquired
  infections
• UTI causes approximately 36 of all hospital
  infections per year
• 80 of those are catheter related
• Increases hospital stay
• Increases healthcare cost
• It is highly preventable
• You can make a difference by doing a few simple
  things!!

APIC Guide 2008 Guide to Elimination of
Catheter-Associated Urinary Tract
Infections. Klevens RM, et al. 2002. Public
Health Rep. 2007 122160167
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Getting to Zero

• Committee developed in 2012 to get to O CAUTIs
• CAUTIs recorded at Aultman
• 2010 106
• 2011 92
• 2012 YTD 17
• Our Goal
• NO CAUTIs from this point forward in 2012
• Zero O CAUTIs in 2013!

Mar 2012 O
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Prevention Strategies

• Eliminate unnecessary insertion of catheters
• Review physician orders to ensure a valid Foley
  catheter insertion order was
  entered
• Educate your patient about CAUTI (use FAQ sheet)
  prior to insertion
• Currently available on Policy Tech - type SHEA
  CAUTI
• Insert Foley catheter using sterile technique
• Secure the catheter as to prevent urethral
  trauma, migration of organisms,
  and kinking/bending of the catheter
• Keep catheter below the level of bladder
• Perform catheter care per policy
• Maintain a closed system

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NEW catheter kits available to assist us to meet
2013 NPSG!

• Kits Include
• Castile soap wipes
• Betadine swabs
• Pre-connected, sealed catheter
• tubing
• Securement Device
• Insertion labels for patient chart
• apply to front of chart, and
• catheter tubing (from BARD )
• Your unit director will communicate with you
  when the new kits are available on your unit

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Insertion of Catheter Policy Revisions

• Steps removed

• Steps added

• Testing urinary catheter balloon
• Already performed by manufacturer
• Use of cotton balls to cleanse urinary meatus
• Product changed to swab sticks

• Use of castile soap
• Use of betadine swab sticks
• Use green sheeting clip to secure catheter
  drainage tube to the sheet
• Apply insertion labels to the front of the chart
  and to the catheter drainage tube

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Catheter 101

• Proper Techniques for Urinary Catheter
  Insertion

• Perform hand hygiene immediately before and after
  insertion
• Remember Wash hands after cleansing patient and
  before donning sterile gloves
• Insert urinary catheter using aseptic technique
  and sterile equipment
• Use the smallest Foley catheter possible,
  consistent with good drainage (18 French or
  larger not recommended for routine use)
• Document date and time of catheter insertion,
  individual who inserted catheter, size of
  catheter , and date and time of catheter removal
  along with who removed it in the patient record

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Catheter 101
Proper Techniques for Urinary Catheter
Maintenance

• Secure the Foley catheter
• Maintain a closed drainage system by utilizing
  pre-connected, sealed catheter-tubing junctions
• Maintain unobstructed urine flow and keep the
  catheter and collection tube free from kinking
• Keep the collection bag below the level of the
  bladder or hips at all times
• Empty the collection bag a minimum of every shift
  and prn or per physicians order using a clean
  collection container
• Rinse the collection container after each use

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Catheter Care

• Revised process for catheter care
• Castile soap water only
• Products must be thoroughly rinsed
• No emollients or residue producing products
• Bath-in-a bag
• Perineal cleansers
• Catheter Care is different than Perineal Care
• Skin protectants emollient products OK for
  perineum, but not at the insertion site of a
  catheter (urethral area)
• Skin protectants emollient products intensify
  formation of biofilm provide a breeding ground
  for organisms
• Biofilm is a very thin layer of microscopic
  organisms that covers the surface of an object.
• http//medical-dictionary.thefreedictionary.com/B
  iofilms

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Catheter Care Product Update

• Why Castile Soap?
• Safe, very mild effective cleanser
• Contains no emollients
• Why not just use the bath-in-a-bag or current
  perineal cleanser?
• Both contain emollients
• Should not be used on the catheter (urethral)
  area because it can increase biofilm formation

