Catheterization Research Paper

Foley catheters comes in a sealed sterile kit. Before opening the kit, make sure you have the right size kit for your patient. They come in 12,14,16 French. (1French=1/3 mm). The smaller ones are usually better for the patient's comfort but the larger ones will help against leakage.

A Foley catheter is a soft, flexible tube that is placed into the bladder to drain urine. For as long as your catheter is in place, you will need to:

Urinary tract infection (UTI) are extremely common healthcare-associated infections, it is estimated that about 6 million American are affected annually. One of the risk factors for developing UTI is associated with indwelling urinary catheter; approximately 80% of UTI are related to the use of indwelling urinary catheter (Lederer, Jarvis, Thomas, & Ritter, 2014). Indwelling urinary catheters are common sources of infection in the urinary tract because they are irritating to the tissue and, when inserted, may be a means of introducing bacteria directly into the bladder if sterile technique is not used

As reported by the Center for Disease Control and Prevention( CDC) indwelling urinary catheter is a catheter inserted into the bladder and remain in the bladder for the purpose to drain urine after a surgical procedure, urinary retention or incontinence. Globe, et, al. (1989) stated that urinary bladder catheterisation could produce macroscopic and microscopic histological changes in the bladder tissues due to the eosinophilic inflammatory response. The severity of that inflammation is according to the duration of the indwelling catheter in the bladder; therefore, it is important to follow the appropriate guidelines that would decrease Catheter-Associated Urinary tract infection (CAUTI). Guidelines established by CDC minimize the duration

The first step nurses can take to decrease the incidents of CAUTIs in older adults is avoiding unnecessary use of catheters altogether. Initially, this begins with nurses knowing both appropriate and inappropriate situations in which a catheter should be utilized. According to (Gould et al., 2017), an appropriate situation is one where a patient has acute urinary retention or bladder obstruction, whereas an inappropriate situation is one where a catheter is being used a means of obtaining urine for culture when the patient can voluntarily void. Nurses can also use basic techniques like palpation, percussion, and inspection to effectively assess urinary retention, which is the main reason for catheterization as mentioned earlier. When techniques like this do not achieve desired results,

This study focuses on whether the use of reminders assists in decreasing the use of urinary cathethers and the occuruence of catheter associated urinary infections. UTI risk increases by 5 percent with the use of indwelling catheters. The Center for Disease Control and Prevention (CDC) has recommended that patients receive catheters if indicated but over 41% of physicians have ignored this and nursing staff have ignored evaluating when the catheter should be removed. Besides noncompliance with the CDC, this study shows for patients who have catheters, the reminder system will help to decrease the length of indwelling cathethers are potential UTI infection associated with it. In previous studies, their has been different views as to whether

The hospital’s current practice for CAUTI prevention includes the use of the HOUDINI protocol. This protocol features the acronym for the strict indications required for the insertion and the continued use of the urinary catheter (hematuria, obstruction, urologic surgery, decubitus ulcer, intake and output, no code/comfort care, and immobilization). The physician places the original order for the catheter with HOUDINI protocol and chooses the indication that applies. The order empowers the nurse to assess the patient daily for the continued indications and to remove any urinary catheter that no longer meets the indications. Hospital wide the protocol has been successful at decreasing CAUTI rates, however the target for CAUTI rates is 0 and our current rate is 1.37 per 1000 catheter days. Intensive care units have higher urinary catheter usage than in medical surgical or telemetry units (Halm, O’Conner, 2014). In MICU the most common indication for a urinary catheter is the need for accurate intake and output on patients with hemodynamic instability. Staff nurses are required to assess the patient daily and readdress the continued indications. In the past month no urinary catheters were removed

Contributing factors to the problem could be lack of education and training in caring for patients with urinary catheters, poor time management to properly care for patients with urinary catheters, and a lack of evidence-based bundled intervention. An example of an inappropriate reason would be keeping a urinary catheter device for convenience due to the incontinence of the patient.

The three questions addressed were: Who should receive urinary catheters, what are the best practices for those who require urinary catheters and for preventing CAUTI’s acquired from urinary obstruction. This updated guideline offers recommendations for the appropriate use of indwelling catheters utilizing appropriate indications for usage, proper techniques for insertion of indwelling catheters, proper techniques for indwelling catheter maintenance, quality improvement programs, administrative infrastructure and surveillance including identifying those at risk for CAUTI (Gould et al, 2009). The strengths of this guideline are that many questions and scenarios are examined in this document and answered in explicit detail. Any healthcare professional can refer to the document to answer most practice based questions that are posed to them regarding indwelling urinary catheters. One weakness identified is the lack of an alternative explored for the external catheterization for female patients, for example the Purewick solution. However, the Purewick was not released until January 2016 and this guideline was last updated in 2009. Integrative Review

Arterial catheterization is a commonly performed invasive procedure in the ICU and anesthetized patients, facilitating accurate hemodynamic monitoring and frequent blood sampling. The insertion of arterial catheter especially in patients with hypotension, edema, and obesity, is often difficult and may require multiple attempts. Repeated attempts may lead to more difficult catheterization due to arterial spasm and may increase the incidence of thrombosis and hematoma formation [1]. The radial artery is the commonest site for catheterization owing to its superficial course and its dual arterial supply to the hand [2].

As previously discussed, one of the major components that should guide the decision of bladder management devices is how it will affect the patient’s quality of life. A person’s perception of self, as well as their ability to bond with loved ones is a large factor in this. As mentioned previously Liu, Attar, Gall, Shah, and Craggs (2010) discuss that benefits of intermittent catheterization, when it is a realistic option, include an improved sense of independence. This higher level of functioning allows the patient to rely less on family or caregivers, while also giving the patient more of an ability to travel outside the home unassisted. Another benefit of the use of intermittent catheterization is that patients feel they are able to have closer interpersonal relationships than those with suprapubic or transurethral catheters in place (Sugimara, Arnold, English, and Moore, 2008). Since other bladder drainage methods require continuous drainage with an attached system, they may become cumbersome, and make it more difficult for patients to be physically closer to loved ones.

Catheters have always been a way to introduce infection into the body. Although, they are needed in some cases, it is of very high importance to insert them with aseptic technique and to not insert them if there are other ways to properly care for the patient. Sometimes as a ED nurse, nurses may get in a rush, and lack the proper techniques or by less wait time and time being an issue. I have long term experience as well, and catheter care, and removing catheters as soon as possible remain of high importance there as well. Without proper care it easily introduces infection for a urinary tract infection.

After triaging the patient, it was determined that the patient required an indwelling catheter to measure urine output because of the patient’s prolonged urinary retention. Evidence-based practice revealed that sterile technique and proper insertion decreases the chances of acquiring a urinary tract infection. Using sterile technique and following the hospital’s policy, I successfully inserted the foley catheter. In the future, I would like to insert a foley catheter in a female patient. Obviously it would be more of a challenge and I still have yet to come across the opportunity.

The overuse or misuse of indwelling urinary catheters (IUC) is a concern in the emergency department (ED) despite the well-known risks and complications. Although the medically indicated guidelines for use are specific, professionals often ignore the guidelines and insert an IUC without applying evidence-based practice strategies to manage urinary output.

Bernard, M.S., Hunter, K.F., & Moore, K.N. (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)