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Product Update Continued

• Why a closed drainage system?
• Using a pre-connected, sealed catheter tubing
  junction prevents CAUTIs
• Why StatLock securement device?
• Minimizes accidental catheter dislodgements
• Firmly holds catheter in place at the Y
• Allows complete freedom of movement
• Latex free
• StatLock Application and Care
• Use skin prep before application
• Apply with click it before you stick it method
• Initial and date securement device upon
  application
• Assess adherement and skin around device daily
• Move device every 7 days
• Remove with alcohol

Pre-connected tubing securement device
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Catheter Care Procedure

• Cleanse, thoroughly rinse, and gently
• pat dry urethral meatus. (Pericare
• bottle may be used.)
• Remove gloves and discard.
• Perform hand hygiene.
• Resecure the catheter with securement
• device.
• Position the patient for comfort.
• Perform hand hygiene.
• Document activity in the medical
• record, including education provided
• to patient/family

• Perform at least every 24 hours and prn for
  soiling.
• Identify patient using two patient identifiers.
• Perform hand hygiene.
• Don clean gloves.
• Place the patient in supine position and expose
  the perineal area to easily visualize the meatus.
• Release the catheter from securement device to
  prevent urethral trauma.
• Remove gloves and perform hand
• hygiene.
• Don clean gloves.

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Catheter Care Procedure

• Female
• Using castile soap and water, cleanse the
  urethral area using circular motions moving
  outward with washcloth, thoroughly rinse with
  water, and then gently pat dry.
• Using a separate washcloth, cleanse the catheter
  beginning at the insertion site moving away from
  the body, using castile soap and water and then
  rinse and dry with clean towel.

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Male
Catheter Care Procedure

• Circumcised
• Cleanse around the meatus using washcloth,
  castile soap and water. Rinse and then dry the
  area with a towel.
• Using a separate washcloth, cleanse the area
  between the scrotum and rectal area, rinse and
  dry.
• Using a separate washcloth, cleanse the catheter
  beginning at the insertion site moving away from
  the body, using castile soap and water and then
  rinse and dry with clean towel.

• Uncircumcised
• Retract the foreskin from the catheter.
• Cleanse around the meatus using a washcloth,
  castile soap and water. Rinse and dry with clean
  towel.
• Replace the foreskin around the catheter.
• Using a separate washcloth, cleanse the area
  between the scrotum and rectal area, rinse dry.
• Using a separate washcloth, cleanse the catheter
  beginning at the insertion site moving away from
  the body, using castile soap and water and then
  rinse and dry with clean towel.

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Removal of Catheter Policy Revisions

• Revisions

• Reminders

• Cleanse urinary meatus prior to catheter removal
  - rinse, gently pat dry after cleansing
• Deflate catheter balloon prior to catheter
  removal
• Document catheter removal in medical record

• Use of castile soap to cleanse urinary meatus
  prior to removal
• To prevent migration of organisms

Liquid Castile Soap
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Documentation Urinary Catheter

• Document Patient Education task
  (fires BID)
• Select Education Provided from navigator bar
• Click box for Infection Prevention

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Documentation Continued

• Document education provided
• CAUTI/FAQ
• Hand Hygiene
• Catheter secure education
• Avoid twisting/kinking catheter
• Collection bag lower than bladder

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Resources

• Smith, S., Duell, D., Martin, B. 2008. Clinical
  Nursing Skills Basic to Advanced Skills. 7th
  EditionPrentice Hall.
• Clinical Care Improvement Strategies Preventing
  Catheter-Associated Urinary Tract Infections.
  2011. The Joint Commission Resources.
• Urinary Catheterization of a Male of Female
  Patient Insertion, Care of Patient, and Removal
  of Catheter. 2012. Aultman Polices and
  Procedures.
• BARD Foley and Urethral Catheterization tray
  insert documents.

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Online Education

• You have completed the Learning Module entitled
  Urinary Catheterization Insertion, Maintenance,
  Catheter Care Removal
• Please go to the quiz section in QUIA and
  complete the quiz Urinary Catheterization
  Insertion, Maintenance, Catheter Care, Removal
• Deadline for completion October 15, 2012

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Questions?

• Patty Russell, BSN, RN Ext. 35435
• UD Main 5 (Chair CAUTI Task Force)
• Kerri Samblanet, BSN, RN, CRRN Ext. 34243
• Step-Down Staff Educator (Co-Chair CAUTI Task
  Force)